The doctor as patient - Letters to the Editor

Townsend Letter for Doctors and Patients,  July, 2003  

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Editor:

I have often been in the position of discussing the needs of the patient, and how sometimes doctors are unaware of the fears, questions, and general uneasiness engendered by the complex and intimidating nature of medical treatment. However, no amount of reading, discussions with patients, dealing with their psychology, or awareness of sensitivities can prepare a doctor as much as actually being a patient. In fact, even being a patient is not sufficient preparation for another hospitalization.

I have had n defective nortic heart valve since I was a child, and I have known for 40 years that someday I would have to have it replaced. My parents were told by the surgeon when I was 18 that he wanted to replace the valve then, otherwise, he predicted, I would have symptoms of heart failure after 10 to 20 years. They also said that I should give up exercise. I did not take their advice.

Years later, after I had run several marathons, I visited George Sheehan, a cardiologist who had written books on running. After lunch he listened to my heart. He told me that I did have the leaky valve, but he said there was no science behind the recommendation that I not exercise. (Of course, I always had in the back of my mind that I might be taking n risk by exercising.)

It has now been 40 years, rather than the predicted 20, and I have done well, but because of the increasing strain on the heart, on March 11th, I had valve replacement surgery to protect my heart muscle from damage. I feel great, but through all the weeks of anticipation I went through the entire range of thoughts, feelings, and fears that any patients would (am I going to wake up?; should I say goodbye before the operation?; will I feel better?; will I be changed mentally?; how will I tolerate the pain and discomfort?). The experience is what all patients go through, and all doctors should try to understand, although they can't be in those shoes until they are.

However, I was also excited during those few preceding weeks about being able to be physical again without limitation, to run, swim, and bicycle with no fear of harming my heart and no symptoms. I love physical activity, and soon I'll be able to go back to all of those activities. Right now I am beginning my walking program, increasing every day, and I can tell I have not been using those muscles -amazing how quickly they lose tone and mass!

Naturally, l took all of the supplements to protect my heart and brain during and after surgery, to promote the healing process, and to maintain my immunity. In addition, l took liver support (silymarin and calcium D-glucarate) to help detoxify the anesthetic. l also did not eat hospital food, but had healthy whole foods brought in for me, and l was fortunate enough to have the nutritionists at the Brigham closely accommodating my own dietary needs. (All hospital food should be so nutritious.) l look forward to my full schedule of activities, aesthetic, professional, and recreational, and I'll have n new understanding of patients.

l was in the hospital just over a week. The care in the cardiac surgical IOU was superb. l had constant attention to my medical and personal needs and my monitors, and careful adjustments to medications by highly-skilled cardiac surgical nurses and surgical fellows. l did have to leave that unit for two days before discharge, and those days left something to be desired.

Hospital staff does not realize how difficult it is to sleep (and how important it is to healing), and they pay little attention to the noise level, night and day at the nurses' station. I finally asked them to shut the door to eliminate the chatter, and that simple step made a dramatic difference in my comfort levels. Hospitals would be well advised to provide ear plugs and eye masks to enhance the possibility of getting adequate rest. (If they are not provided, bring your own.)

It is not easy to have an operation on the heart, even though the technology is far superior to what it was 40 years ago when they first wanted to do mine. In coming out of anesthesia, they have to make sure your breathing is strong enough to take out the breathing tube. By the time you are that awake, you have recovered your gag reflex, and it is common to gag on the tubes before they are removed (I did, several times). This is quite painful on the evening of the operation, in spite of ample medication.

After the tubes are removed, it is an incredible relief (for the patient and for loved ones watching the process). At that time, you realize how dry your mouth and mucous membranes are, in spite of ample fluids being given intravenously. It is n great relief to be allowed to suck on ice chips, enough fluid to wet your mouth without being likely to choke. The problem, however, is that ice chips are more likely than water to provoke vomiting. Having survived the discomfort of the gagging, I was unpleasantly surprised by the pain and wrenching of two episodes of vomiting.

Because I recommend chelation therapy for arterial disease, I have seen many patients who have had coronary artery bypass grafts (CABG). A number of them have had it more than once, which is now n much greater shock to me than it was before I had my own open heart surgery. I am shocked because repeat OABG is almost totally preventable through lifestyle change.