Part Five (i of iv): Surgery

June 14, 2014 § 2 Comments

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The Sequence

 

When your cardiologist tells you that he feels ready to “recommend” your little patient for the surgery that has been monopolizing your conscious thought and subconscious mind for long months, he is not being ironic.

What it means is that [gross oversimplification forthcoming] within a week or so, he will explain to a committee comprised of other very smart people that he feels this particular patient will be physically ready to undergo heart repair in about a month’s time. He will make the case that the outcome of the surgery should be successful, and why, perhaps referring to her file at different times. A business meeting of sorts. If all agree, you will then have the green light to call and make an appointment with “the surgeon,” whose name you might realize you’ve theretofore not heard spoken above a whisper.

By the end of roughly ten days, we heard back that Lucy’s case had been approved and we were provided with the contact information we would need to schedule the meeting with Lucy’s surgeon. We called. We scheduled. We had an appointment on the books for the end of the month.

We were reminded by the nurse over the phone that Lucy would need to be present. It hadn’t occurred to us not to bring her along, but if she hadn’t said that right up front, who knows.

It is easy to think that this meeting is about pure grown up stuff, and it is. You’re going in to talk surgery. What that day, the days before, and the after should look like, and about your role in all of this. But the meeting isn’t all about you. The surgeon is a doctor, after all, and a doctor needs a patient.  It stands to reason that he will want to examine her with his own eyes.

Make sure you bring your little patient with you to her appointment.  “You’d be surprised how many don’t,” the nurse told us.

 

 

The Surgeon

 

On a hot August afternoon we drove to a gleaming office building in a bustling medical district in north central Austin. There were high-end grocery stores inside high-end shopping centers scattered amongst more office buildings and lab clinics and retail stores. There were up-market fast food spots and buzzing hipster cafes and self-righteously dingy bicycle shops on every corner.  A Starbucks here and there.  An indy coffee house every so often. Nice restaurants.  Substantial lunch crowds. Around corners and out of eyeshot, tony mature neighborhoods and big and little updated homes bought and sold at the premium price per square foot. A Prius or an Audi or a BMW in every driveway at night.

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I remember pulling into the parking garage, finding our spot. Getting Lucy’s car carrier out of the back. I remember feeling nervous. I think Missus was too, thinking back on our idle chitchat in the car. Lucy had on a little dress and a bow on her head that would not stay in place — the elastic band kept slipping all the way up off her head or else working its way down to rest clumsily across her eyes.

We’d dressed also. Not that we dressed up or that we normally go around looking grubby. Missus had done her hair, wore something nice and looked pretty. I’d worn a good shirt and my good pants. It was like we’d dressed for church maybe. Another surreal day in a surreal pilgrimage. Another milestone. It isn’t every day you meet a heart surgeon, much less the one that will be patching up your own infant pride and joy. We wanted to make a good impression. We wanted to appear, at the very least, to be the most competent parents EVER. No one better able to care for this sick little baby you’ve been brought together to discuss.

From the elevator to the waiting room, we drew knowing nods and partial smiles from passersby. You must be here to see Doctor Fox. Again approaching the sign-in window, well before making it to the clipboard: For Doctor Fox?

In the waiting room, wider smiles and looks of solemn approval from waiting patients, all of whom were old enough to collect social security. Obvious authorities and appreciators of anything and everyone on the sprightly end of the grandchild genus.

Reading the names and credentials of the twenty some odd stately, cerebral, in some cases odd-looking vascular and cardiothoracic surgeons pictured in frames along the hallway, there was only one in the group who had the word Pediatric pre-fixing his title. He was the only pediatric heart surgeon, in fact, serving the entire Central Texas region. Before he hung his shingle in Austin folks around here would need to drive their little patients to Houston or Dallas to be fixed up. No longer. We had our guy now. In his yearbook-style photo on the wall he looked young, but not too young. He appeared smart enough to hold his title. A competent face. A good first impression. A good sign.

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We were shown to our exam room and instructed to undress Lucy for her weight check. A nurse came back soon and traded pleasantries with us as we went about the usual collection and sharing of data: Weight, heart rate, blood pressure, medications, dosages, allergies to any medications. None? Great. Thank y’all. Maggie will be in to see you in a minute.

Maggie, we would find out, was more or less Doctor Fox’s right arm. Not only did she handle all of his scheduling and untold other clerical and administrative charges – you could easily imagine that she casually wielded no small measure of hiring and firing authority – she also seemed to function as his warm up and his closer. An affable buffer between the uneasy parents and the busy surgeon.

She is a tall, down-to-earth kind of Texas gal with a ready smile and an easy nature, quick to swap mom stories or dish on her husband and three grown kids, boys all. Being in Maggie’s presence, or even on the phone with her, is to be swept briefly into a kind of backyard barbeque stratum where the men are off to one side pitching horseshoes and the women are on the other, snickering at them over the rims of margarita glasses, musing about what laughable creatures they are.

Jovially unimpressed by her boss, who she casually refers to as He, Maggie had soon seamlessly segued into a step-by-step description of what the pre-op appointment entails (“At least half a day – bring a lunch.”), and then the morning of the surgery. She gave us a glossy pamphlet that featured a little boy who’d been through heart repair, a little older now, and pictured him smiling and playing in the grass. A happy toddler, all boy, blonde hair and blue eyes. A light, vertical, hardly perceptible scar dissecting his sternum as if drawn on in peach Crayon.

She explains where you will report and when. She tells you who will come at different times throughout the morning, and what their jobs are. She tells you when it’s likely to get emotional: When they come to take her from your arms; when they push her past you on the way to the operating room, fully unconscious and fully intubated, on a respirator, seemingly every square inch of flesh with a probe stuck to it, clear tubes or red and blue and green wires sprouting from all over.

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Doctor Fox looked just like his picture. I quickly formed the impression that he was older than he looked. He offered a kind smile and a soft handshake. A surgeon, after all. He was well dressed but not overdoing it. His shoes looked expensive but not showy – fitting for a person occupying his station in life. He seemed the right combination of smart and human, no weirdness or air of intimidation about him.   At every increment the right balance of professional and person standing with you in a strange near silence that was trying not to be. He performed his own routine examination of Lucy and then welcomed Missus to dress her again, satisfied.

We exchanged greetings and went through some getting-know-you stuff. He is a family man. Multiple teenage daughters. A girl dad, like myself. Not bad. By way of some casual mention of Maggie, he divulged with something like quiet pride a fact that explained a lot. He and Maggie had known each other since kindergarten. Austin natives both, and products of the same neighborhood. She’d worked for him longer than one would think he could have been a surgeon, nearly twenty years, and now it would appear that she was the unquantifiable emollient that made his business run. You had to like that.

Missus and I sat side by side across from him, Lucy in Missus’ arms. The first order of business Doctor Fox seemed to want to clear was the When. As there didn’t seem to be anything more pressing on our calendar, the When made no difference to us. ASAP please. Yesterday if possible. Or whatever works for you.

Doctor Fox explained that a colleague from Dallas, with whom he worked frequently, would be in town on business during a certain timeframe, and that he would like to schedule the surgery to coincide with that. He explained that while he didn’t foresee any problems with Lucy’s operation, he liked, as a matter of practice, to stack the odds in favor of the best possible outcome whenever possible. It seemed that while he in no way doubted his own abilities, his professionalism would not let his ego stand in the way of making a sensible business decision. Two pediatric cardiothoracic surgeons in the room are better than one, I think he was insinuating. No objections from us.

And like that we had a tentative date and time on the books. It would be firmed up by telephone after the appointment. This settled, the salad plates cleared, the doctor then bent his head over our reason for our being there on that hot August afternoon.

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By now he was into the meaty part of a grim monologue and the tone of his voice while calm, was no longer conversational exactly. It had taken on another aspect. The professional timbre was still there but the volume was lower and he was in another gear now. There was a softness in his voice that, combined with our earnest attention and solemnly nodding heads, suggested the deepest intimacy that can exist between strangers.

He describes some of the challenges of performing stitch work on a heavily layered and fluted muscle the size of a walnut. He describes the three areas of Lucy’s heart that need repair (one main hole; two smaller ones), precisely where, and how and why this is going to make things better. He explains that the survival rates for these surgeries are amazing, and how they’ve climbed in recent years to ninety-nine percent. That being said, he acknowledged.   If you happen to fall within the one percent, this number doesn’t really impress you.

There exist 1-3% individual chances of a handful of things happening during or after surgery that can foil an ideal outcome, cause problems, grave and not so, and they must be delineated. This is what this meeting is about. Not to frighten – to inform. He goes down a mental checklist, maybe a printed one, I cannot now recall, and he does not breeze through the content. Each item is given its due deliberation before moving on to the next. The conversation, if you can call it that – the information, is as difficult to ingest as you might imagine.

At a point, main eye contact had all but ceased. Our eyes were on the floor, Missus’ fighting back water.  The doctor’s gaze shifting from our combined center to Lucy’s, now sleeping in her carrier on the floor beside. We were, all of us, locked in. A fly on the wall would have known that whatever was being said there was no business of his and buzzed away. The most incorrigible eavesdropper approaching this scene would have slowed and, dipping her head, quickly thought of someplace else to be.

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I’ve often thought to myself that he did a more than admirable job, not only with the whole matter, but especially of acknowledging an unfortunate piece of business.

When it was time to deliver the most grave statement in a very weighty soliloquy he paused slightly, but not too long. About the measure of time it takes to depress the clutch. He adjusted the cadence of his voice and maybe the volume of it by a shade and, in the attitude of an orchestral conductor  deftly turning his wrist, then inclined his head vaguely before speaking the words, some variation of which you knew were coming.

Of course. Some children don’t survive this….

And on a little more. All of the other information was relevant and useful, but these were the words he’d been speaking toward all along and that he’d delivered countless times and fine-tuned until the tone had come pitch perfect. Not routine or dismissive. Not apologetic. Not melodramatic. Not just a statement. An admission: Not all things go as planned. Even under the best of circumstances. This is the nature of this.

But of course, this you already knew, he seemed to also be saying.

We moved on and closed up with typical nice-meeting-you, thanks-for-your-time type chatter. We met with Maggie again for instructions on scheduling the pre-op appointment and for a parting dose of her infectious mirth.

We drove home that day with a sense of relief of having the conversation behind us and feeling good about the hands we were in. The hands Lucy was in. The surgery less than a month away.

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