The Day Our Hearts Stood Still

by

Emery L. Campbell

"Congenital aortic valvular stenosis." Medical jargon, you mutter, turning your attention elsewhere. When you know that the term describes a grave heart defect, however, and that the heart in question belongs to your child, then the matter assumes an altogether new dimension.

My wife, Hettie, gave birth to our second son, Julian, on June 12, 1967 in London where we lived while I worked in England for a U.S. multinational firm. My employer transferred me to the U.S. in late 1968, and we took up residence in Princeton, NJ. Shortly thereafter a pediatrician's routine checkup revealed that Julian had a "heart murmur." Later a pediatric cardiologist at New York's Cornell Medical Center diagnosed the condition that I cited above, a narrowing of the valve through which blood flows from the heart into the main cardiac artery, the aorta.

Our son had had the problem since birth, although previous examinations had not detected it. Exposure to German measles during Hettie's pregnancy may have caused the abnormality. There is no way of determining this with certainty. My wife rightly feels no guilt in this regard, but she does harbor a lingering resentment that a neighbor woman carelessly brought her daughter to our house while Hettie was expecting Julian, knowing that the little girl had come down with the disease several days earlier.

Initial indications categorized the condition as minor. The cardiologist felt that it might lessen or disappear with time. She recommended periodic checkups to monitor the valve's performance. Meanwhile she saw no reason to restrict Julian's physical activities.

The condition remained stable. Doctors still discounted the need for undue concern. We moved back to England in 1973. Doctors at London's Guy's Hospital continued to monitor Julian's health.

Once during his pre-teen years the physicians at Guy's decided to thread a thin tube, or catheter, into his heart through a leg vein. This would enable them to measure the pressure across the valve to clarify the condition's gravity. Catheterization itself entailed a risk. They explained the technique and its implications, and we had to sign a release before they could proceed. I recall feeling a stab of nausea on signing the form.

Julian suffered no ill effects during the intervention, however, and the doctors again reassured us that we need not feel immoderate anxiety about the problem.

In 1981 Hettie and I had to move to Argentina for my work. Most of Julian's schooling had taken place in England, and he had just gained admission to Dulwich College in south London, a highly regarded faculty equivalent to a combined American high school and junior college. We feared that taking him to South America would disrupt his education, so we made a difficult decision to leave him at Dulwich as a boarder. We explained the heart condition to the school authorities and, on medical advice, arranged that he could participate in all school activities, including sports, in which he felt comfortable.

Julian completed his schooling at Dulwich College without incident. During those years he flew to Buenos Aires for holidays and summer vacations. All appeared normal. He continued periodic checkups.

In early 1988 we moved to Lawrenceville, Georgia, a suburb of Atlanta. Later that year Julian also came to the United States from England. He first stayed with us, then found a place of his own in Atlanta where he began work as a computer systems administrator.

Then at age 23 disturbing symptoms surfaced. He would tire easily and had dizzy spells, once almost fainting at work. His co-workers took him to a nearby clinic where a superficial examination led to a diagnosis of hypoglycemia, a blood sugar disorder that can lead to light-headedness.

We all realized at that point, however, that he needed a thorough checkup. A cardiologist at Atlanta's St. Joseph's Hospital conducted several tests including another catheterization. They revealed that his aortic valve had deteriorated. Now leaking, the valve allowed back-flow of blood each time his heart expelled it. The organ had become enlarged and less able to support physical activity. The doctor urged immediate valve replacement surgery.

Julian showed more courage and composure than his mother and I did. The news devastated us. We subsequently accompanied him to meet with Dr. Douglas Murphy, a noted Atlanta heart surgeon, who explained in detail the necessary surgery. He would open Julian's chest, connect him to a heart-lung machine, and stop the heart. He would then excise the defective valve and replace it with a St. Jude's valve, a plastic and metal device.

Dr. Murphy told us that he and his colleagues performed some 1500 of these operations annually with an extremely low rate of complications or mortality. Open heart surgery had become almost "routine" (what an innocent word for such trauma!), but this offered us small comfort.

Few individuals as young as Julian require valve replacement. The need usually arises from failure due to advanced age. In such cases the surgeon often implants a pig's heart valve to replace the patient's defective one. The implant may fail after ten or fifteen years, but for an elderly patient this may suffice to allow him to live out a normal life span.

In a younger person, however, a failure in middle age requires repeating the operation. Lewis Grizzard, the humorist and Atlanta Constitution columnist, had to undergo three heart surgeries for this reason and died shortly after the last one. Thus pig's valves do not suit individuals of Julian's age.

Since the development of the St. Jude's device in the late 1970s heart surgeons had implanted many, with no reported failures. Blood clots form more readily on artificial valves than on pig's valves, however. A recipient of one of the former must therefore take coumadin, an anticoagulant medication, for the rest of his life to forestall this. Coumadin presents no significant physiological side effects, except that someone on the drug runs the risk of excessive bleeding in case he sustains an open wound.

He must also exercise great care to avoid infection in the valve area which often proves difficult to treat. Dental work, for example, requires prior doses of antibiotics to thwart infections that otherwise might enter the blood stream during tooth extractions or even simple cleaning. One must stop taking coumadin temporarily as well during such dental treatments, and of course in case of the need for any other type of surgery.

We left Dr. Murphy's office with long faces, although we had to concur in the inevitability of surgery. Without it Julian risked sudden death at any moment. But Julian himself had to make the decision.

After a day's reflection he checked himself into St. Joseph's Hospital. Hettie and I visited him two days later on the eve of the operation which Dr. Murphy had scheduled for the following day at 9:00 a.m. We could hardly speak. Finally Julian asked us to leave. He said we made him nervous!

Hettie and I entered the hospital at 8:30 the following morning, announced ourselves at the reception desk, and took seats in the lobby. Dr. Murphy had predicted a two hour operation. Time wore on, but we heard nothing. The clock approached noon. Our anxiety increased.

At last we begged for news at the desk. To our dismay they told us only then that we should have gone to a special waiting room adjacent to the operating room on a higher floor. We rushed up there and found, to our immense relief, that the surgery had gone well. They had already moved Julian to an intensive care unit to watch for possible postoperative complications. They would still keep him in the ICU for some time, but we could see him.

Words cannot adequately convey our shock at first sight of him. He lay in a semi-reclining position, ghostly pale, eyes swollen from two and a half hours on the heart-lung machine. Tubes for oxygen and to aspirate fluid from his lungs ran into his mouth and down his throat, held in place with adhesive tape. He had just recovered consciousness. Restraints on his arms kept him from pulling the tubes from his mouth. A drain tube ran from his chest to a jar on the floor. Wires joined sensors attached to his upper body to bedside monitoring devices.

We could hear his heart beat on an audio monitor, and pulse blips also appeared on a TV-like screen. A nurse caressed his face calling him "Sweetie" and assuring him that all was well. Hettie and I burst into tears. Writing of it brings a lump to my throat even today.

The nurse finally convinced us that Julian's condition gave no cause for alarm. At her suggestion we left, shaken but relieved, so he could sleep.

The next day he appeared much improved, although he still couldn't talk because of the tubes down his throat. He wanted to tell us something, so we gave him a pen and a pad of paper. He scrawled a barely legible "Where's my check?" Later he said he had no memory of writing that and had no idea what he meant!

The following day we found him on his feet exiting his bathroom. He had already taken a few steps earlier in the day.

"Put your ear here," he said, pointing to his chest where a wide strip of adhesive tape covered a nine-inch vertical incision. We held our breath and listened. The St. Jude's valve clicked with every heartbeat!

Julian quickly regained strength. After seven days we took him home with us to recover. Six weeks later he returned to work and has done well ever since.

That day at St. Joseph's Hospital our hearts and the earth itself came to a halt. Now the world has resumed its spin and we function normally in it once again to the measured beats of an artificial St. Jude's heart valve. The surgeons gave our son back to us. Hallelujah!

Impressum

Tag der Veröffentlichung: 30.12.2009

Alle Rechte vorbehalten