Friday, October 2, 2009

"Surgeon Search - Chapter Three" (I was going to call it "The Final Chapter", but it sounded too creepy.)

The parking lot was a zoo. Jammed lanes, narrow parking spaces, abandoned cars sitting everywhichway. It’s like the people dashed out of their cars and raced to their appointments, like it’s a sold-out football game, and they don’t want to miss the opening “kick-off.” Confused cars are looking at each other, going, “They just ran out.”

This is hardly a conducive atmosphere when you’re shopping for a heart surgeon. The first two hospitals we visited (heart surgeons’ offices are located in hospitals) offered valet parking. The chaos here suggested the “Fall of Saigon” parking lot, where the Vietnamese dumped their cars before climbing onto the helicopters.

Recapping for new readers, Dr. M and I are making a grand tour of heart surgeons, to determine which one we’ll select to repair my leaky valve. Surgeon Number Three is our final candidate. (The “Rule of Threes” does not just apply in comedy.) We interview him, and then we decide.

The Waiting Area, once again, is nondescript and borderline shabby, especially around the carpeting, but with one minor difference. The smallish room includes two flat screen TVs, one broadcasting a series of nature shows – when we arrived, a school of multi-colored fish were swimming in formation, generating a calming influence on the entire room.

The other screen, set up by the seats, featured a selection of games – Checkers, Solitaire, Battleship, interspersed with a continuous loop of smiling photos of the office’s doctors and support staff. If you’re judging surgeons by “Waiting Areas Designed To Make You Forget Why You’re There”, this place was the hands-down winner.

Also a plus – our appointment started precisely on time. We were shocked. There was no time to play checkers.

A final Waiting Area observation. A woman sitting next to me revealed that her husband, who’d had a “triple by-pass” performed by the surgeon we were about to meet, had been released from the hospital two weeks earlier and was already feeling great. As if on cue, her relaxed husband stepped into the room, looking as if he’d recently had a massage rather than open-heart surgery. It almost felt like they were “plants”, like the doctor had offered them a reduced rate for the surgery rate if, afterwards, they would hang out in the Waiting Area and look like “It’s nothing!”

After a brief pre-interview, we were ushered into the surgeon’s office – medium-sized, with a magnificent view of the Hollywood hills. This is, ultimately, not a big factor in our decision-making since, as a patient, it’s unlikely I’ll be recovering in the guy’s office. I’m just saying it was a truly remarkable view.

Surgeon Number Three was tall, gray-haired, reserved (either by temperament or professional distance) and a bit shaggy in an Alsatian dog kind of a way. He spoke in an indeterminate accent; you couldn’t tell where he was from, possibly Spain or Italy. His first and last names both ended with an “o.”

Surgeon Number Three reviewed CD’s of my angiogram and my TEE test, where they put a camera down your throat, thankfully a small camera. I am grateful for these technological advances. In the old days, they put a painter down your throat.

Oh, yeahhhh!!!

All three surgeons we met with agreed. I had a mitral valve in need of repair. We found no “different drummer” dissenters who studied my case and proclaimed, “They’re all crazy. You’re fine!” No. Three surgeons – same diagnosis.

Here’s the difference.

Surgeon Number Three was a robot guy.

To put it kindly, the surgeons we interviewed earlier were not fans of the robotic option. One surgeon reported, that as an expert witness, he testified against robot surgeons in court. The second surgeon characterized his competitors as cosmetic surgeons of the heart. Their only value was for people seeking smaller scars.

Surgeon Number Three made the case for his experience (150 valve repairs, all performed robotically). He had few kinds words for traditional surgeons who “go in the front” (meaning they crack your chest open), accusing them of an unwillingness to consider a new approach.

Robotic surgery is not without risk. Nor is it without post-operative unpleasantness. (I’d say “pain” but why scare myself? I read this too.) And yet, the technique does have an undeniable appeal. Using the House Hunters analogy, the House and Garden network show on which Surgeon Search is based (a couple looks at three properties, and at the end, they choose one to buy), this third interview was like being shown a property with intriguing possibilities, and then being told, “Oh by the way, this house comes with an indoor swimming pool.”

On the other hand, two highly respected surgeons had assured us that robotic surgery is crap.

Plus, the parking at that place was atrocious.

Plus, my daughter Anna alerted me to the possibility of “evil” robots.

They look reliable.

And then,

They turn.

Okay. Our tour is over. It is now time to evaluate the pluses and the minuses and make our decision. Our options: Three knowledgeable experienced and highly respected surgeons. The question is:

Which one will we choose?

The tension is mounting.

Weigh in with your choice, if you wish. Our decision will be announced on Tuesday.

To assist in your decision-making, I will attempt to hyperlink once again. Mr. Drum Roll? If you please.

Surgeon Search – Chapter One

Surgeon Search – Chapter Two
I seem to have my "scheduling" function back. Yay. It is my habit to schedule my posts so that, East Coast or West, the post will be available at 7:00 AM. Six o'clock Central Time. Seven-thirty in Newfoundland.

Thank you for your patronage.


Anonymous said...

Something to consider:
Maybe you need to look at a forth house.
In my limited but considered opinion, people who spend years and years perfecting a skill are loath to give it up when something new comes along, especially when they have to put more effort and time into learning how to do it. Think of the resistance to 'going metric' (which I still can't do) or using the Cuisinart to make gefilte fish.

10570Fan said...

I have never had heart surgery, but I have had a couple of 'serious' operations. I have found when you are visiting doctors to talk about things that are way out of your league (meaning you didn't go to medical school and only understand the subject matter on the surface level) - it's best to go with the doctor with whom you feel the most comfortable. You don't have the expertise or knowledge to know which procedure is best (I mean - how many 'unsuccessful robot surgeries are there vs. the total number of surgeries overall)- so decide if you have to 'work' with a doctor, which one do you want to 'work' with....

Mark said...

I was once a teen-aged heart surgeon and can help you out for free. When I was 17, my sister worked for a renowned heart surgeon -- a peer of Debakey who shared the same surgical suite in Houston. She got me a summer job as a goffer, and I was issued scrubs and a lab coat with my name on it.

My primary function was getting lunch, but once that was handled there wasn't much to do. At the end of each day, I walked around with "the chief" and a gaggle of interns on rounds. If I was the last one leaving a room, sometimes a patient would ask me a question that started with "Excuse me Doctor, do you know..."

But the part of this story that should be of great interest to you is that before I retired as a heart surgeon and returned to high school, I swiped (as a momento) a surplus heart valve made of teflon fabric, stainless steel and plastic. Now it may be 1973 technology, but it has zero mileage on it and is pretty much brand spanking new.

You can have it for free.

Not sure I remember exactly how to put it in, but I'm a big fan, so I'd be honored to give it a try.

Les said...

I'm coming up on the eighth anniversary of my quadruple bypass (in the pike position) following a (fortunately) minor heart-attack. Because I was a relatively young guy at the time (42), they figured they'd roll me into the cath lab, do an angioplasty and get out before the anesthesiologist's kid's football game was over (it was Friday afternoon). Then they got in there, starting looking around and said, "oh, crap" (I was lightly sedated, and that's the PG version) when they saw my arteries looked like Fibber McGee's closet (shout out to the old-timers out there).

I didn't have the chance to shop surgeons, but fortunately for me I was already at the best teaching hospital in the region, and I drew the head of the department by chance. He did the job and some days later, I wobbled home.

My point? There are two. First, I feel great, all these years later. I do what I'm supposed to -- eating-wise, exercise-wise, medication-wise -- but the bypass was the Great Reset Button of the Universe that gave me a chance to do so.

Second, and the part you might actually care about, the time it took me to recover from having my chest cracked open was way, way longer the recovery time for my heart after it was oxygen starved. It was months before I could sleep on my side -- which is my preferred position, and thank you, Tempur Pedic mattress -- and I still have some soreness and odd annoyances (I lost weight and the ends of the wire they used to sew my sternum back together now stick out and poke me) all these years later.

If I was doing it now, I would go for the least invasive procedure possible -- I just think it's easier for your body to deal with, and the fewer traumas you have to recover from, the better. After all, if you left out the heart stuff and just heard someone had been cut open like a trout, you'd be plenty concerned as it is, right?

There's going to be some post-op discomfort, yes, no matter what you do. But the imagining is worse than the reality 95 percent of the time, and doing nothing is not really an attractive long-term option. Make your choice, then summon all the confidence and serenity you can and go forward. From reading your blog, I know confident and serene may not be your default M.O., but I bet you can muster it, especially with such a loving and supportive family as you describe.

Good luck,

A. Buck Short said...

Admittedly I haven’t even played a doctor on TV, but going with your demonstrated devotion to the Old West, I’d advise strongly considering robot Doc. Double-O. Look at the clues. I am, of course referring to the old west of the 1950’s and the Cisco Kid TV series. Cisco played by Duncan Renaldo, and previously by Caesar Romero. Pancho played by Leo Carillo. Cisco’s horse, Diablo. Pancho’s horse, Loco. All based on the book by O. Henry.

And of course, the mandatory closing following the obligatory lame attempt at humor:

Old Woman in the Cantina: What will you have?
Pancho: Something to eat and a cerveza.
Cisco: I'll have a senorita.
Old Woman in the Cantina: I am the only senorita here.
Cisco Kid: Make that two cervezas.
Pancho: Oh Cisco!
Cisco: Oh Pancho!
Together as they ride off: Hahahahaha, Hohoho ho ho.

Incidentally, did you ask what each of them charges, or are you 100% covered? This is the kind of luck I’ve had choosing a dentist. Our family has been going to, let’s call the guy Dr. M for 20 years. We have been certain for quite some time that Dr. M had to be the world’s most expensive dentist. Immediately on entry you are gang-flossed by 16 hygienists. He puts the mirror in your mouth and tries see the next payment on his hummer. For year’s we’ve been promising ourselves to look for another dental practitioner; but you know how it is, you think you’re out, but they keep pulling you back in.

Sadly the same cannot be said for my dental work. I am at an age when all of the fillings of a lifetime have somehow gotten together and decided to make a break for it. I see Dr. M with two gaping crevices roughly the size of Florida sink holes. Following the usual thorough examination I am presented with Dr. M’s “Plan of Treatment” totaling $13,116. . It would literally be in poor taste to reveal the teeth in question, but let it suffice to say their names are: 6,7,8,9,10,11, 23,27,29,30 and 31. Everybody says some version of, “That’s ridiculous. You need to get a second opinion.” To which I am open.

Out at the barn, my wife introduces me to, let’s call him Dr. P, the dentist whom she has been instructing in the fine art of horsemanship for the better part of a year. I complain about the amount of Dr. M's written oral-estimate and schedule an appointment when he says he’s pretty sure he can come in under my guy.... Another set of X-rays, because I’m too embarrassed to ask my guy for the ones he’s had shot by Vilmos Zsigamond, and a bill for the examination of $250 – which I cannot even consider submitting to insurance that is supposed to pay 100% for preventive care, because I already submitted the previous exam one month ago. Long story short, Dr. P tips the scale at $22,300 just to round it off. Admittedly he had advised that his plan of treatment was somewhat “more radical” that that of Dr. M. But when I leave Dr. M I do get the “free" toothbrush, floss, and paste sample. With P it was just the floss.

The search continue with a recommendation from a co-worker who "knows a guy, who knows a guy."
In the meantime have been developing a dependency on creamed corn.

diane said...

I don't know that I really want to influence your choice, but I'll weigh in because it's my nature to do that. I like Surgeon Number 3 because he is willing to embrace new technology and because I have always been in favor of the least invasive means of fixing things inside me. But what I really want is for you to be comfortable with your choice. Your best option will be your confidence in your surgeon. Pick the one that makes you feel that he can handle anything that happens.

Brian Scully said...

Go with the one that has the best parking. And if more than one of them has good parking, then use a candy-machine in the lobby as your tie-breaker.

Rick said...


A friend recently had bowel surgery. It was done lapiscopically ... which is a new technique ... probably somewhat akin to robotic heart surgery. Outcome magnificent!

I think a general rule of thumb is go with the most modern procedure. Many surgeons, after they train, are reluctant (too lazy? too busy?? too set in their ways???) to learn new techniques ... which are being invented every day.

Your robotic doc obviously has worked very hard to keep up with all the modern procedures. And also obviously knows the limitations (if any) of robotic surgery. So if he is confident about your outcome ... I think that is the way to go.

Good luck!