As I Lay Joking - having surgery - Brief Article

During a recent routine visit, my doctor placed two pairs of educated, sensitive fingers on the two sides of my neck and drew a tentative conclusion. To test it he sent me to get a sonogram, then an MRA. Both suggested that I had a 70 percent blockage in my right carotid artery, 90 percent in the left. The carotids channel blood to the brain; I was told that a 70 percent blockage presents a tolerable risk, but 90 percent means you're a lot more likely than the next person to have a stroke and die, or, worse, become a vegetable.

Duly warned, I checked out two surgeons and chose one, in large part for his deskside manner: he chuckled when my bearing asked for that response. At his behest I took more tests: an EKG, "blood work," another sonogram, a stress test. Met the doctor's staff: all friendly and efficient. At the appointed hour (7:45 a.m.!) I went breakfastless to the hospital's ambulatory surgery unit, got a room, donned the appropriate garb. Met the two back-up surgeons and the anesthetist, all friendly and capable of chuckles. (I tested by asking one of them to remind their boss that the carotids are on the side of the neck, it's the jugular that's in the middle.) By 10 o'clock I was being wheeled into the O.R. and rolled onto the table. Gently.

Though they didn't register at the time, there must have been a couple of needle jabs that benumbed parts of me and put me into some kind of trance. I had planned to check whether the faces above me were focusing on me or on their luncheon plans, but it's hard to do so with your eyes closed. On the anesthetist's request, however, I was able to count from 1 to 10, then backward from 10 to 1. Then again. And again. It got boring (or I wanted to be cute to the last), so I switched tongues: "Un, deux, trois, quatre, cinq..." No chuckles. Tried again: "Eins, zwei, drei, vier..." Heard the anesthetist say something to the surgeon. And that, I learned later, is when an element of suspense entered the story.

It seems that I was not only slurring my words, in all languages, but slowing down, and this meant that not enough blood was getting through to my brain. If this persisted I would soon lose not only my patches of French and German, but also my command of English, down to "Mama" and "Dada," plus maybe how to blow my nose. My six-and-a-half-year-old daughter Sarah would not wish to tempt me again into a game of Tickle Torture. After sixty-five years of nicotinization I'd have to quit smoking: Nobody would give me a light.

The problem rose because the arterial blockage was even worse than the pre-op testing had revealed. My slurring told the surgeon there wasn't time to keep cleaning it out, so he created a bypass to channel more blood upward and save my French accent, and quite possibly my life. Then he finished the job and sewed me up.

Outcomes: Because I had to have a transfusion, having lost a lot of blood, I spent an extra night in the hospital, for a total of two. As I write, ten days or so after going home, the stitches are out, my neck is still sore, the wounds are healing, I get a shot of pain from time to time, and my voice is gravelly. A happy ending, or nonending.

Let us now shift gears. For me, this story is worth telling not only because I have a (mostly passive) role in it, but because it has a moral, having to do with money. By my count at least fifteen highly trained people worked together to save my language and/or life. Add the rent for my room and the O.R., a unit of blood, the use of high-tech equipment, the new tubing in my neck (a part of me will be forever Gore-Tex). Put it all together and it would probably cover the down payment on a Mercedes. All right, pay for a Honda. But I don't have to worry about it. Through a family connection I have comprehensive medical coverage from an insurer that ordinarily, if sometimes slowly, pays all or most of what providers bill it for.

It strikes me that anyone in this enviable fix has to reflect at least in passing on all those out there who have no health insurance, or lousy insurance, who may have well-clogged arteries or other conditions that can't be cured by yoga or an apple a day, who don't routinely visit their doctors because they don't have doctors, who don't have much if any choice among surgeons and hospitals, and who therefore suffer avoidable but debilitating or fatal strokes or other grave ills, even though most are a lot younger than I and are much more needed by their families.

Ergo: our health-care system is wonderful. But it isn't fair. Tell it to Congress.

Robert G. Hoyt is Commonweal's senior writer. He has interesting scars.

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