Repairs at the Cleveland Clinic

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.

Comments

[zia yusuf]

Bob,

First of all glad that all went well. Second, thanks for sharing your decision making process. Sharing such an experience is quite unusual but very helpful to those considering a similar process.

Wishing you the best of health.

Zia.

[Chris T]

Welcome back, Bob, and best of luck with your recovery.

I hope that folks have the opportunity to publicy acknowledge jobs well done by thier coworkers, colleagues and business partners in the same manner you did. Nice touch! A class act.

[Marjorie]

Welcome back! As an OR nurse (neuro and ortho, not hearts :)), it's nice to hear that a patient had a great experience with the surgical team. I wish I could follow my patients to the floor and get their feedback on how they felt during the limited time they were awake. It sounds like Cleveland Clinic is doing things right.

Anyway, hope that your recovery is going well. Take care of yourself...

[Randy Bosch]

Bob, Very glad to learn that you had a successful "renovation", and were well-prepared in advance for it. With all the negatives floated about health-care in the last year, first hand accounts of great practitioners are important - there are very, very many of them!!

All the best as you continue to mend. I'll wait for the philosopher's viewpoint to emerge!

[Todd Sattersten]

Let me add my happiness that you are doing better.

Continue to get better.

We must talk soon.

[Harry Beckwith]

Good to hear Bob. I just took in your first lecture on Creative Organizations, came over here to see how you are doing. Here's to good healing, and see you this fall. . .

[edbatista]

I'm very happy for you and your family, Bob. And I appreciate your shout-outs to your nurses and your description of the joy your surgeon takes in his work--both are quite inspiring. Enjoy the Oxycodone, and I hope you're back on your bike soon.

[Chris]

Bob:

So glad you had such a positive experience at the Clinic - and not only because I live in Cleveland. While it is not a perfect place, the commitment to excellence in cardiothoracic care is mirrored across much of the organization - I can speak personally of exceptional orthopedic experiences and know of many people who have followed your example for heart surgery.

Congratulations on the positive outcome to date. You clearly recognize that one of the most important aspects of recovery is exercise. Keep up the great work - we definitely need your continued wisdom!!!

[Panamomma]

Bob - Glad to hear you are recovering well and your experience was a relatively good one. Surgery is always tough and recovery even tougher. Good luck with it all.

[www.facebook.com/profile.php?id=745791008]

Glad you're well and back in action. You've inspired me to write a blog post about my surgery last year, which I believe can help others form their own opinion about making choices when faced with prostate cancer.

You sound great! I'm so delighted that you had a great experience and have shared it with us.

Thanx again
-Joe

[T.]

Greetings from Turkey. It is great to have you back and a pleasure to see how you continue to reveal the little but significant details of good organizations

[DC Jobs]

Glad the surgery went well! Nice to see that you got the most out of the experience by using it as a case study in efficient management and customer relations!

[Des Pieri]

Great to hear that you are well and on the mend. Congratulations on the successful surgery.

[Anon]

Awesome!

By chance do they use Dr. Atul Gawande's (http://gawande.com/) surgical safety checklist?

http://www.safesurg.org/

If so, this event is a most interesting intersection with your "Hard Facts, Dangerous Half-Truths And Total Nonsense" as well as TNAR (that there rule :-)).

[CC]

Bob, missed your witty and insightful posts while you were out. Good to hear that you are on the mend, take it easy and take good care of yourself. May your new valve give you many more good years!

[Scott Eblin]

Dear Bob -

Welcome back and congratulations on a successful outcome. Sounds like you made the right choice with Cleveland. My dad had a heart procedure there last year and we could not have been more pleased with the staff and care there. The Clinic is a model for what our health care system could be.

Take good care of yourself in the coming weeks.

Cheers -

Scott

[Gretchen Rubin]

So HAPPY to hear that you're feeling better and on the other side of the operation. Take good care!

[Jindo Fox]

Bob -- You're a true class act for publicly remembering and praising your doctors and caregivers after such a life-changing operation. I'm very happy that you're recovering, as I've missed your posts here. Please continue to take care of yourself and know we're thinking of you!

JF

[Carol Murchie]

You're, as the fishermen say, "a keeper" so take care and get well soon so that we can benefit from your insights. And as for the Oxycodone, enjoy the ride!

Carol

[Maureen]

welcome back! I love reading your posts, so you have been missed. glad to hear you're on the mend.