Open-heart surgery requires both emotional and physical recovery

It took close to five hours of open-heart surgery at the Minneapolis Heart Institute on Aug. 26 to replace my leaky mitral valve. "It was tedious," my surgeon, Dr. Frazier Eales, said. But successful.

Today, I'm back at the Star Tribune newsroom, working full-time as a reporter, which I've been doing for nearly 47 years. I'm 73 years old. I'm getting better but still don't feel like my old self yet. Medical professionals tell me that's normal and it could take up to a year.

Recovery, it turns out, is more complex than I thought it would be. I got a hint of that in a letter Eales' office wrote to the firm that administers medical leaves for the Star Tribune. The letter said I'll "require 12 weeks to recover both physically and emotionally."

Emotionally? What was that all about?

"When the body is not feeling great, the mind is not that far behind," said psychologist William Robiner, director of health psychology at the University of Minnesota. "Your body needs time to heal, and your head, also."

Emotions can be raw, especially early on. My cardiologist, Dr. Rob Schwartz, said that after surgery, patients often say they feel like they've been hit by a truck.

Doing much of anything at home put a strain on my chest. Lifting a few dishes or a pot of water was daunting. Turn the wrong way and there's pain. I quickly stopped using an opioid painkiller the hospital gave me and switched to Tylenol.

"Open-heart surgery, such as you had, is a major dose of trauma," said Eales, 69, who has done, by his own estimate, 8,000 such operations. I was one of his last patients — he retired in October. "You sort of had a real brush with mortality," he said. "It is the most physically traumatic thing that happens [to a person] in their lives. I don't think you can understand the physical trauma unless you've been through it. I haven't been so I don't think I fully understand it."

There were more than 293,000 major heart procedures conducted in the U.S. in 2018, according to data from the Society of Thoracic Surgeons. Coronary artery bypass graft, the most common type of open-heart surgery, accounted for more than half of these procedures.

"There was a time when doctors in the early 1900s felt if you touch the heart, people die," said Dr. Robbin Cohen, an adult cardiac surgeon at the Keck USC School of Medicine in Los Angeles.

But the development of the heart-lung machine in the 1950s, perfected in the 1980s, made it possible to stop the heart during operations. Risks from open-heart surgeries keep falling, Cohen said.

Two weeks after I got out of the hospital I started my rehab at Fairview Cardiac Rehabilitation Services in Edina, a one-hour session, three days a week.

Some of us in rehab seemed exhilarated to be working out. Some seemed despondent. Many of us, especially in the early going, looked stunned.

"Some people are scared, anxious, sad and angry, and some people are depressed," said Corey Speaker, a cardiopulmonary rehab therapist who supervises the unit.

To screen for depression, patients fill out a questionnaire and those who show signs of depression are referred to an in-hospital counselor or the patient's primary doctor.

One of the patients on the unit, Doug Kuehn, a retired factory worker from Plymouth, had open-heart surgery in September.

Waking up afterward, he said, "I was overjoyed I made it," he said.

While he was frustrated at things he couldn't do, like raking the leaves, he's grateful for all the family support.

Also working out was Tom Hanneman, an anchor and reporter at Fox Sports North, who had sextuple bypass surgery in July. He said he woke up in the intensive care unit, looked around and thought, "Oh, so this is what it's like when you die."

He soon found out he hadn't.

Dr. Chris Armstrong, my primary doctor, has treated many open-heart surgery patients.

"They all are surprised that it was a bigger deal than they thought it would be," he said. "They are so tired and wonder why the stamina has taken so long to come back. They knew their chest would hurt. They didn't expect that it would knock them backward."

Same here. Even as I get better every day, I want to get better faster.

I was a little apprehensive I wouldn't survive the operation, though the odds of making it were about 95%.

"Mortality is staring you right in the face," said Schwartz, the cardiologist. "Some wonder, 'Is this the beginning of the end for me?' "

The rehab specialists realize we are riding a psychological roller coaster.

"We get to see people when they're down — at the lowest emotionally and physically — and watch them recover," said Robin Stewart, a cardiac rehab therapist on the Fairview unit. The therapists there always had a warm word for everyone.

One patient was Robert Karol, 67 a psychologist, who counsels people with brain injuries. He said that after the operation he decided to take the same approach he teaches his patients. "I came at it not with, 'Oh, my gosh, this terrible thing happened.' I came at it with, 'What do I need to do to handle this?' "

He said he's made lifestyle changes that include improving his diet and increasing his exercise.

Carolyn Smith, 73, of Medina, said she was visiting her aging parents in Missouri when she had to undergo open-heart surgery in February 2018 for four blocked arteries.

"I felt the most vulnerable in my life," said Smith, a former Medina City Council member. Her father was dying at the time, her brother died a few months later, and after the surgery, the incision had to be reopened because of an infection. "I'm not as brave as I used to be … and I think it's difficult to get over it all."

Sharon Radd, a professor of organizational leadership at St. Catherine University, had open-heart surgery in September. "Medical care focuses so much on the body," said Radd, who's writing about her recovery, including the emotional side, in a blog, awomanwithheart.wordpress.com.

"As my body experiments with feeling 'normal' on an increasingly regular basis, my mind recovers at a different pace," she wrote in one blog. "This physical experience has overwhelmingly dominated my relational, emotional, temporal, positional, cognitive, and psychological existence and engagement."

This was my second open-heart surgery. I had an aortic valve and a portion of my aorta replaced in November 2015. I think I was less focused on emotions due to surgery back then because that July, my wife, Gillian, of 43 years, to whom I was devoted, died. At that point, I was in an emotional tailspin. I got through it with the help of family and some caring friends. In 2019, support came particularly from my new wife, Rosemary, whom I'd married the year before.

Eales operated on me both times.

In the 2019 surgery, Dr. Chris Behrens, the anesthesiologist, said he first administered a lower dose of anesthesia designed to reduce anxiety.

Eales said he cut me open down the sternum with a small electric saw. The second time it took longer to get to the valve because scar tissue had formed from the first surgery.

In the first surgery they replaced the valve with cow tissue. In the second, I got tissue from a pig.

In November, the Minneapolis Heart Institute at Abbott Northwestern let me view one surgery close up. I watched as Dr. Tom Flavin reached into a 79-year-old man's chest after the man had been placed on a heart-lung machine and his heart had been stopped. Flavin turned the heart over so he could view the artery he was about to bypass. Hearts, he acknowledged, are pretty resilient.

There was surprisingly little blood. "There's a common misconception you'll see lots of blood," Flavin said. Although I was covered head-to-foot in sterile outer garments, Flavin suggested at one point I back up before he made one cut that he said could produce a spurt of blood.

"I just don't want you to get sprayed," he said.

There was no spurt.

Some folks struggle after surgery.

"I'm not the same person I was," said Carlos Garcia, 74, of Brooklyn Park, a retired letter carrier who had bypass surgery in January. "I'm not as outgoing. … I have emotional breakdowns. I started weeping. I didn't know why. My wife wanted to know what's wrong. I need to get back on track."

By contrast, Mounir Guirguis, 87, of Bloomington, a retired systems analyst who had open-heart surgery a year and a half ago, said, "I feel great." He regularly walks on his treadmill. "I can read a book," he said. "I can enjoy the sunrise and the sunset. And I go to the Minneapolis Institute of Art from time to time."

These days I work out at my local YMCA, lift light weights and stretch, and run on the indoor track. I'm doing more around the house, but Dr. Armstrong has advised me not to shovel snow. He's gotten my blood pressure lowered with a change in medications and I had a post-op checkup this month with my cardiologist.

How's my recovery? I asked.

"Awesome," Schwartz said.

I'm feeling better.