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Goals and Expectations- July 25, 2009

August 26, 2009

When I checked into the hospitals at 5:45 AM yesterday, one of the forms I filled out asked this question, “What are your goals and expectations regarding the procedure you are having done today?”

That question caught me a bit off guard. I was there to have an arteriogram. My new vascular surgeon wanted to try and open at least one of my femoral arteries. I have no pulse on either leg below the lower abdomen. My right foot turns a lovely shade of purple frequently.

It seems the arteries on my legs are much like the arteries of my heart, prone to blockage. I had a CABGx3 in Feb., stents in May for failed grafts and still have two blockages, one that couldn’t be reached, one artery too small to stent.

Yet, this new vascular surgeon thinks that surely he can open up at least one leg. That will help the leg of course and then he could do a femoral to femoral bypass to open the other leg. That isn’t as big a surgery as an aortic bypass he had told me. All this would give my new cardiologist femoral arterial access, better than the smaller brachial arteries.

My previous cardiologist, while generous in his life saving tactics for awhile, had reached either the limits of his abilities or his patience and had sent me home with no further options. So, here I was, at a new hospital, a new doctor and asked this one profound question. What was MY goal, my expectation?

The fact that this question was being asked was a large part of my answer. I was never asked if I wanted to have bypass surgery. There was no question of goal or expectation. It was “emergent.” Isn’t that an interesting way to describe it? The option was death. The goal obvious. The expectation (hope, prayer), life.

In May, the stent scene was again, “emergent,” after failing horribly my first post-op stress test. Again, no questions were asked. No choices to be made. “You are not a candidate for another bypass,” he had said. Same goal, same expectation, same choiceless choice.

Yesterday, I was there by choice. The state of my body though perhaps fragile, was not under immediate threat. I had wondered if I was rocking this fragile boat by having this done.

Second guessing was a well practiced ability of mine. Having one so smart as a cardiologist (Cardiac Interventionist no less) at a major teaching hospital tell me nothing more could (or would?) be done had activated my tendency to doubt myself, though to say that part of me had ever lay in dormancy was probably a gross untruth. At any rate, I questioned whether I was perhaps planning my own demise by rocking this fragile balance of heart/artery disease. I’d read the risks and the mortality and morbidity percentages. For this procedure, they ranged somewhere between 0.6% and 6.2%. My history had shown I had yet another tendency, to be that tiny percentage.

I’d come to realize over the past few weeks, that though not backed by research analysis or written in my chart, or even voiced by the powers of medicine that be, I had my own theory. I didn’t know the why’s and how’s and certainly not the what now’s, but I knew at a deep level of knowing, that the likelihood of his opening up my femoral arteries with a mere wire was remote.

I, from somewhere, knew that my arteries have been in something of a flare, much like experienced in Rheumatoid Arthritis or Lupus. With that belief, was an accompanying belief I realized yesterday, that this flare would pass. This tendency of my arteries to become blocked and re blocked, would pass. It would not completely disappear, like all such behavioral tendencies, but would reach it’s peak and then subside back into a non critical condition. It would become a simple code on my chart like one of these scars on my body; like a tattoo with a doozie of a story. I don’t know how, but this I somehow know.

I was having this test, I realized, for this new doctor. I sensed he really wanted to help me. He really believed he could. He thought…no…he believed, I was going to live a long time and I would need my legs to enjoy all that living. I wanted to support him in supporting me. He needed to see for himself the state of my arteries. I wanted him to see. I wanted him to have the whole picture, the truth and then help me from there. My tendency to self doubt also included the possibility that I could be wrong. This just might work.

With all that said, what was my goal for the day though? What was my expectation, my hope, my prayer? It was simply to be able to go home at the end of the day. My prayer was that this led to no emergent situation, no high dramatic heroics. Whether the procedure was successful or not really didn’t matter so much. My choice was the same as before when I had no choice. It was life.

That seems like a silly answer, that anyone would of course choose life. I would have never denied, ever that life would be my choice. Yet, there are so many ways we make choices. The previous year, those twelve months leading up to this cardiac “event,”
had been a year that in many ways, had broken my heart.

While it also included much of life’s greatest joy, it was filled with hurt and betrayal and pain. The weight of it had been immense. So much of what I believed to be true had been proved a lie. So many I thought my friends, had proved the opposite. Nightmares from my childhood had come knocking to be faced and felt and healed. My heart had been shattered and on many days it was all I could do to breath, while pretending that no hurt had been done or felt or known.

It was only in almost losing life that I came to know how much I wanted to continue to live. It was only in finding life so fragile that I was strong enough only to hold onto who and what really mattered.

Those that really mattered I found were few but whose love for me was never contingent on what I did or gave, only on who I was. The things that mattered it seemed had no price tag other than my love. What mattered poccessed a timelessness and strength all else had not. Only in my almost losing did I realize I had almost chosen to leave. By not choosing life, I had almost chosen death. By ignoring my breaking heart, it had almost broken beyond repair.

I wrote on the form yesterday, “My goal is to live. My expectation is to go home with my family this afternoon.” I knew as I wrote those words, that some cosmic interventionist could translate my words to mean going home to God, but I had to trust that my intention would be the driving point of attraction or intention or prayer.

Sure enough, After a valiant effort, my sweet new surgeon who looks, talks and acts like he belongs more on a football field than an operating room, gave up getting into those femoral arteries bound with what now resembled cement. He sent me for a CT scan then on to recovery. He said we’d talk in a couple of weeks after his vacation and then mine. He said that an aortic bypass was probably the only option and still, in my case, the best one. “You are so young, you need a more long lasting solution,” he again told me.

I heard his intention and in it, his belief. His intention is to help me. His belief is that I will live a long time. His intention matches mine. So does his belief. My heart did not break beyond repair. I chose to live. I choose it now. Again and again. That says nothing negative about future post physical life expectations. It just means there are far more things to love about life in the here and now than there are to dread.

It means that with that choice I accept the responsibility to let go of anything that doesn’t support life. It means I support and appreciate all who support my life. It means I choose again and again to treat each day as a gift, each embrace as a treasure, each kiss as a blessing and each moment as heaven on earth.

By letting go of all that is not life, I choose to accept all that is. It’s simple. It wasn’t easy. It probably won’t be easy tomorrow and the tomorrow after that. But even in a dormant state, this molecular tendency will guide me not to further brokenness, but to wholeness.

Today, I am a little sore. There is barely a bruise and I’ve started back on my precious plavix and aspirin and the other drugs I appreciate. I had to take a few nitro last night, typical behavior of my heart after a big day. I feel tired.

My family looks tired too. They were sent (due to the number of them) to some obscure waiting room and couldn’t then be found when I reached recovery. They couldn’t hear the pages summoning them, nor could their cell phones pick up the signal coming from the recovery nurse’s frequent calls. So, though the surgeon found them and told them all was well as I was being rolled away for the CT scan, their continued waiting led to frantic worry. They have spent much time in states of worry and fear as I lay in a medicated state of comfort. They are the unsung heroes of all this. My angels in this heaven on earth.

Today, I drink lots of fluids to flush out the contrast, rest and appreciate this living. Now, I’ll head to the shower, after taking off this bandage. Have you ever had a Brazilian wax? I think I’m about to experience one by adhesive instead of hot wax. Ahhh- all those life supporting gifts!

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