Thursday, May 05, 2011

The Journey We Take Alone -- Part Five

By Alexander "Sandy" Prisant

Among the few timeless words, memorable to us all, there are: “To everything there is a season, a time for every purpose under the sun. A time to be born and a time to die.”

Depending on your frame of reference, the source is either Ecclesiastes 3:1-8 or the pop group The Byrds. But either way there may be something to this. For all the evidence that we live in a world of chaos and Chaos Theory, for all the arguments, coming from Woody Allen to Professor Stephen Hawking, that life is purely random, there are certain patterns that you see in your life and I am now seeing in mine--life waxes and life wanes. The whole universe operates in cycles and seasons. We see those cycles -- almost elegant ellipses -- that shape segments and the entirety of our individual lives.

As I record the medical miracles that saved my life against all odds at the beginning, it is now six decades later and I am again facing the same kind of surgical challenges. Conventional medicine has kept me going for an awfully long time, but now the cycle is coming full circle. Six board certified specialists have now told me that I can only be saved by a transplant. And not a small one. A combined heart and kidney transplant. Echoes of my life at age two are coming back to me.

Back then of course I knew nothing. Now I have lived with all this for so long that I have long since stopped waiting to hear the worst.

You will not hear it from transplant specialists, either. Surgeons are known for their egos and self-confidence. Cardio-vascular surgeons are known for super-sized egos. Transplant cardio-vascular surgeons are the next level up from there.

First you arrive in a standard waiting room. Lots of young women with clipboards moving amongst lots of waiting patients. At least 20. A flutter of panic: My God, are they all waiting for the same heart that I need?

Finally, after all 20 have been called, you hear your name and go to an ordinary examining room, where an ordinary medical assistant asks you the very same questions you were asked at your last ten medical appointments. This appointment seemed so important that we’d typed out a full chronology of my medical history—three pages—and a full-page drug protocol—every medicine taken at every hour of the week. It didn’t matter. The assistant pecked haltingly at her computer entering the information, asking questions about what was clear, in black and white.

When she left, the examining room returned to uneasy quiet. What would happen? Ten, 20, 30 minutes. A shortish man with thinning hair in a white medical coat opens the door. You rush to greet him. This is the man who will save me? Again? No. It is the surgeon’s assistant, but he is affable, intelligent and reassuring. He asks the logical questions about you and explains major transplants as something this team does like others wash up the dishes. You have been put completely at ease and you haven’t even met “the Boss” (as his No. 2 puts it.)

And then he appears--Dr. Ray Hershberger, Associate Cardiovascular Chief, Miller School, University of Miami. Former Director of Transplantation at Oregon University in Portland, publisher of dozens of papers, winner of almost as many honors in heart failure, heart transplantation, and genetic/familial cardiomyopathies.

Lean, personable and well over six feet, Dr. Hershberger fills the room. Physically and mentally. When you are in the hands of these specialists there suddenly are no obstacles that can’t be overcome. The negative prognosis of the previous five doctors you saw suddenly mean nothing. Really. Nothing.

We haven’t even begun the avalanche of medical tests that must be undertaken and they’re already talking about 80% and 90% survival rates after five, ten, 20 years. What, you’re thinking, is going on here? Every issue you raise makes them say that makes it even better. “You need a heart AND a kidney? Well, frankly that’s easier for us.”

It is? Why? How? And they just keep smiling and talking—all with great sincerity. It feels like you’re having your tonsils out. When do we get to the scary part?

For the patient that’s the good news. The bad news is that you are putting loved ones through the grinder again. My wife sits beside me—still in shock from this year’s three hospitalizations and the emergency procedure last month that saved my life again. “More surgery?" she is thinking. "The biggest surgery of all? Preceded by months, maybe years, on a waiting list for the man whom I’ve fought to keep alive for over 40 years?” As hard as the team has tried, my wife gets up and leaves the room.

She has to have a cigarette.

Sandy Prisant lives in Florida with his wife Susan. He embarked on this writing project in March. Part One appeared March 13, 2011. Part Two appeared March 16, 2011, Part Three appeared on March 27th and Part Four appeared here May 1st.

1 comment:

Dr. Mel Waldman said...

Dear Sandy Prisant:

So here we go again. You were the miracle-child and now, you’re a marathon survivor against all odds in need of a heart and kidney transplant. It’s your time again to confront death, as you did in the beginning. And you ask yourself: Do we live in a universe of chaos? Or do we inhabit an incomprehensible world with repetitive patterns and purpose? Perhaps, we exist in both. Whether our world is driven by chance or destiny, random acts or hidden patterns that form a cohesive whole, we must struggle to make sense of the narrative we call our life.
What I wish for myself I wish for you-to live passionately and to fight passionately against death. Why? Life is sacred and precious. I live with chronic pain as many of my peers do and I have also faced life-threatening illnesses. Despite my medical problems, I embrace life and look forward to exploring its sundry mysteries for as long as possible. I will not go quietly. There’s much I wish to accomplish in the days and years ahead. And if I had only one more day to live, I would tell those I love how much I love them. I would laugh uproariously. I would cry and mourn for all that death would take from me. I would listen to the mundane and existential problems of others. When I let go of my ego and focus on others, I’m extraordinarily happy. And of course, I would write. Writing is my lifeline and my joy.
Death waits for every man and woman. And I say-so let it wait a while. There’s still a lot left to be done.

Dr. Mel Waldman