Mending a broken heart: How they fixed my faulty ticker

Jan. 26—MARIETTA — Lying on an operating table one Friday afternoon in December, a surgeon drained my heart of blood and stopped it from beating.

This is my "Other than that, how was the play, Mrs. Lincoln?" response when asked how much I enjoyed the holidays.

The trouble began last summer during a routine check-up.

Listening through his stethoscope, my primary care physician, Dr. Feroz Lalani, heard a heart murmur and advised a visit to the cardiologist.

"Was this really necessary?" I asked, thinking of all the things I'd rather do — which is anything — but made the appointment.

"You do have a heart murmur," confirmed cardiologist Dr. Micah Tepper, after listening with his own stethoscope.

Offering blessed consolation, my godmother sent word that she'd had a heart murmur her entire life and it hadn't bothered her. But a battery of tests brought an unwelcome diagnosis. Blood is supposed to flow out of the heart's mitral valve, the cardiologist explained, but because mine wasn't closing properly, a "severe" amount was flowing backward. That causes all kinds of undesired problems.

Tepper referred me to doctor No. 3, this time a surgeon at Wellstar Kennestone Hospital.

Shrinking the doorframe

"Think of your valve as a door," the surgeon, Dr. Richard Myung, said. In my case, the door frame was too large. Myung recommended heart surgery that involved sewing a plastic ring around the valve to bring the doorframe back to normal.

There are other kinds of treatment.

Some people have their valves replaced with pig or cow valves. Others have mechanical valves installed. But Myung said a pig valve can wear out after five years, requiring surgery again. (No, thank you.) And mechanical valves require a lifelong diet of blood thinners to prevent blood clots.

"Repairing it, however, basically returns your life expectancy back to normal, and you don't run those risks of having an artificial valve. So it's a game changer," he said.

OK, but what's the cause? Poor diet? (Guilty.) Lack of exercise? (Guilty.) Something else? (Probably guilty).

No, in my case, it's congenital, Myung said. The cords to the valve sometimes just wear out and break. And failure to treat this problem results in congestive heart failure.

He got my attention.

Myung explained how mitral valve prolapse, my diagnosis, affects roughly 2% of the U.S. population.

"Now that doesn't mean all 2% are going to need surgery or go into congestive heart failure. But if you think about the numbers of just 2% of the population carrying that diagnosis — that's an incredible amount of patients. And quite frankly, a lot of those patients aren't even diagnosed."

Why?

Because most people my age (early 40s) either ignore the symptoms (I hadn't yet noticed symptoms) or don't see a doctor on a regular basis. They don't know they have a problem. Which is why Myung said I owe a debt of thanks to Dr. Lalani for discovering the heart murmur before the damage was done. Catching it in time likely added 30 years to my life.

Surgery was scheduled for Dec. 2. Myung's assistant advised me to clear my calendar for the entire month because it could take that long to recover. Asked about an advance healthcare directive (something I've not thought about before), the stress level rose from 10 to 11.

After leaving Myung's office, I rang up state Rep. Sharon Cooper, the longtime health committee chair in the Georgia House of Representatives.

"Tell me everything you know about Dr. Richard Myung. Before Dec. 2."

450 hearts a year

Born in Los Angeles, Myung, 51, grew up in the Bay area. He completed his cardiac surgery fellowship with Emory Healthcare. (As it happens, Emory helped Wellstar Health System launch its open heart surgery program in 2005.) A few years later, when Myung was at Emory, Emory staffed him as a surgeon at Wellstar in 2009. He has since risen to become director of Wellstar's open heart surgery program and co-director of Wellstar's structural heart program.

Myung and his wife, Lindsey, a Sprayberry High School graduate, live in east Cobb with their three children, ages 7, 5 and 4.

As director, Myung leads a staff of about 100, including two other surgeons. He does about 450 open heart surgeries a year, which amounts to about 6,000 since 2009. His team does about 1,200 a year.

The most common reason for open heart surgery in his program is coronary bypass surgery, he said, estimating the procedure makes up 50% of the case volume, followed by about 25% valve surgery, 20% aortic aneurysms and the remaining 5%, miscellaneous.

My investigation into his background revealed glowing reports from Rep. Cooper and others. Not a single negative remark.

"He's outstanding," I'm told. "This is who you want," said another.

This is the kind of thing you need to hear about someone operating on your heart.

The day of surgery

Surgery check-in was 5:30 a.m., a part of the day I hadn't seen in a long time, and don't plan to see again. The nursing team hooked me up to various tubes and used an electric razor to shave me from neck to toes — the argument being once surgery is underway, there is no time for such things.

Lying on the hospital cot and looking very much like a plucked chicken, Myung comes by to say the surgery will have to wait a bit. My insurance company has incorrectly marked the operation "outpatient" rather than "inpatient" under the assumption that after being carved up like the Christmas ham, I will rise from the operating table and go skipping out of the hospital and off to Starbucks. If the aim is to minimize stress, thinking about how to afford heart surgery on the day of the operation is not an effective strategy.

Morning turns to afternoon as the hours tick by, and it's assumed the operation will be postponed to another day. It's not until late in the afternoon, when I'm ready to be checked into the old Milledgeville asylum, that Myung's miracle-working staff, who have been on hold with the insurance company for eight straight hours, told me the bean-counters finally agreed to mark the procedure as inpatient.

They wheeled my bed into the operating room.

Bring on the blessed anesthesia.

Myung reached my heart by cutting into my right side, just below the armpit, rather than the traditional middle-of-the-chest slash.

"It's a much faster recovery especially for young men," he said. "Very few people actually do it from the side. It takes special instruments. Special training, etc. I'd say 99% of the surgeons in the country still go through your front."

He called this the "minimally invasive" technique, though "minimally invasive" is not the phrase I personally would use to describe the five-inch incision decorating my body, among the other lacerations involved.

Throat tubes and muscle relaxers

The first thing I noticed after regaining consciousness was the throat tube, which caused a choking sensation that also prevented me from crying out for help. I signaled for pen and paper, but didn't know if the message was readable to Kennestone's intensive care nurses.

I must have become agitated because they warned that unless I relaxed, I would be restrained. This is not a fight I was going to win, and I went limp, waiting for the tube to be finally — and painfully — yanked out.

Complaining about this later to Myung, he explained that in any chest surgery, patients have to be able to breathe on their own before the tube is removed.

"There's a lot of folks who are just too sedated who can actually appear alert, but just cannot physically take a deep enough breath to come off the ventilator," he said. "We actually try to get everyone off the ventilator within six hours, but everyone wakes up from anesthesia a little bit differently. And so you run the risk of actually pulling the tube out too early. And then they can't breathe, and it can be quite traumatic to have to put the tube back in. So we have to make sure the patient is wide awake and breathing on their own before removing the tube."

To this, I have no rebuttal.

After the insurance screw-up and the breathing tube business, I list the Tyrannosaurian pain as the third biggest negative of this affair.

The aftermath of the surgery hurt far more than any procedure I've had before, more than an appendectomy, more than dental surgery, more than any of them.

Between the incisions that peppered the body, and the long tubes left in the chest to drain excess fluid, a deep breath brought about the kind of pain that elicited every prayer in memory. Not until a synthetic morphine drip, oxycodone pills and a muscle relaxer worked in unison was there relief.

Myung told me some people wake up without feeling any pain.

I'd like to meet these people.

"We are a little bit more judicious about people who have had chest surgery, because obviously if you give them too much pain medication it can be over sedating and they'll stop breathing. So there's a fine balance between treating the pain and making sure they're not over sedated," he explained.

Again, I have no rebuttal.

From the Friday of the surgery, Myung kept me at Kennestone through the following Tuesday, at which point I was released to my family to recover. The first couple weeks I was fairly helpless: unable to drive, unable to lift anything heavy. Daily vitals of blood pressure, temperature and weight were checked and recorded to make sure the recovery was on track.

Follow-up visits with Drs. Myung, Tepper and Lalani revealed the operation was a success, which was a relief after looking like a stabbing victim. And as there's only so much Netflix a person can stand, I returned to work three weeks after surgery.

Now on No. 5 of a 36-session cardiac rehabilitation course, I slowly return to normal.

I brought a photographer along for a January visit to see Dr. Myung.

"You realize, this is the man who stopped my heart from beating," I told the photographer.

"Yes, but I also restarted it," Myung replied, in typical good humor.

'A dream job'

I asked the surgical wizard what the biggest challenges of his job are.

Achieving a work/life balance is the first thing. Another is the changing work environment.

"Insurance companies obviously are more difficult," he said.

The severity of patient illness is also much higher. Part of this he attributes to new therapies that allow for the treatment of sicker people. Part of it is that Kennestone Hospital has one of the biggest emergency rooms in the country. And part of it, he suspects, is the post-COVID world.

"I think a lot of folks just sort of stopped taking care of themselves and now we're seeing the ramifications of that."

At the same time, Myung said he will remain in his role "for as long as God thinks I can do it. I have a dream job here."

Expanding on this, he said while Wellstar is a huge system with access to all the cutting-edge things found at big university hospitals, "We still have the small community hospital feel. We have the Dr. (Joseph) Browns." (My anesthesiologist, who has the bedside manner of St. Francis.)

"We have the nurses who just want to hang out and talk to you. For example, we have five core cardiac anesthesiologists, Dr. Brown's partners, that I've worked with my entire career. It really is a family, and we're all friends outside of the hospital, and you just don't get that at some of the other programs around here. And I personally think it shows. You're not the first patient to come back and say, 'Wow, that was a really, really great experience. I didn't expect it to be that.'"

For the Thanksgiving holiday every year, I write a column listing what community leaders are thankful for. People frequently cite their health, and I often give them a hard time about this, asking for a more original answer. But I've since gained some perspective. Without your health, you have nothing. The team of doctors, nurses and medical professionals who saw me through this saga gave that back to me. I am thankful for all of them.