March 19th, 2007
Monday 19-March-07
Hello,
For those of you who don't know, last week was The Directors Cup. This is a ski racing event in which I have participated for almost 30 years. This year the event was held in Steamboat Springs, Colorado. Time trails were Thursday, and the actual race is over two days, Friday the 9th and Saturday the 10th. There are 4 races on Friday, the tequila party Friday night, and then the final 2 races on Saturday. Friday night I was undefeated and our team was in the hunt for first place. Two of my four races had been won in under 0.1 of a sec !! Saturday morning I won both of the final 2 races, more due to generous handicaps than good skiing. After my races, I was hanging out at the bottom of the race course watching the others finish. I recall it was not very cold, and it was all very social.
My story begins as Erin's team was racing and I noticed that I was getting a little light headed. I decided to lie down on the snow for a few minutes. Moments later I was surrounded by all sorts of people from the Directors Cup. Despite my best efforts to have them leave me alone, ski patrol was called and I soon found myself reciting my name, where I was, and proudly answering the question "Who is president of the United States". After a few minutes, I told ski patrol that I was ready to ski down to the first aid shed and let them look at me. Erin explained to me that I was taking the sled and being that it was already there, it was the path of least resistance. At the first aid shed, I was walking around and letting them examine me. No chest pain, no numb extremities, perhaps some very mild blurred vision, but not much. No real pain at all, but it did feel like my chest was bruised. Partly to keep Erin happy and partly due to the persistence of the Ski Patrol at Steamboat, I agreed to go to the hospital for an EKG.
The local hospital in Steamboat has 23 hospital beds, and 10 Emergency Room beds. The EKG was clear and the blood work did not show an elevated level of Troponin (an enzyme that is released during a heart attack). Evidently I was not having a heart attack, but the doctor suggested I stay in hospital overnight. I thanked him for the offer, but told him I would gladly come back if I was not feeling well in a few hours. Of course, I had no intention of ever coming back.
We headed back to the hotel, I sent out a few emails, split a hamburger with Erin, and tried to relax for an hour or so. I still felt a bit uncomfortable, and in another effort to shut Erin up, I once again agreed to go back to the ER so I could prove to her I was still fine. About 2 hours after we initially left, we walked back into the ER so they could take another EKG and do whatever else was necessary to quiet Erin down
The pain was not that bad, but it was a different kind of pain than I had ever felt before. The best description I could muster was a bruising under my rib cage. Saturday night I saw the ER doctor, he gave me a little morphine (that took over 2 hours to fill) and I agreed to spent the night in the hospital so they could monitor me "just in case." Erin went back to the hotel around 10PM and hung out with a few friends then went up to our room to pack up as we had to switch rooms the next day. Sunday morning when she called me I told her to take her time, the local internist had yet to show up and I was with a Physicians Assistant.
What I didn't know was that Erin had already had many phone calls with our dear friend, Holly Anderson, who is my primary physician. Holly also happens to be a stunning cardiologist (both in looks and skill).
Around 10AM Erin arrived and at 2PM, Mark McCaulley, the internist, arrived. When Mark listened to my heart he heard a murmur. He double-checked with Holly as to whether I had ever had one before (I hadn't) and then they decided to rush me off for a CAT scan. I remember getting up from the scan and walking over to the CAT display asking Mark if he had found anything. He pointed to a little circle with a line squiggling thru it, kinda like a Ying/Yang symbol. He said the line was not supposed to be there.
I don't really remember much else, so the next 48 hours are what Erin and others have described. I will explain the memory loss a bit later in this email.
Mark wheeled me back into my room where I asked Erin if she wanted the good news or the bad news. She asked for the bad news: I told her I had an Aortic Dissection. Neither of us remember what the good news was.
Aortic Dissections are very rare. For every 1000 emergency room patient who have cardiac issues, only 1 is an Aortic Dissection. In my case both EKGs and blood work did not suggest anything. Sometimes ultra-sound will detect it, but sometimes it doesn't. The only certain method is to have a CAT scan. The mortality rate goes up 1% for every hour that passes
At that point, the Steamboat hospital went into over-drive. There were instantly about a half dozen people in the room working to lower my blood pressure and anxiety and to stabilize me. The internist began coordinating with Holly to find a hospital that would agree to take me as the medivac helicopter couldn't take off until one was lined up (apparently this is high risk surgery and not everyone is willing to do it). Holly called the head of cardio thoracic surgery at New York Hospital, who is the go-to-guy for this type of surgery. He got in touch with Dr. Joseph Cleveland, one of the top surgeons at University of Colorado's hospital, who agreed to operate on me Sunday night. It wasn't a done deal yet though, as the hospital had to agree to give me a bed. Again, Holly got on the phone and, voila, I had a bed. I was on a helicopter to Denver by 6 pm Sunday night and on the operating table by 9 p.m., while Erin was alone in a 3 hour taxi ride down. John and Sharon Bopray, who we had just met at the DISC, were incredibly helpful - letting Erin be with them, helping with our bags, skis, etc.
Erin arrived at the hospital at 10PM. Solveig Tschudi, Otto and Yvonne's daughter, was already there when Erin arrived at the hospital and I was already in surgery, but a surgical fellow came out to tell her to expect roughly a 12 hour surgery. They had identified that they would be cutting out about a three inch defective part of my aorta and replacing it with Dacron. This required a heart/lung bypass. It also meant that they had to "freeze" me and put me into suspended animation (deep hypothermic circulatory arrest to the doctors) by bringing my temperature down to 18 degrees and stopping all circulation, including to my brain, for about 22 minutes. Apparently, this can be done for about 40 minutes without any lasting impact.
About 2 a.m., Erin went back to get an update. At that point, they said things had gone faster than expected, the majority of the surgery was over and they were starting to warm me up. Despite initial projections that I'd be in ICU by 4:30, apparently I got there around 8 a.m, as my blood took its time clotting.
As Erin walked into ICU at just after 8, her sister, Kelly, arrived from Chicago. Kelly's been here all week helping sort out the details. She has been invaluable in helping both Erin and myself.
I was on a ventilator when I was first brought up. I don't have much of a memory of ICU (apparently, when they stop brain flow to your brain it impacts your short term memory although it has now come back other than a gap of a few days). They tell me that I winked at Solveig when she came into ICU and flipped Erin the bird when she couldn't figure out that I wanted a drink. They took it as a good sign.
I was out of ICU by Tuesday morning and started walking around the floor by Wednesday. I left the hospital Friday. Erin and I are enjoying a suite at the Denver Marroitt until Wednesday when I have a follow up examination with the surgeons. I expect to be back in NYC for dinner Wednesday.
They tell me my recovery has been in the top 1% so far. I am feeling pretty good, and the most uncomfortable moment was when I foolishly asked one of the surgeons to describe what they had done to me. His eyes lit up and he was practically giddy explaining how they had to saw my sternum to open it up, then pull my ribs apart before putting me into a deep freeze to suspend the blood flow to my brain (let me quote the medical report):
Having reached 18 degrees centigrade, and isoelectric silence with a BIS monitor, we terminated cardiopulmonary bypass and began deep hypothermic circulatory arrest. While under the period of deep hypothermic circulatory arrest, we used...
With the patient in steep Trendelenburg, we used ophthalmic cautery and placed an aortic vent in the aortic interposition graft. We secured this Rumel tourniquet and reinitiated cardiopulmonary bypass. At this point , we began rewarming and after approximately a 1-1/2 hour period of rewarming we noted that we had return of temperature to 36.5 degrees centigrade....
A few interesting moments/thoughts:
Sunday after they realized I had an Aortic Dissection, I asked Holly if they were going to perform micro or macro surgery. She explained it was as macro as it gets, and I said that's bad.
After the surgery, I had 4 tubes protruding from my chest along with a haf-dozen wires going to my heart. Thursday night, just after I had taken my Ambien to sleep and lowered the bed. I heard a slurping sound coming from my chest. It seems one of the larger tubes they had going into my gut had slipped almost entirely out and some air was being sucked into the tube. After about 1 hour they just yanked the thing out. Needless to say the Ambien had no effect that night.
I should also mention that after having had bandages on most of my chest being changed daily, along with various IVs or either arm, all with very secure medical tape, I have a new found respect for the pain associated with waxing.
The operation was early Sun night/Monday morning. I left IC on Tuedsay, was walking the hospital on Wednesday, discharged on Friday. Yesterday Erin and I walked to a few blocks for some Pizza, the went to the Cherry Creek Mall. They have an Apple Store. What she didn't tell me is that they also have Tiffinay's and Mavado. We went out for dinner came back and watched Star Warz on TV. Tonight we are taking Solveig out for dinner.
Closing Thoughts:
The three inches of my ascending aorta replaced with Dacron appear to be doing well. I still have a tear in my descending aorta. The doctors didn't operate on it as they said it was just too much for a body to go through. Apparently, we'll monitor the descending aorta with regular cat scans and blood pressure medication. They think it's unlikely that I'll have any future problems related to the dissection and sometimes the descending ones can heal because there is less pressure than on the ascending one.
Apparently, this is probably something I was just born with. It's not about diet or lifestyle. The fact that I had been skiing a lot this year, at a good weight and already living at a high altitude really helped. The Director Cup folks insisting on calling and listening to the ski patrol - and, of course, Erin's semi-hysterical insistence, all helped too. If this had happened in Sun Valley, I would probably have gone home, taken a percocet, gone to sleep and not gotten up.
I am extremely appreciative of all the phone calls, emails, flowers and gifts, good wishes and positive energy coming our way. It's hard to express the comfort having Holly guide this process, or of the support of Solveig provided by spending the first night with Erin. Even harder to express is the appreciation for Kelly who was on the first plane out of Chicago and didn't leave until a week later.
Speaking for myself, I feel most of the attention is misguided, I was just a prop, Erin is the one who managed to deal with extremely difficult issues while under incredible stress, she is the one who deserves the applause.
One of our friends commented that he was not surprised I survived; he already knew how lucky I was when Erin agreed to marry me !
We should be in New York for the next month or so. Let us know if you're in town. I think I might have some free time on my hands.
-- Lenny
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