Please forgive my vague post a couple weeks back saying that Work Matters would be silent for a few weeks, but I wanted to protect my family's privacy as I had a serious health matter to deal with. I am glad to say I on the mend and (slowly) getting back to work far more quickly than expected.
On April 6th, I had open heart surgery at the renowned Cleveland Clinic to fix a leaky aortic valve. This problem was detected about five years ago and my doctors have been keeping an eye on it since then. Essentially, the problem was that my valve was leaking badly enough that about 50% of the blood that it pumped out was leaking back in. This is probably something I was born with that just got worse over the years. I was without symptoms, and in fact, until a just a few days before the surgery, was riding my bike through the hills around Stanford for a good 90 minutes at least 5 times a week — in part I kept of the exercise because, as my doctors advised, the better shape I was in going into surgery, the better shape I would be coming out. It was also crucial to maintaining my mental health. But as there was eventual risk of heart failure, my doctors helped me make the decision to have the surgery before any irreversible damage occurred. I was also pleased to discover from various other tests that (despite my family history of blocked arteries and an imperfect diet and other health behaviors) my coronary arteries were clear and so there is no indication I will need anything stents or a bypass in the foreseeable future and that the repair should last a long time.
I went through a fairly complex decision process with numerous conflicting opinions about whether to do it at Stanford or Cleveland, whether to wait or do it now, and what kind of valve to have (tissue –usually from a cow or pig –or mechanical). I decided on Cleveland because they do so many more of these surgeries than Stanford and, as I decided on a tissue valve, they especially do far more of those (perhaps 1000 a year) than other places — and volume is among the main predictors of surgical success. I also was impressed by their low mortality and complication rates and that they simply seemed generally more organized than Stanford. Of course, their are many great places to get heart surgery, and Stanford is one of them. but I was more comfortable with Cleveland. So, although I never thought of myself as a medical tourist, there I was, fitting the definition perfectly. Fortunately, my Stanford insurance appears to apply in Cleveland as well as it would in California. I would describe the Cleveland Clinic as a kind of heart surgery factory. but one where nearly every employee we met, from the people who cleaned the floors and rooms, to the dedicated nurses (especially Amanda, Theresa, and the rather magical Virginia), to the cardiologists and surgeons, where competent and compassionate. Many employees at the clinic wear buttons (see to the left) that say "Patients First." If my experience is representative, this isn't just hollow talk, that saying guides and reflects how people at the Clinic think and act.
I am especially grateful to my surgeon, Dr. 
Marc Gillinov (pictured to the left). Dr. Gillinov is surrounded with a team that worked together to keep track of the big
picture and little details associated with each patient — which I found most comforting as in too many hospitals information flow is remarkably bad. Gillinov
also operated on Robin Williams, doing a very similar operation, cow valve and all. Check out this video of Robin Williams on
Letterman talking joking about the surgery… at one point Robin does an imitation/paradoy of
Gillinov’s voice that is pretty spot on: http://www.youtube.com/watch?v=6IhaAC4dN2Q. Not
only is Gillinov quite famous on the traditional
measures used to judge surgeons (experience, awards, publications in peer reviewed journals) and well-loved by those who work with him (rather than respected but deeply
feared and disdained for his narcissism, which are hallmarks of too many other
world-class surgeons), he has a child-like enthusiasm about
practicing his craft. Dr. Gillinov seems to bounce around the hospital spreading
positive energy — one of is colleagues said her nickname for him was "Sparky." He loves his job as much as anyone I ever met — the last time I encountered that same level of dedication, joy, and pursuit of perfection all in one package happened several years back when a group of us interviewed Brad Bird, Pixar's Academy Award winning director.
I also want to give a huge thanks to my primary care doctor in Palo Alto, the amazing Jeffrey Croke (pictured to the left), who first detected the problem and provided clarity at a key moment when I was receiving conflicting opinions and to Dr. Erik Price, my cardiologist in Palo Alto, who is better at explaining things than anyone I have ever met. I was helped by so many doctors and nurses at Cleveland, and was sufficiently delirious much of the time, that I can't remember them all (I mentioned a few by first nake above), but I want to mention and thank Chris Webb, a Cardiothoracic Nurse Practioner who did such a great job of keeping track of my case as a whole and Dr. Colleen Koch for special help getting a great cardiothoracic anesthesiologist Michelle Capdeville. My brain seems to be working just as well (or some would say just as badly) as before the surgery. For this kind of surgery, where I went on the heart-lung machine, a big part of the anesthesiologist's job is to protect the brain. And I was especially taken with the Dr. William Stewart, a cardiologist at Cleveland who showed remarkable wisdom — especially the ability to treat me as a whole person rather a collection of symptoms. I will eventually do a post about just Dr. Stewart, as I found him to be such an exceptional human-being.
I don't want to leave the impression that every thing went absolutely perfectly, that I was the perfect patient, or that the people at Cleveland are without flaws. None of that is true, as I have more than my shares of human flaws, the Clinic is a human organization, and as in all places, some people are stronger and more caring than others. I also can't assure anyone that they will have as positive an experience at Cleveland as I did — there are always risks and variation across cases. But for me, the experience (and so far the outcome) have turned out better than I ever hoped. Today, just two weeks after surgery, I feel far better than I ever thought was possible at this juncture. This is serious surgery as they crack open your chest, put you on the heart lung machine, stop your heart, cut out (and repair) the bad parts and put in new good ones. In my case, I have a new aortic valve that that is built around a cow's valve (see the picture to the left) and they also did repairs to the "aortic root" by replacing much of the tissue with Dacron. I have some aches and pains and am taking some pain pills. But I am up and around, able to work three or four hours a day, and have
done a 45 minute walk each of the last two days (with a little rest in
the middle). And my mind feels quite clear — although in evaluating this post and other things I write (as I slowly return to work) in the coming couple weeks, please keep in mind that they are written by a man who is slightly stoned on Oxycondone.
Thank so all of you who wrote comments and nice personal emails in response to my post saying I was out for awhile, and to my family, friends, and colleagues for being so supportive. Please forgive me if I am a little slower to respond to things than is usual, as I am trying to pace myself.
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