By David Leach
On March 1st my aortic valve was replaced. I received extraordinary care, was discharged on the third postoperative day, and am doing very well. When I arrived from the operating room to the intensive care unit I had an endotracheal tube, two chest tubes, an arterial line, a jugular vein Swan-Ganz catheter, two 14 gauge intravenous lines, a urinary catheter, various chest leads monitoring my heart rhythm, a pulse oxygen monitor and I have rarely felt better. In fact I was filled with joy. The Society of Thoracic Surgeons rates the 1300 plus cardiovascular surgery programs in the U.S. and I was happy to discover that my local thoracic surgery program was highly rated. I was grateful to have a disease that was fixable and a surgeon who knew how to fix it. I was also terrified at what I would have to go through to get it fixed. I did not anticipate joy…
Before surgery I was surrounded by a loving wife and several competent caregivers. Their many good hands made it easy to accomplish the necessary surrender to the occasion. I am 72 years old, have had a very good life, and was not really afraid of dying. My main concerns were two: if I did die I did not want my wife to suffer; and I also did not want to have my brain compromised to the point that I would be a burden to her. I am happy to report that my percentage of correct responses to Jeopardy questions is the same as it was before surgery.
Something remarkable happened during my second night in the intensive care unit. My nurse told me: “we are having some trouble getting your blood pressure up.” I thought that this was not good news and began to play out various scenarios in my head. I cannot say that I lost consciousness at that point and I can say that what I experienced was not a near death experience, yet something did happen. It was life transforming, very positive, and will be remembered the rest of my life. For me it was the ultimate reflection.
I felt myself falling into a beautiful white cloud, a cloud that supported me ever so gently yet ever so firmly. I became aware of love. I knew that I was loved, that my wife was loved and that no matter what happened she and I would be cared for. It was incredibly comforting and real. I don’t know how long the cloud thing lasted, perhaps just a few minutes, yet the feeling of being loved and being safe persists even today.
I was discharged into an early North Carolina spring with instructions to walk progressively longer until I was walking 45 minutes a day. Many days I did this outside. Cherry trees were already in bloom, serviceberry and pear trees soon followed and then, at last, dogwoods. The birds were all in their spring plumage. Wild turkeys were abundant, the males in full display while the females feigned disinterest. Bears were emerging and in my neighborhood encounters were a few times every week. We nodded to each other. I felt deeply connected to all living things. I was aware that we all shared the same fate: the gift of life. Our common vulnerabilities bound us together and somehow contributed to my healing. We were all in this together. I noticed them and they noticed me. People were next. I found it almost impossible not to notice almost everyone everywhere I went and I knew that they too were loved and ultimately safe. We are all wounded and vulnerable and yet my illness and its aftermath made me aware that healing is a communal event. We heal by acknowledging our connection to all living things; we heal in relationships. We are a community of living things, healers unaware that we are healing, unaware that we are being held.
While I can’t say that I would recommend open heart surgery to anyone interested in improving their reflective capacities, I can encourage everyone to notice all living things. Healing, as it turns out, has a lot to do with noticing, with patience, with reflection, and with a deeper understanding of hope. It is said that faith is the substance of things hoped for, the evidence of things unseen (Hebrews 11:1). While that may be true, I would argue that noticing and reflecting upon what is noticed can render at least some of what is unseen seen.
So what does any of this have to do with medical education? My caregivers were noticing very different things than I was noticing. Their diligence in keeping me alive enabled me to reflect on and respond to my life and theirs. Their discipline enabled me to become more human. I am grateful. Lesson one: learners should learn what to notice to keep the patient alive. Lesson two: learners should notice, foster and use their own humanity. Our connectedness makes for better caregiving and more effective healing. We are all in this together.
David C. Leach MD, was trained and practiced as an endocrinologist. He served as the Executive Director of the Accreditation Council for Graduate Medical Education (ACGME) from 1997 – 2007. He is a member of the Board of Trustees of Mercy Health