Friday, February 20, 2009

Heart aches 5

Let me say something about the scars. Like most people who face open heart surgery, I was anxious about having the evidence of it carved into my flesh for the rest of my life. I read a good deal about post-op scars, what they looked like, how they healed, and what might be done to ameliorate them. And, once again, I found a good deal of nonsense on the Net, some of it pernicious, some well-intentioned. But I think that anyone contemplating the surgery ought to know my experience so far, at least.

In the site of the man who seems to make a living of his surgery, there is a photo of his week-old post-op scar. It is a neat line down the center of his chest, as if some mischievous child had taken a Sharpie pen and ruler to him in his sleep. Then, some months later, we see him on the beach with no sign of the operation visible. Some people actually suggest that one should be proud of one's scar and put it on display as a testament to the years of life which one has gained through the surgery. I find this idea morbid, and I have already expressed my attitude on this point.

In my case, the incision is not a trim vertical line, but a rather jagged one, stretching from the level of my collar bones to the top of my abdomen. Why it was not possible for the doctor who made the incision to cut a straight line I cannot tell. I do it every time my son and I build a wooden ship model and we have to cut the sails. Their edges must be perfectly straight for appearance sake, and so we have devised means and adopted tools to accomplish this. Perhaps modern heart surgery could benefit from the ancient art of model ship building.

The incision is sewn shut subcutaneously, for which I am grateful since there will be no attendant signs of the stitching (like the eyelets on your boots through which the laces pass) to give me a truly Frankenstein allure. Then the incision was slathered over with a kind of glue that helps bond it together. Derma-bond I think it is called. Now for this much I was prepared, both by my research and by my doctors.

What I was not prepared for is the fact that I have not one, but seven incisions on my person, meaning, eventually, seven scars. In addition to the chest incision, there are three punctual defects below the chest incision and at right angles to it, from which the drainage tubes in my chest cavity protruded. These are nasty, roundish holes, still bearing their sutures.

(I should mention also that the wires used to close my sternum, which was bisected by a circular saw, are still there and will remain for the rest of my life. In addition, the wires implanted in my heart to monitor its behavior, which were snipped off at the level of the skin, will also remain inside me til death, and, in fact, will long outlast my decay.)

In addition to these, there are, of course, three incisions on my left leg, where the donor vein was 'harvested' as they quaintly put it. I was told quite solemnly that I ought to be grateful for these, since in the not-too-distant past, the vein was removed through a single incision running almost the entire length of the leg. In my case, this would have meant a three-foot-long scar stretching from just below the groin to just above the ankle. And I am grateful that this was not necessary, though no one prepared me for the fact that the incision on the inside of my knee, though which the vein was removed endoscopically, is practically a mirror-image of the one on my right knee, a jagged, ugly wound which I received years ago from a broken piece of glass. The other two are much smaller and I think they should heal with little or no scarring.

(The one real anomaly in all of this is the continual nagging irritation in my ankle where, I can only assume, the vein was cauterized after it was cut. I can actually feel the truncated stump of it moving beneath my skin, and it causes me a good deal of unfamiliar discomfort. I cannot cross my ankles, nor can I allow the bedclothes to rest upon it. I feel as though I want to wear a rubber band around my ankle to keep the vein from moving, but all this begs the question: What are the implications of losing this vein and its blood supply? When I asked the surgeon's assistant this question, he glibly responded that I don't really need it since nature gives us a spare. I replied that, from my passing acquaintance with nature, I do not believe that this is how it works; in its hard-bitten drive for efficiency, nature rarely gives us a spare anything. Thus, my question remains unanswered.)

And so, in my case at least, the surgery leaves, not a neat, ten-inch incision on the chest, but a jagged, foot-long trough, at the base of which are three more incisions. Those, together with the three in my leg, make seven cuts in all. I would make some ironic reference here to the seven wounds of Christ, but those were inflicted as punishment, while mine were inflicted 'for my own good.'

I note all this not in complaint (it is too late for that to have any meaning), but so that those who face a similar ordeal may have some honest and specific account of the implications. I mentioned to a friend that my chest now looks like a Jackson Pollock painting. While this was intended as hyperbole, the fact is that my flesh will remain a landscape the lines and contours of which will forever remind me both of the surgery, and of the misleading assurances of those who, while doubtless expert in the cutting of the heart, nonetheless lack understanding of how the heart, the mind and the soul all function together in the course of our humanity. We are not collections of organs mechanically interlinked; we are organisms, the integrity of which bends from the merely mechanical to the eternal.