How to agree to the very disagreeable

February 20, 2007

I’ve decided there are two kinds of open-heart surgery:

  1. The do-it-now-you-have-no-choice kind.
  2. The yes-you-need-it-but-the-timing-is-up-to-you-but-do-it-soon kind.

The first category includes just about every heart surgery you’ve ever seen on “ER.” The second category includes me and people like me. Guess which category I consider to be more agonizing?

I certainly don’t mean to denigrate those with emergent or near-emergent heart problems. The coronary bypass has saved countless lives, forever blunting the fatal overtones of the term “heart attack.”

It’s just that… if you combine Category 2 with someone like me, someone who likes to think, and ponder, and evaluate (even ruminate)… well, just ask Dr. Liang. He tried for nearly three years to convince me to have my aortic root fixed. For most of that time, he failed.

The psychological process I’ve gone through to make the decision to have elective heart surgery is long and complex. I’m sure it will make a mildly-interesting blog post sometime. But I can sum it up pretty well: before I could schedule the surgery, I needed to accept that the surgery was inevitable.

My doctors at Stanford were never equivocal on this. From the first day, Dr. Liang made clear that my aorta needed to be fixed, sooner or later, and preferably sooner. He repeated that to me whenever we met. And I believed him. And yet… and yet there remained, and to this day remains, a small voice in my head, asking, questioning, denying: maybe my anatomy, although unusual, is “normal” for me. Maybe it doesn’t represent the risk they think it does. Maybe there’s some other way.

Despite her concern for me, Debbie quietly accepted my need to be skeptical, to question and to research. She knew that I needed to work through the process in my own way. After years of procrastination and denial, after reading medical journal articles and juggling my conflicting thoughts into a thousand different combinations, last fall something changed. For some unknown reason my chaotic feelings and beliefs settled down into a smooth surface. I talked to a patient who had undergone the procedure. I called Stanford and almost scheduled the surgery. Then, later, I called back, and did.

My doubts are still with me, but now they coexist instead of overwhelming. I’ve accepted that there’s only one way through this situation. From that acceptance flows everything else.

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