Wednesday, April 20, 2016
Tuesday, April 19, 2016
Tomorrow is scheduled an aortic valve replacement, a procedure which is a routine cardiac operation and normally holds little significance for me other than when it causes a delay or cancellation of a more interesting operation, namely the one that I am scheduled to perform. Not to diminish the value of the heart, nor to minimize the role of the surgeon taking control of it (temporarily), it is an important organ. Some would say critical even, so much so that one can not live without it, maybe even calling it the most important organ of all. This last point is of course debatable as one can easily show that life is just as impossible without other organs. The absence of a functional brain, GI system, lungs, skin, even a skeleton will render one's body just as pointless. Perhaps the heart also houses the individual's spiritual and/or emotional center, while simultaneously pumping blood with its life sustaining oxygen, nutrition and immunologic support to every other organ system in the body. Consider heart felt emotions, feelings from the heart, heart aches, hearts that go out to others, places hearts get left, hearts that are given or taken away, or any other of a number of biologic impossibilities that are attributed to this fist sized muscle bundle cradled deep within the chest. Possible, but maybe such phenomena are more appropriately credited to the infinitely more complex bundle of neurons contained within one's skull. I will leave that debate for the philosopher's.
OK, back to the above mentioned heart surgery. It involves not just any aortic valve. Despite the fact that 67,500 aortic valves are replaced every year in this country (2013 data), this one is different. At least for me it is. It involves my father, someone I met on my birthday and have known ever since.
Some combination of age, genetics and total lifetime pizza consumption has rendered his valve stenotic. Stiff and inflexible, rigid and narrowed, the valve makes it necessary for the heart to pump much harder than intended to force adequate blood volume through it with enough pressure to reach every nook and cranny of the organs so dependent upon it. Now God was smart during those 7 days when the world was created, and blessed us with cardiac surgeons (and cows as I will explain), who can replace the valve with a new one, new at least to the recipient. This replacement valve comes from a cow, a bovine xenograft. It just so happens that the bovine derived valve is a good fit for the human heart is reasonably durable, and provides little in the way of immunological problems (coincidence or by design?). Another philosophical debate comes into play here, and that is the relative value of God's creatures. I think it is safe to assume that these donor cows do not give up their valve voluntarily, but rather are coerced into it. In those initial 7 days of creation, I imagine that a lot of issues came up and it is quite conceivable that not every eventuality received adequate consideration. It has become the case that cows eat grass and live in the field, and humans eat these cows on wheat buns with ketchup, or on platters with baked potato, and reserve that same cow's heart valve, previously functioning as God originally intended, for use later in life when the cumulative effects of the aforementioned consumed hamburgers on their own aortic valve have finally been realized. Maybe there is justice in this after all.
Preparations for the surgery are well underway. Numerous showers have been taken with bacteriostatic surgical cleanser, swabs with MRSA killing ointment have coated the nares, medications have been adjusted, mouthwash used, fresh clothes donned daily, enema (really?), shaving of the beard, and seemingly endless phone calls from family, friends, acquaintances and well wishers received.