Editorial: Just a little pinprick. . .

Dr. Phillips is a Professor in the Departments of Radiology, Neurosurgery, and Otolaryngology-Head and Neck Surgery, and the Director of the Division of Neuroradiology in the Department of Radiology, University of Virginia Health Systems, Charlottesville,VA. He is also a member of the editorial board of this journal.

Those of you who know me, or who know music, will recognize the title as a line from Pink Floyd, The Wall , which is one of my favorites--one that I've played in my reading room. But, on to the current topic. I enjoy writing these little stream-of-consciousness bits and trying my hand at being entertaining. I appreciate all of the wonderful feedback from many readers of this little column. I'd

like to always be humorous in these remarks, but this one won't be quite so funny, although the topic is near and dear to my heart. Ha!! "Into each life a little rain must fall…" Have you noticed that you can't put things off indefinitely? At some point, with many of life's little items, you've got to do something, although you might actually wish that it could just be delayed forever. I know this. Very, very well.

In medical school, I volunteered for a weekend study of an influenza treatment. $400. Hey, that's beer money! I can distinctly remember the brief comment from a physician who enrolled us in the study that I had a "murmur" but it was nothing, and, most importantly, it wouldn't exclude me from the study. Later, my noisy little heart was ignored by many others. I finally had a cardiac echo, and it was documented as mitral valve regurgitation, mild or moderate, depending on the day, and of not much consequence. I kept running and living my life, and I was not very concerned. Until this year.

My yearly follow-up echo this year was worse. I had popped a chordae, and my regurgitation was now described by a word that I now use more seriously and with trepidation-severe. Now, people, as well as the murmur, were much more serious (including, most importantly, me), and it certainly appeared that I had to get it fixed. After briefly considering percutaneous repair (nope, not a candidate), I had to see a surgeon and contemplate some pretty scary stuff. At least, that is, if you consider it scary to have a sternotomy, get your heart stopped, undergo bypass, and have someone open your heart up, fix it (no duct tape, please), and close you up with wires. Whew. Technically, it was planned as a quadrangular resection, with placement of an annuloplasty ring. It's plastic surgery for your mitral valve. I had a transesophageal echocardiogram and a cardiac catheterization and then arrived on the day of the surgery with all the fear and loathing it brings.

Well, after picking the right surgeon (thank you most profusely again, Irv), a modestly painful period of recuperation, and slow, then more steady improvement, I'm back. My surgery is nothing more than a memory and a fairly impressive scar. I experienced modern medicine from the other side, and it was both wonderful and disturbing. The wonderful parts? A dedicated and skillful surgeon and surgical team, a superb nursing staff, supportive and caring friends and family too numerous to count, my wife and kids who (other than my daughter having a brief and embarrassing little vasovagal moment) were ALWAYS there, and, interestingly enough for me, colleagues from other clinical areas (neurosurgery and ENT) who spent very valuable time coming by to just say hi and visit me. I will never forget them. If you want to truly find out who your friends are, lie in the hospital for a good while. The disturbing parts? Lying in procedure hallways alone, nights in the ICU with your own cardiac monitor as your only soundtrack,having the staff acting excited around you for an unknown reason, and long waits for information. A hospital can be a scary place. However, in the end, all was well, and nothing succeeds like success, as my father would say.

So, what have I learned from this? First of all, it's better to be in a state of perfect health than in any other state. Except for Hawaii. Ha! Second, let people do their jobs. If you trust them, just shut up and let 'em work. I pressed a few times. I was wrong. Just as I hate people asking me inane questions about imaging, surgeons hate inane questions about their procedures, nurses hate inane questions about their work, the cafeteria staff hate inane questions about their jobs, and so on. Yes, you have a right to know. And, yes, you don't know everything. Sorry. It's just the truth. Third, nothing can prompt a more personal and deeper introspective period than the imminent threat of death. I think my little surgical encounter was as good as another 10 years of living in terms of wisdom and insight.

I've been asked to relive the surgery numerous times, and I have. I don't mind that people want to know (in fact, I am happy to talk about it). At some time in the near future, I'll get tired of talking about it. And, you know, I think that is a truly magnificent thing. We live in a time when you can have open heart surgery and just get tired of talking about it. I have also, as a critical aside, gained an incredible respect for people up and down the ranks at my institution. They are all phenomenal.