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February 28, 2008

A LAYMAN’S PERSPECTIVE OF CORONARY BYPASS SURGERY

Filed under: By Paul Jason — Administrator @ 8:57 pm
  Paul Jason
 

 

Chapter 7:   Can I Get a Second Opinion?  

One of the things that I discovered during my illness is that people that you least expect to give you support and assistance take on roles which are truly astonishing.  One such person is a client of mine who is a real estate builder/developer.  He called me at the hospital a few hours after I checked back in, when he discovered from my secretary what had happened.  After I described  my current condition to him, he asked me whether or not I was going to have the surgery performed at Montefiore Hospital and, if so, who the surgeon would be.  When I gave him the name of the surgeon who had visited me, he exclaimed: “That’s the doctor would performed triple bypass surgery on my father over fifteen years ago.  He’s great.  My father is almost eighty years old now and the bypasses are still holding up.”
 

Truly comforting news.  But I still knew I had to get a second opinion. And I didn’t know who to get it from.
 

My client told me that he had had extensive business dealings with a well-known philanthropist, who had given generous endowments to several metropolitan area hospitals.  This philanthropist had heart problems himself, and had an outstanding thoracic surgeon.  Within an hour, my client called back and said that I should arrange to have my film delivered to this surgeon at his office near Columbia-Presbyterian Medical Center in Manhattan at 10:00 a.m. the next day, a Friday.
 

The arrangements to deliver the film the next morning were made. Before 10:30 my bedside phone rang.  It was the thoracic surgeon.  I was startled, and thankful, that he would take the time, on such short notice, to review my film and to call me.  I guess that’s why he’s in the “Castle Connolly Guide: How To Find The Best New York Area Doctors”  also.  He confirmed the severity of my arterial blockages and said that I was not a good candidate for angioplasty and the insertion of stents.  He agreed that a quadruple bypass operation should be performed.
 
Then I asked him whether he thought that I should remain at Montefiore and have the recommended surgeon perform the procedure.  His answers to both questions were in the affirmative.  He opined that Montefiore has a very good cardiac program, that he knew the surgeon at Montefiore, and that this doctor was a very competent cardiothoracic surgeon.
 

Whew, what a relief! I had lucked out: without leaving the hospital, I had received my second opinion and professional guidance as to where and by whom the surgery should be performed. The die was cast.  The only remaining questions were: when would it happen, and would I survive?
 

 I then called the surgeon’s office, advised his staff that I was still a patient at Montefiore, and had decided to have him perform the surgery.  Since the weekend was fast upon us, they advised me that the procedure would occur the following week, as soon as the doctor had an “opening.”  (A double entendre?).


Needless to say, my anxiety began to build over the weekend.  And, somewhere along the line I’m sure they started to introduce sedatives into my IV.
         

I forget who first said it, but “into every anxiety a little misery must come.”  In my case, the misery came in the form of gout.  The classic gout symptom is sudden, severe pain in the joint of the big toe, although it may also occur in the ankle, wrist, knee or elbow.  The pain ordinarily intensifies and the joint becomes very sensitive to the slightest pressure applied to it or the surrounding skin. My left big toe started to kill me.  I guessed, just from general knowledge, that it was gout, but I had never before experienced it . . . why now?
 

Gout, I later learned, is a type of arthritis, and it occurs when uric acid accumulates in the body and forms crystals in a joint. It is known that a gout attack can be precipitated by injury, surgery, the consumption of large amounts of alcohol or protein-rich foods, fatigue, stress or illness.  Hmmm.  Gout is also associated with high blood pressure, and the chance of an attack increases when the victim is taking the blood pressure medication “thiazide”.    Hmmmm.   Had they introduced thiazide into my IV?
 

All I know is that the attack came suddenly and within one day I could hardly stand up because of the pain in my left toe. What a predicament!!  Here I was on the verge of open heart surgery, during which I knew  they  were going to remove a vein from my leg . . . and I couldn’t even stand up.  If I couldn’t stand up prior to the surgery, what would it be like after the surgery?
 

I advised the medical staff of my affliction and the diagnosis of gout was confirmed. Some medication was introduced and, impressively, within a day, the symptoms were under control.  After another half day they were gone altogether.
 
On Sunday I was advised that the operation would not occur on Monday, but would probably happen on Tuesday
.
On Monday a young man walked into my room and advised me that he would be the anaesthesiologist for my surgery.  He asked me a bunch of questions and then asked if I had any questions.  Of course I couldn’t think of any pertinent questions because I had not been under general anaesthesia since I was twelve years old.  That had been a horrendous experience, but I had every reason to believe that things had changed since then.
 


The one thing I did tell the anaesthesiologist was that I was terrified; that I had no adult surgical experience; that I didn’t know what to expect; that I was distraught over the idea of being wheeled into the operating room while I was still conscious.  I asked if I could be rendered unconscious before I was brought into the operating room and he said “Yes.”  This served to allay a good part of my apprehension, for I felt that if I were rendered unconscious prior to entering the operating room, I would be totally oblivious to anything they did to me.  If I survived, no one could truly prepare me for the ordeal of recovery; only someone who has experienced it can have any valuable preparatory information, and, even then, each person’s body reacts differently.  I knew several by-pass patients personally, so I had some idea of the immediate effect of the surgery.  But, at least if I survived, I could look forward to the  restoration of my life; and, if I didn’t, I wouldn’t know what happened.
 

Monday night, April 3rd , a nurse’s aide appeared in my room and advised me that he was going to shave me in preparation for surgery the next day.  Now, there’s shaving, and there’s shaving.  The aide proceeded to remove all of my hair, from my nose to my toes, front and rear.  I had grown a full, but trim, beard more than thirteen years previously.  I had watched it turn from a reddish-brown to salt-and-pepper gray.  Three years prior, I had decided to remove the sides of the beard and retain a mustache and goatee.  In fact, I had grown rather accustomed to, and fond of, facial hair. As a result, when he finished, I felt like a naked ape.
 

Talk about shock!  This was the first time I had seen my clean shaven face in all those years. For the first time I had to acknowledge Nature’s brutal ability to change us  imperceptively  as we wander through life.  I peered into the bathroom mirror at the strange face staring back at me.  God, I hadn’t realized how much my face had changed over the years.  After looking at myself in the mirror every morning and night for thirteen years – - – that’s about 9,500 times – - – one sort of gets an image of what one looks like.  Was that really me?
 

It surprises me that in moments of great stress, the human mind can occupy itself with such trivia.  It must be a natural defense mechanism.   

To be continued next week….
 

February 22, 2008

Fad Diets

Filed under: By Tamra Rosenfeld — Administrator @ 4:45 pm

  Tamra Rosenfeld

 

Have you ever walked into a bookstore and noticed there is an entire stack of diet books in the most popular book selections?  There is so much confusion on the “right way to eat”.  Do you choose low fat, low carb, low glycemic index, etc.? 

A diet in moderation with healthy choices is the healthy way to go and this needs to be followed lifelong.  There is no magic way around it, 3500 calories is equal to 1 pound.  If you have 3500 calories in excess to what you need you will gain 1 pound.  If you have 3500 calories less than what you need you will lose 1 pound.  Fad diets work temporarily because if you eliminate something you normally eat, you will be eating fewer calories.  Chances are you will eventually crave these food items and plummet at them full force when you go off the diet.  Many of the diets today limit important nutrients that your body needs.  Fat is an essential part of a diet and so are carbohydrates.  Without fat you are depriving yourself of fat soluble vitamins such as vitamins A, D, E, and K plus essential fatty acids.  Without carbohydrates you are depriving yourself of valuable anti-oxidants found in fruit, plus many of the B vitamins found in grains.  Without protein you deprive yourself of essential amino acids, iron, and vitamin B12.  With the correct balance of food all of these vitamins and nutrients work together in your body to give you energy, and keep your body systems in balance.

Fad diets also do not address behavioral modification, personal problems and goals, and emotional eating.  Without behavioral modification it is difficult to stick to a diet plan.  As a result many people “yo-yo” diet.  “Yo-yo” dieting is a term to describe losing and gaining weight back.  When you lose weight you lose lean body mass.  To maintain your lean body mass you need to exercise along with dieting.  When the weight is gained back only fat mass returns.   

So skip the fad diets, learn how to eat the right foods in moderation, and focus on deterring emotional eating!

February 14, 2008

A LAYMAN’S PERSPECTIVE OF CORONARY BYPASS SURGERY

Filed under: By Paul Jason — Administrator @ 7:16 pm

  Paul Jason

Chapter 6:   Our Cardiac Care Menu Today Features . . .
   

What is it about hospital food that makes it so unpalatable?  Is it the presentation, the quality or the flavor?
 

Now, I’ve been told that some hospitals (precious few by most accounts) do, in fact, serve reasonably attractive, tasty meals.  Most, unfortunately, do not.
 

Why the American public, otherwise blessed with such a diversity of quality, succulent food choices, is willing to tolerate the unappealing nature of hospital food is beyond me.
 

After all, food is one of life’s pleasures.  It is, and has always been, in virtually all societies, an essential cornerstone for celebration, camaraderie, thanksgiving and comfort. And, certainly, there can be no more critical time for the individual succor and comfort that well-prepared food can provide than during the course of a generally depressing hospitalization.
 

Some people eat to live; others live to eat. I have always enjoyed food.  To me, it is tangible evidence of God’s bounty, not to be taken lightly; a simultaneous source of sustenance and pleasure, best enjoyed in the company of family and friends, but satisfying enough even when consumed in solitude. Although I had, during the past ten years, subjected myself to a low-fat, low-sodium diet, I nevertheless continued to thoroughly enjoy flavorful, well-prepared food.  The appearance and smell of good food, combined with its taste and “mouth-feel”, creates an undeniably pleasurable experience.
 

Talk about smell.  How come hospital food smells like no other cuisine that we encounter in the multitude of our other worldly activities?  It remains a mystery to me.
 

Lastly, there can be an inexplicable quality to well-prepared food that transcends the mere ingredients. People in some cultures, and individuals throughout the world, believe that foods can impart more than the nutrients contained within them  – - that they can bestow a spiritual energy effused from the preparers. In recent years the film “Like Water for Chocolate” conveyed in classic fashion this mysterious side to the aura of food.
 

In any event, here I was, in the days leading up to my surgery, a virtual captive to the culinary artisans of Montefiore Hospital.
 

Now I can understand that some people are admitted to hospitals in a state of acute distress, and that, as a result, food is the last concern on their minds.  And other people enter hospitals already severely limited to medically-prescribed, restricted diets.  But most of us are not that curtailed, until such time as the medical staff renders us so.
 

Here I was, not in any particular pain; nor was I incapacitated.  I was, so-to-speak,  nervously awaiting a life-saving surgical procedure. If ever I was in need of some healthy, savory, comfort food, it was right there and then.


 

But no relief was in sight.  Instead, I was inundated with the relentless, uninspired cuisine of the unimaginative and the mundane: lumpy hot cereal; chicken boiled to oblivion; milk served in a little waxy container; little squares of red Jello; hard-boiled eggs with solid yolks (wait a minute – - – I thought this was the cardiac floor?).   Help!  I must be trapped in some elementary school student cafeteria. I think the airlines do better, even at thirty thousand feet.
   

Now I know that the culinary efforts at hospitals can be better. Perhaps they don’t want to make it better on the theory that every patient is entitled to a complete hospital “experience.”  But I happen to have a brother who is a graduate of the French Culinary Institute in New York City.  Ten or more years ago, writing on behalf of Weight Watchers International, he was able to create a whole bunch of pasta recipes, for example, that were relatively low in fat and sodium, and were easy on the palate.  Recipes such as “Sicilian-Style Pasta with Califlower”, made with extra virgin olive oil, red onion, pines nuts, low-sodium chicken broth, basil, parsley, grated cheese, black pepper, garlic and raisins.  Each serving contains 384 calories, 11grams (or 25%) from fat, and 385 mg of sodium.
 

Or “Pasta Puttanesca”, made with olive oil, onion, garlic, canned low-sodium tomatoes, ripe olives, ground red pepper, water-packed tuna and black pepper.  346 calories per serving, 6 grams (or 15%) from fat, and 293 mg of sodium.
 

Or “Penne with Grilled Vegetables”, made with red and yellow bell peppers, eggplant, onion, zucchini, mushrooms, olive oil, garlic, rosemary, thyme, sage, grated cheese and parsley.  274 calories per serving, 6 grams (or 19%) from fat, and 58 mg of sodium.
 

He was also able to create non-fat Brownies, made with egg whites, prune butter (yes, prune, but you don’t taste it in the final product), vanilla, Dutch-processed cocoa, all-purpose flour and a little salt (instant espresso powder is optional).  Delicious!!   And I’m not kidding.
 

I think you get the idea.  But if you’re interested in a few more flavorful recipes that
other health-oriented chefs have been able to invent, read on.  The following is just a sampling:
 

Mushroom Barley Soup” made with onion, garlic, olive oil, fresh mushrooms, dry sherry, reduced-sodium soy sauce and dill weed. 590 calories per serving, 17 grams (or 26%) from fat, and 700 mg of sodium.
 

Orange-Jicama Salad” made with jicama, oranges, coriander, orange juice, balsamic vinegar, olive oil,  black pepper and a dash of salt.  107 calories per serving,  3.5 grams (or 29%) from fat, and 100 mg of sodium.
 

Dill-Poached Fish Fillets” made with cod or Dover sole, fresh dill weed, fresh lemon juice, water, black pepper and a dash of salt.  71 calories per serving, 0.5 grams (or 7%) from fat, and 100 mg of sodium.                                                                                                                                                           


 

Oven-Fried Potatoes” made with fresh lemon juice, olive oil, rosemary, garlic, black pepper, vegetable cooking spray and a dash of salt. 158 calories per serving,  2 grams (or 11%) from fat, and 100 mg of sodium.
 

Apple Crisp” made with green apples, fresh lemon, raisins, brandy, brown sugar, cinnamon,  whole wheat pastry flour, old-fashioned rolled oats,  toasted wheat germ, salt, light olive oil and maple syrup.. 244 calories per serving, 7.5 grams (or 27.5%) from fat, and 140 mg of sodium.
*                                                           *                       * 
I am unconvinced that food served in a hospital has to taste like “hospital food.”  And it certainly doesn’t have to smell like “hospital food.”  Maybe . . . just maybe . . . improvements in this area of hospital administration might make a difference in the perception of concern and caring, and the reduction of stress, that patients so desperately need during their hospital stays. I find it disconcerting that hospital administrators appear to be so oblivious to this glaring inadequacy. Aren’t they ever patients in their own hospitals?
 

Instead of incorporating the serene and spiritual value that nature’s bounty has to offer towards the healing process touted by their institutions, they shortsightedly concern themselves solely with its minimal nutritional value, all to the detriment of the patients. Low in taste and, I suspect, low in cost, such food brings the spirit down rather than lifting it up.
 

So I’ve come to this conclusion: It’s time to get rid of the greedy bean counters and bring in the gourmet bean cookers.

To be continued next week….
 

February 8, 2008

Exercise and Osteoporosis

Filed under: By Vadim Vilensky — Administrator @ 9:03 pm

  Vadim Vilensky

Human bone is a dynamic organ, which has many functions in our body. As calcium is removed or added, our bones change and remodel every minute of the day, in order to maintain strength. The excessive loss of calcium, usually associated with aging, is called osteoporosis. The bone becomes too fragile to withstand the ordinary stresses of activities of daily living, and can fracture. Osteoporosis is a major health issue, with about twenty-five million Americans being affected. Osteoporosis causes over one million fractures yearly. The American Academy of Orthopedic Surgeons estimates that one-third of women and one-fifth of men living to age eighty-five will experience a fracture of the hip due to osteoporosis. 


The good news is that there is growing evidence that exercise can prevent, or even reverse, age associated loss of bone density.  A group of scientists from the University of Florida found that six months of high intensity resistance exercise was successful in improving bone mineral density in healthy elderly individuals. 
In another study, researchers from Spain also concluded that strength training increased bone mineral density (BMD).  Their study involved older individuals (average age 70.9 years) who had osteoporosis. The subjects worked out three times a week for 24 weeks, completing three circuits with 10 multiple-joint exercises.


Among my clients, there are several women who have achieved a significant improvement in BMD after a few years of heavy resistance training, without taking any medications.  One client, who is post-menopausal, showed a marked increase in BMD over a four year period by doing heavy resistance training.  In 2005, after one year of resistance training, her Bone Densitometry showed a 4.9% increase in the density of her AP Spine over the previous test done in 2003, but also revealed mild osteopenia.  A Bone Densitometry completed in December of 2007 showed that her AP Spine age increased another 2.4%, her LAT Spine improved 19%, and the osteopenia no longer exists.  Statistical comparisons show the AP Spine total value is 116%, the LAT Spine value is 118%, and the L. Hip (neck) value is 88% compared to a 30 year old woman.  When compared to other 59 year old women the results are 135%, 159%, and 105% respectively.  These results prompted her physician to say that this 59 year old woman has “the bones of a 30 year old.” 

 

If you think you are at a high risk for osteoporosis (i.e. female, over 50), or just want healthier bones, here are some suggestions to get your resistance training program started (consult your physician first):
  

   

   

  1. Perform eight to twelve different resistance exercises that train the major muscle groups. Bones improve in the area where you apply the load. To build density in your legs, do squats, lunges or leg presses.   For the arms, do bench presses or push ups.  For the spine, do squats with weights or deadlifts.
  2. Start with a minimum of one set of 8 to 10 repetitions of each exercise to the point of volitional fatigue. If you can do more than 12 repetitions, increase your lifting weight. The higher the load (lifted weight) the more effective it is to increase BMD. Beginners should start with lighter weights, and gradually increase load and volume.
  3. Use a variety of exercises for each muscle group. Changing your program will create a better response from your body, and will keep you from getting bored of the same routine.
  4. Perform each exercise through a full range of motion, with both the lifting and lowering portion in a controlled manner. Keep a good posture.
  5. Combine strength training with balance and stability exercises on some days. Balance is essential in preventing falls during the activities of daily life. When lifting weights on an unstable surface, reduce the amount of weight.
  6. If possible, exercise with a training partner or a personal trainer who will be able to provide feedback, assistance, motivation, and make it more fun.

 

  

   

 

February 6, 2008

A LAYMAN’S PERSPECTIVE OF CORONARY BYPASS SURGERY

Filed under: By Paul Jason — Administrator @ 8:22 pm
   Paul Jason

 

                                             Chapter 5 
 

The balance of the day on which my cardiac catheterization was performed was spent in a private room on the sixth floor of the north wing of the hospital, officially known as North 6, and designated as the “Intermediate Cardiac Care Unit”.  This is a cardiac monitoring unit, also known as a telemetry unit.  Patients in this unit wear a telemetry box which is a cardiac monitor.  The functioning of each patient’s heart is monitored at a central station twenty-four hours a day.
 

 

Now  things started to get a little complicated in this unit.  I had always thought, in my experiences as a visitor to sick patients, that the central core station in each section of a hospital was manned by RNs and an intermittent  flow of MDs (that’s why it’s referred to as the “Nurse’s Station”, right?).  I was also aware of orderlies roaming the halls and rooms cleaning up this thing and straightening out that thing. In the catheterization lab there had been a physician, a physician’s assistant, a registered nurse, and, I believe, a  technician.  But here, at North 6 there is a Roster of personnel sufficient to boggle the mind of a Pentagon bureaucrat.
 
First, according to the Roster pamphlet I discovered,  there’s a nursing staff composed of Registered Nurses (RNs), Licensed Practical Nurses (LPNs) and Nursing Attendants (NAs). The Registered Nurses are divided into five categories: an Administrative Nurse Manager (who “oversees the overall functioning of the entire unit and staff and assures that  “quality care and services are delivered to the patients”); an Associate Administrative Nurse Manager (who assists the Administrative Nurse Manager, what else?); Patient Care Coordinators (each of whom has the responsibility to “coordinate staff and unit activity for a particular shift”); Staff Nurses (I guess these are the fabled “angels of mercy”); and Clinical Care Coordinators (who identify and facilitate “options and services to meet the individual health care needs of patients and their families”).
 

The LPNs are responsible for “delivery of appropriate nursing care under the supervision and direction of a RN” [emphasis added].  NAs assist patients with daily living activities such as eating, bathing and walking, as well as “carrying out other specific duties delegated to them” by an RN.
 

In conjunction with nursing services there are Monitor Technicians, whose primary job is to keep an eye on  the central cardiac monitors and alert a nurse if a problem arises.
 
Then there’s a medical staff composed of Attendings, Residents, Interns, Physician Assistants and Nurse Practitioners (more about these categories later).  There are also  Unit Secretaries, who have “clerical responsibilities which include maintaining [patient] records.  They usually are the ones who respond to your call-bell when it rings on the intercom in the nurses station” [emphasis added].
 

Of course there’s the Service Associates, whose responsibilities include housekeeping for the unit (Oops!  I think I referred to them as orderlies), transporting patients  to other parts of the hospital for tests, and serving meals to patients.


There’s also a Unit Manager whose job it is to supervise the unit secretaries and service associates, besides being responsible for maintaining unit supplies and equipment.
    

In addition, the following people are available for consultation:  Registered Dietitians, who evaluate and oversee patients’ nutritional needs and can develop a diet plan “tailored” to an individual patient’s needs (if only they could master the art of making the stuff look wholesome and taste good!!); Home Care Nurses, who make determinations regarding the services a patient may require after discharge from the hospital and arrangements for the same; Pharmacists, who “review the appropriateness of patients’ drug therapy, including drug dose and interaction”; and Physical and Occupational Therapists, who evaluate the condition of patients and help develop customized activity treatment plans.
 

Whew!! Multiply all of those categories by the number of daily work shifts, and a virtual army of personnel is passing in and out of a patient’s room, and in and out of a patient’s life, faster than most sick people are emotionally or physically prepared to comprehend or deal with. On paper it all seems organized and logical.  In practice, however, it is a whirlwind of strange faces, most of whom the patient cannot distinguish by rank or category.  Was that a Resident, a consulting MD, a Nurse Practitioner or a Physician’s Assistant who just left my room??? The confusion is exacerbated when you have a fever and/or you have a cardiac monitor hanging around your neck and/or you have an intravenous tube hanging off your arm and/or you are receiving medications which dull your awareness and/or your eyeglasses are in the drawer of the night table next to your bed.
 

But, I digress.  Sitting in bed all day is not the type of regimen I’m  used to.   True, I had suffered ventricular fibrillation (perhaps even cardiac arrest) awhile ago, but I felt better after a few hours and  my mind was alert. Therefore, I decided to look through a book that, fortunately, I had borrowed from my secretary and brought to the hospital that morning.  The book is entitled  “Castle Connolly Guide: How To Find The Best New York Area Doctors” (Third Edition) and is designed to be  a consumers aid in choosing a doctor.  In it, you can find out about a doctor’s medical school education, his residency training, his fellowships, board certifications, hospital appointments, etc.  Thirteen hundred pages of information. The book is organized so that you can find a physician by name, by medical specialty or by the county in which he/she maintains an office.
 


To find the best doctors in the New York Metropolitan Area, Castle Connelly says that it “randomly selected 20,000 board certified doctors from over 55,000 doctors” in that geographic area and mailed them a form requesting that they nominate the best from amongst their peers, with emphasis on “excellence in patient care”.  Additionally, Castle Connelly communicated with 6,000 nurses in the region, and 3,000 health care professionals in major medical centers and hospitals, all randomly selected, and asked for their input.  This process resulted, they say, in the nomination of over 17,500 doctors.  Their research staff then went through the tedious task of verifying information and undertaking thousands of personal telephone calls to corroborate the recommendations.  The list of nominees distilled down to a little more than 6,000 doctors, deemed to be the “best of the best” in their respective specializations.  Each of these doctors was then apprized of his/her nomination and was requested to complete a professional information form.  This data constitutes the basic information in the Guide.
    

I was quite satisfied to find that three of the five physicians in my cardiology group were in the Guide, including the doctor that I had consulted.  The other two physicians, the youngest members of the group, were not; and, one of these had been the doctor who performed the catheterization that morning.
 

Of greater importance, for the moment, was the fact that both recommended surgeons were in the Guide.
 

The Guide also contains profiles of some of the major hospitals in the area drafted by the hospitals themselves.  Major medical centers included are Beth Israel Medical Center, St. Luke’s-Roosevelt Hospital Center, The Long Island College Hospital, Montefiore Medical Center, The Mount Sinai Medical Center, The New York Hospital-Cornell Medical Center, Columbia-Presbyterian Medical Center, NYU Medical Center and Saint Vincents Hospital and Medical Center.  Listed, also, are specialty hospitals such as Calvary Hospital, Four Winds Hospital, Hospital for Joint Diseases, The New York Eye & Ear Infirmary and St. Francis Hospital-The Heart Center.  Finally, there is information on a group of regional medical centers and community hospitals.
 

In its promotional information section, Montefiore Medical Center announces that its “cardiothoracic surgeons perform over 1,400 heart surgeries each year, including coronary artery bypasses and valve repairs.”   Also, their  “interventional cardiologists perform more than 4,000 catheterizations.”
 

Well, that was reassuring.  At least I was in a hospital that had extensive experience with people suffering from my malady.
 

The next thing I did was call my cardiologist.  I told him that I was contemplating having the surgery performed at Montefiore and that his partner had recommended two cardiothoracic surgeons.  He asked me for the names, opined that both were excellent surgeons, and offered his choice of the two to perform my surgery.  He said that he would contact that doctor and ask him to visit me so that I could meet him and ask  any questions that I might have.  I agreed that that was a good idea.  He also said that the surgery should be performed in the next week or so.
 

Later that day the surgeon did appear at my room. He was a man in his 60’s, plain, calm, confident.  He  examined  me  briefly  and  then  explained  the  nature of  the
proposed surgery, assuring me that my overall health indicated that I was a good candidate for this procedure.  He suggested that I get a second opinion and decide if I wanted the surgery to be performed at Montefiore.  If so, he was prepared to accommodate me, and told me to call his office to schedule the surgery.  He said that the operation would take between six and seven hours, and that barring any complications I would be out of the hospital four and one-half days after the date of surgery.  Four and a half days?  Boy, some bean counter must really have this down to a science!


He, too, said that I could leave the hospital (!!!) to get the second opinion and make my decision; but, the surgery should be performed in the next week or so.
    

Immediately upon his departure I went back to  Castle Connelly and rechecked his credentials.. He is a board certified thoracic surgeon, having done his residency more than years ago.  He had a fellowship in general vascular surgery,  and is a Lecturer in Surgery at the Albert Einstein College of Medicine. His area of special interest is cardiac surgery.
 
So it was, that approximately twenty-four hours after my catheterization, on Thursday, April 30th, I prepared to leave the hospital, go home and contemplate when, where and by whom I should have my by-pass surgery performed.
 
By  11:00 a.m., I notified the nurses’ station that I would be vacating my room in a little while.  I dressed in street clothes and was just about to walk out of the room when the telephone rang.  It was my son, the lawyer.  The conversation went something like this:
 

 ”Hi. Dad. How do you feel?”
 

 ”Okay, I guess.”
 

 ”What are you doing?”
 

 ”Oh, I’m just about to leave the hospital and go home.”
 

 ”Go home?? Don’t do it!!  I’ve been speaking to some doctors that I know and they say that you should stay right where you are.  The weekend is coming up.  What will you do if you have a cardiac problem over the weekend?  Especially if you’re not at home.  You might wind up, if you’re lucky enough to survive, in a hospital that you don’t want to be in, under the care of a doctor not of your choice.”
 

 Well, I guess all of that schooling paid off after all.  He’s probably right, I thought; I should stay here until I decide what to do. I’ve already experienced fibrillation.  What if I have a heart attack?
 

Within five minutes after I finished my conversation with my son, the phone rang again.  This time it was my daughter, another lawyer.  The conversation went something like this:
 

Dad, I’ve been speaking to my brother, and I’ve also consulted a doctor that I know.  The consensus of opinion is that you should not leave the hospital unless you have an immediate contingency plan so that you are not at risk.”
 

 ”Okay. I guess you’re both right”.
 


As a layman, I was torn between the advice of my attending cardiologist and surgeon on the one hand, and the informed concern of my family on the other.  I was not equipped, by education or experience, to evaluate this situation.  After a few moments I decided to follow the best instincts and advice of my loved ones. 
 

I went out to the nurses’ station, and checked myself right back into the hospital.  I returned to the room,  got undressed, and  climbed back into bed.

To be continued next week…

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