Preparing for Surgery

Hi friends and family!

I wanted to give you all an update on everything as we are now just two weeks out from surgery. First off, I am still feeling fine. The only thing that I have really changed about my routine is I have not been exercising as intensely as I was. I have found that though I feel fine, it makes me really anxious to get my heart rate up above 160 or so. Being anxious complicates getting your heart rate back down, so I figure that for the next two weeks 45 min on the treadmill walking 4-5 days a week will be fine.

Other adjustment made are taking iron supplements to keep my blood counts as perfect as possible and detoxing from caffeine. I figure the surgeons probably won't care if I get a caffeine headache but I will, so I am all the way down to one cup of decaf (not completely caffeine free).

I am nervous, of course I am. But I have really felt the strength and peace of all of your prayers throughout this. My family and I are confident in the ways that God has blessed us throughout this so far and will continue to carry us though. I am blessed to have been equipped with lots of stress and anxiety reducing practices from my experience in medical school. I already know things that work for me and things that don't. Journalling, yoga, and (don't laugh) deep breathing really help me focus on the here and now versus that hypotheticals that can drive me in circles. If you have never tried taking a 5 second inhale, pause, 5 second exhale, pause... for one minute, you might be amazed how much that can refocus your thoughts towards more productive things.  [If interested in my personal technique, I'll attach it to the end of my post.]

Now for some details about the surgery. It will be August 25 at 8:00am at Vanderbilt in Nashville. Dr. Michael Petracek (Pet-race-ick) will be the surgeon. He has done over 2500 of these surgeries and does 4-5 of these approaches per week. By "approach" I mean right chest incisions described below.  He and Vanderbilt itself, are widely regarded as being excellent at what they do. Dr. Petracek is the chair of department of cardiac surgery. I asked him how long I would be out of work for and he said, "one week at least." I thought I had misheard him, but he clarified, "I've had a doc go back to clinic a week after surgery. You will be really sore and I don't recommend it, but you could go back after a week if you needed to." We agreed that four weeks (the increment my school makes the easiest) should be good but we will obviously take more time if I need it.

As far as the actual surgery, there will be about three incisions. They will hook me up to the heart and lung bypass machine through my femoral artery. This will keep my blood pumping and oxygenated while they work on my heart. There will be a catheter in my neck called a Swan-Ganz that will snake down to my heart and help them drain part of the heart for the surgery. Finally the main incision will be on my right chest through my ribs around where the bottom of a bra sits (image on the right versus zipper on the left). That will be where they push everything aside to work on my heart. They will get everything working, cool my body down to decrease metabolic demands, and then paralyze my heart. They will enter the heart through the right atrium and sew a bovine pericardium (covering of a cow's heart) patch into where my septum should have been. When that is in place they will start everything back up again (Whew!) and check with ultrasound to make sure that there aren't any leaks. Then they will back-track and sew everything up. The surgery will take between 3-4 hours all together.

The main risk that I will be facing after surgery is an arrhythmia. The heart conducts electricity to make it beat but you can't see the wires with the naked eye. They know about where everything plugs in, but there is always a risk that they could nick a wire and upset how my heart is beating. Most likely this would put me into a rhythm called atrial fibrillation (which some older people go into because they are old). The main risk of this is blood clots because the blood gets jiggled around and get sticky. So if this happens, I will probably be asked to take an aspirin to thin my blood until my heart heals and flips back into it's normal rhythm.

We anticipate that I will spend 24-48 hours in ICU and then 4-5 days in the hospital. We are going to wait and see on coming back to Memphis. But that is the plan. If you have any other questions, just let me know. Thank you all so much for the prayers and support!




Praying and Breathing:

I actually learned breathing practices by a different name from my training to go to American Samoa in 2008. During that session, we were praying an abbreviated "Jesus prayer" and encouraged to match it with our breathing. Breathing in, we pray "Lord Jesus Christ"; breathing out "have mercy on me, a sinner." Actually, according to a Ph.D. psychologist at Vanderbilt that I met this week, taking a longer exhale than inhale helps to relax the body. So naturally, the extra syllables of "on me, a sinner" prolong the exhale to provide additional benefit. The benefits of praying are obvious, but I would add that this provides a cadence so that you don't need an app with swirling lights or a clock to time your breaths to.

My Big Heart

Hey friends and family,

I just wanted to give you guys a central place to get updates on my current little hiccup health-wise. As most of you will have noticed, I waited a while to talk about this on Facebook so that my family and I would have more information when the questions came. So here is the story from the beginning.

March 2014: I went to my PCP before I started studying for USMLE Step 1 for a check up. He heard a heart murmur which he described as a "pan-systolic flow murmur". I had been told I might have a little heart murmur when I was in seventh grade but we were assured it was nothing to worry about. I went back two weeks later and he heard the murmur again. We decided to pursue an echocardiogram (ultrasound of the heart) to make 100% sure that there wasn't anything to the murmur. I have never had chest pain or symptoms so we just "knew" it would be nothing to worry about.

April 2014: I finally got around to having my echo two days after taking Step 1. The ultrasound tech mentioned on her first view of my heart that she could tell that the right side of my heart was too big to fit on the screen like it should. She took all of the pictures she could and kept "hmph-ing" to herself perplexed at why the right side of my heart was so big. She walked outside to see if there was a cardiologist who could make sure she was doing everything she needed to and brought Dr. Garg in. He knew within the first minute or so of flipping through my scans that I had a hole in my heart. That was a shock. He told me he would get back in contact with me later in the day after he had done calculations.

He called me back a few hours later to tell me that I had an atrial septal defect. That's a hole between the right and left atria (septum = wall). At that point he said that my right heart was twice the size it was supposed to be because of this defect and that it would need to be corrected. He said we had to do a cardiac MRI to figure out how big it was and what approach we could use to fix it.

MEDICAL INFO TIME: 
I am not a cardiologist, but if you are confused on what I mean by ASD or atrial septal defect...
You have four heart chambers. Up top we have atria (singular atrium) and down low we have ventricles. The blood is supposed to flow as follows: Body --> Right atrium --> Right ventricle --> Lungs --> Left atrium --> Left ventricle --> Body. It obviously gets oxygen from the lungs to feed the rest of the body. The heart is obviously just a pump attached to a lot of flexible pipes. The size of the pipes depends on the thickness of the pipes and the pressure (which depends on the volume) of the flow through the pipes.

My heart flows as follows: Body --> Right atrium --> Right ventricle --> Lungs --> Left atrium...some goes through the hole back to the right atrium and some goes --> Left ventricle --> Body. Because there is more volume in my right atrium and ventricle, there is more pressure and that pressure has made the right side of my heart expand. Basically my right heart is doing twice the work yours is if you are normal.

Yes, this has been present my whole life. When you are in the womb, your heart starts off as a single tube. It then divides into your main vein (vena cava), one atrium, one ventricle, and then your main artery (aorta). As it grows and beats, it twists around itself and grows one septum to separate the atria and one septum to separate the ventricles. The wall between my atria only grew to about 25% of what was supposed to be there. Usually, they can figure out what went wrong based on how the hole looks. Turns out mine is too big for them to even figure that out.

Back to the story:
The next step was to find out if they could fix it with the catheter from my leg and a man-made patch or if they would have to do open-heart surgery to fix it with a piece of my own tissue that they could cut down to size.

May 2014: I got my cardiac MRI and Dr. Donovan (the radiologist) asked me to come to his office so he could explain the films to me because I am a student (very generous of him). He explained that because my right heart was actually pumping three times as much as it should have been (not two like the echo said), I would definitely have to have it repaired sooner rather than later. Also, the MRI revealed that my heart didn't have enough of the wall to attach the man-made patch to. Unfortunately, that is where we are now...scheduling open heart surgery.

Yep, that's right. As an asymptomatic, healthy 24-year-old, I have earned myself a ticket to open heart surgery. Pretty crazy. And yes, we are talking crack my chest, put me on heart and lung machines, stop my heart, operate, restart my heart kind of heart surgery.

We are investigating different options of possibly not having to have the massive zipper-looking scar down the middle of my chest called minimally invasive approaches. We are hopeful that we can find a surgeon that will spare me the horrible scar. The bottom line is we have to get this fixed before my heart gets any bigger and decides it's tired and can't handle the load. That is called heart failure. We are also preventing something called pulmonary hypertension which would eventually head me towards transplant. I am quite attached to my own heart, so we will be doing this soon. How soon, you ask?

Because of my school schedule, I am hoping for either July or September. However, cardiothoracic surgeons care relatively little about my school schedule, so we will see.

I would like to end with my list of things to be thankful for in this season. This is just a beginning of the huge list as God has revealed such faithfulness every step of this journey.

1. My awesome level-headed husband and super-supportive family
2. Not having symptoms or pulmonary hypertension
3. A cardiologist who really cares and gets me information fast
4. A radiologist who still texts me to check for updates
5. An awesome team at "work" who let's me go to appointments when I have to
6. A super understanding medical school who has encouraged me to take care of myself
7. The prayers of all who already know
8. My friends who are already planning a "Get well party"
9. Everyone who has been supporting my family as this is immeasurably hard on them
10. Friends in the medical field helping me get recommendations
11. Dr. Garg's nurse Lisa who is setting up appointments with surgeons right now so I don't have to and calling my insurance and all that jazz.
12. Access to medical care and diagnostic tests I need and medical knowledge to help me answer my own questions.
13. My normal EKG last Monday showing me that my heart is still being awesome at what it does and working perfectly with what it has got

I guess that is coolest thing about this...my heart has been doing triple the work it is supposed to and keeping up well-enough for me not to have ANY symptoms or problems. If nothing else, that assures me that God has put a fighter heart in me that will take this surgery in stride and appreciate the relief it will bring.

I appreciate all of your prayers and support. Feel free to contact me with any questions.

FAQs:

Yes, my heart should shrink back down to normal after the surgery. It will start to feel the relief and start to remodel within one hour of the surgery (WOW) and take about 6 months to a year to get back down to normal.

Yes, I will have to go to the CV-ICU for a day (hopefully only a day) and then be in the hospital for a few days.

Yes, I have contacted people in Memphis and Vanderbilt. No, I have not contacted Mayo.

No, this isn't super rare. Actually some people have tiny ones that never cause problems.

No, the murmur shouldn't have been louder earlier in life. This murmur comes from blood rushing through a pipe or hole. My hole is so big it's not making that much noise because there's not really anything stopping it from flowing there.

Yes, every surgery has risks. However, this is not a complicated procedure for CT surgeons to perform. Most heart surgeons have done lots of these.

Yes, it will be safe for me to have kiddos later. They said give it about a year post-op and my heart should look like normal.
No, that doesn't mean we will have a kid in a year. Sorry, Mom.

Anatomical Reflection

This is the reflection written for our cadaver memorial by my anatomy lab dissection group as we near the end of gross anatomy. I think it sums up our journey this semester perfectly.

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Upon entering medical school, as students we first thought about our cadaver as a means to an end, just a human body with structures and relationships to memorize. It only took one day’s dissection, however, to make us realize that this human body was not just a learning tool but also an incredibly generous gift. Through it, we have grown to appreciate the sacrifice that many have made for our future as physicians.

The anatomy lab has traditionally been a rite of passage, a test of “intestinal fortitude” against the smells of preservatives and decay as well as the ability to memorize as many intricate details of the human body as possible. While some days we were frustrated by the nonconformity or complexity of our patient, we found a second wind of motivation from our deep gratitude to each anatomical donor. Because of their gift to us, we are allowed a unique hands-on perspective into anatomical relationships that no text or other resource can match.

We will never forget how the muscles, nerves, arteries, and organs all orchestrated this man’s emotions, thoughts, and actions, though we will never truly know him. We will never know what his voice sounded like, though we know the contours of his larynx. We will never know what would make him smile, though we understand the position of his facial muscles. His scarred lungs or the screws in his fibula force us to consider our shared experiences as human beings, though we will never know the circumstances behind them. There is much of his “humanity” that will always be a mystery to us even though we have
delved through almost every part of his body.

Still, there is so much more to humanity than the biology and chemistry inside of us. Years down the road, we want to remember that being human involves more than what the eye can see. We now have the structural foundation upon which we may better understand our patients, not simply as biological machines but as complete persons. We cannot underestimate the complexity of our nature, and we are obligated sincerely to give thanks for the generosity of our cadaver who enabled us to gain these insights.

New Beginning

Hi Readers! Again it has been almost 5-6 months since my last post. I guess not that much has been going on in the big picture of life.

As many of you know, last week, I started medical school at the University of Tennessee Health Science Center in Memphis, TN. Although I am still not fully adjusted to being out of the great state, I am finding this to be exactly the place for me.

If you had told me a year ago what my life would look like right now, I would never have believed you. I am so blessed to be where I am with who I am with. I have grown to love Memphis and (almost) all of it's quirks. It's an interesting place to live because there is a lot of work to be done. There is a lot of reconciliation from past generations and scars that are more apparent here than anywhere else that I have lived (which isn't saying too much).

Medical school (at least at this point, 1.5 weeks in) is so much more than I could have hoped for or imagined. There is a lot to do and learn and study but I am actually feeling really good about this decision (ask me in another 1.5 weeks right after my first test). I don't think that I could have chosen anything better for myself. If you have known me for a while, you know that medicine was never my plan to begin with, but a journey that God led me to, kicking and screaming at points. I believe that God knows my heart and soul in such an intimate way that because I asked, He led me to where I am supposed to be.

The first day of gross anatomy might have been the best single day of my life. Now obviously there is fierce competition for that spot (i.e. time with family, Samoa, Uruguay, Chile, Guatemala, time with friends, etc.) but in terms of the coolest thing by far I have ever seen was opening one of the most generous gifts that a person can give. It strikes me every single time I walk into the lab that these people made conscious decisions to give their bodies for my education without even knowing me or what kind of doctor I would become. It is a true gift of the person and the family. I am so grateful-- there is no other way to learn human anatomy.

I love the blend in medicine of people and science. I am a curious person and love to explore, question, understand and tinker with things. However, I am also very dependent on social interaction for fulfillment. I love how medicine is now a "team sport" as it was called in our orientation week. I love that in the first weeks here we are taught explicitly about being professional, personal, and caring for our patients. I really thought that medicine would mold me into something that I am not, and that may still be true. But not right now. I can say with confidence that medicine (right now) is molding me in to something that I already am.

I have no illusions that this is not going to be an easy path. It is one of the most difficult ambitions to pursue. That is why I am glad though, that it was never my plan to begin with. It's all about becoming the person that God created me to be. I know (at least right now) that the healing and restorative work in my life will be through medicine. I hope I never lose sight of my passion and motivation for this life, the redemptive work of the Creator for His creations.

Update on Life

Hey readers. I can't believe it has been almost 6 months since I posted anything on my life here in Tennessee. I apologize for that. Please know that life up here has been a little crazy as my family, Garrett, and I struggled down this road to get to where I am now.

Now I can confidently say that I am in a good place where I feel comfortable updating everyone on the whole process.

Where med school is concerned, I have made some changes that I am very confident in. It is a long story, but I have decided to give up Texas A&M and pursue my medical education at the University of Tennessee Health Science Center where Garrett is a first year. Initially, I did not thinik that I would be allowed to apply or if I did, even remotely considered. However, God has worked through this situation with me. Without going through everything, I think it will suffice to say that I am on the waiting list for UT and will hopefully get to start in August. Plans do change and I am learning the art and virtue of being flexible where life plans are concerned.

Garrett and I have found a church home that we have really grown to love. It's a small church, under 100 members, and doesn't have a building. We meet in the bottom floor of a hotel in downtown Memphis. It's about 5 minutes from where I live and the church is really intentional about getting out into our community to make a difference and spread the kingdom of God. Garrett and I are involved in the couples small group and I attend the women's small group as well. Once a month, we go out to an outreach to make and serve dinner to some of the homeless population. The church family has really been our main body of support in Memphis. It has been such a huge blessing.

Work at the Church Health Center continues as well. I spent eight months working on the phones and at the front desk to start off with. Although it was a bit harder to get up and go to work in the morning than it is now, I feel incredibly blessed to have had that experience. I learned a lot about how real practices work behind the scenes. I have matured a lot just from having a real job that wasn't always super fun.

Now I work back in the clinic scribing for an internal medicine doctor. Basically, I am his right hand where computer things are concerned, putting in orders, printing prescriptions, and the like. I also get patients from the waiting room and take their vitals, etc. The doc I work with, Dr. Jennings, is a great Christian man and a great teacher. He's been in practice for over 30 years in private practice and resource clinic settings. I have learned so much since starting to work with him. I honestly look forward to going into work in the mornings and staying late is no struggle. I know that the experiences I am gaining now are going to be invaluable as I move futher into the medical field in the near future.

Finally, Garrett and I are doing great. We have really enjoyed being in the same place (obviously) and are so grateful for the support that we have received. God has been so good to us. Garrett has been a wonderful support and done a great job prioritizing with school and everything else.

Anyway, I think that is all I have to report on for now. Thanks for sticking with me and thanks for the prayers as always.

St. Ignatius Loyola and Bonhoeffer

Anyone who has known me for a period of time knows that my faith story involves a man by the name of Dietrich Bonhoeffer, a German man who lived and died during the time of Nazi Germany. God used his story and his book, "The Cost of Discipleship," to touch me deeply during my junior year of high school. The influence still carries on today in how I deal with things, think about decisions, and more broadly my overall view on spirituality.

A family friend who had read this very blog recommended that I look into the spiritual practice of the "Examen" prayer. I did a little research, bought "The Prayer that Changes Everything" by Jim Manney, and started to think seriously about making this prayer a part of my daily life and spiritual routine. I finished reading the book this morning and it has really caused me to think a lot about how I am living my life at this point. Several things really touched me as I read more about the traditional "Examen" first brought about by St. Ignatius Loyola which many of us recognize as the founder of the Jesuits.

My limited experience with anything "Jesuit" was limited to a the movie "The Mission" and a trip here... to the Jesuit mission in Brazil that was the basis for the movie.



But the book, written by a contemporary American, really struck my interest. As you can see if you have read my blog recently, this year has been filled with decisions and important crossroads. I have been down and out because I was struggling to see the light at the end of the tunnel of these roads and fearing that I was going to make a decision that I would regret for the rest of my life.

The Examen is a prayer and a way of thinking...and a way of going throughout life in each present moment. Kind of like when yoga instructors ask you to clear your mind and focus on each breath...and then you can start doing things...not really...but kind of. I can't even pretend to understand the practice completely and I have not started practicing it yet but I am very excited. There is one quote from the book that I would like to reflect on with you now. It is by St. Ignatius Loyola in his book, Spiritual Exercises.

"I will ponder with great affection how much God, our Lord, has done for me, and how much He has given me of what He possesses, and finally, how much...the same Lord desires to give Himself to me."


This is the passage that I have chosen to focus on this week and reflect on now. Let's break it down: "I will ponder with great affection..." This is a choice to do something with my mind. This is not being blown here and there by my emotions or how I wake up in the morning but a personal choice to put on an "attitude of gratitude" (Manney's words) and move from there. I will chose to go into the place in my mind where I can see things in the presence of my Creator rather than being focused on how I feel about life that day. This is a statement that I am about to acknowledge the love that is a gift and makes my life so much better. That thought fills me up with joy so that I can proceed.

"...how much God, our Lord, has done for me..." This one is easy. He sent His son to redeem me from my sin. He lifts me up when I am down. He calms me when I am anxious. He carries me when I am weak. He's created a world for me to live in. He's always present even when I chose to ignore it completely.

"...and how much He has given me of what He possesses..." Wow. Life everyday for 21 years, countless heartbeats, breaths, drinks of water, food, experiences, life in general. Again wow. Relationships. I am a beloved daughter, granddaughter, sister, sister-in-law, niece, cousin, friend, girlfriend, student, neighbor, co-worker, employee, person on the phone at CHC, educator, former-intern...just to mention a few. The love that God shows me everyday though the relationships that He's given me is incredible and impossible to ponder enough. I am a social person and at the heart of us all is that longing for closeness with people here on earth. God has given me so many relationships and connections it knocks me off my feet. He is also the giver of love, grace, mercy, peace, my emotions, worldly possessions, comforts, and desires. All good things come from Him. My talents and dreams are a reflection of who He's created me to be. Instilled in me with purpose. His purpose. More on that in a minute.

"and finally, how much...the same Lord desires to give himself to me." Wow is not the word here. In fact, I am void of a proper way to respond to this. He is the creator of Heaven and earth and desires to have a relationship with me. He's given me all of these things I've mentioned and more but still longs to give himself to me in a loving relationship. I'll need to reflect on this a little later when words come back to me.

One of the focuses of the Examen is working through your daily walk and thinking about it through the eyes of God. We are to focus on the moments of our day that make us "feel something." We are to focus on our emotions and what those can reveal to us. One central question that this prayer can answer is, "What do I really want?" That is, what is it that I long for when all of my illusions of what a "good life" means have been stripped away and I focus on the meaning of life as giving praise, reverence, and worship to God.

At first when I read that passage about what I want, my Bonhoeffer sirens started going off. God used that moment in a powerful way to reshape my spirituality a bit. Bonhoeffer's book, The Cost of Discipleship, emphasizes that when we are called by Christ to be a disciple, "Christ bids us come and die." It's hard to explain how this had shaped my view of God. I believed that this meant that my dreams and desires were meaningless and even if it was miserable, I was to run the race that He set before me. For this reason, I couldn't reconcile any pleasure of this life with God's calling on my life. I believed that we were called to be anything but comfortable; therefore, comfort was a sign that I was doing something in my life for myself and not for God which was wrong; therefore, anytime I felt good or comfortable, I was doing wrong and should get out of that situation because it wasn't the will of God. I lived that way for a long time and it shaped how I viewed things. I strived not to take time, energy, or anything, for myself because all things I had were of God and to be given away to his purposes which I believed were ALWAYS outside of myself. I should add the honest addendum that I was irked when people did things for themselves because I viewed that as being outside how Christians should live.

It's incredible how strange that sounds to me putting it out there that way. I cannot pretend that I have lived everyday of my life for the past four years never doing anything for myself or enjoying anything. I did. I guess the addendum is that I almost always felt guilty for it. I don't want to pretend that this way of striving to live "selflessly" is all bad. But I did notice that I couldn't do it and now I recognize that my spiritual pendulum had swung a little far.

Now hopefully, you can see why my sirens went off when Manney and by extension, St. Ignatius Loyola, asked me to think about what I want from life. My immediate slurred Bonhoefferian response was, "What does it matter what I want? This life is about anything except for what I want. This life is about what God desires for me to do and what I want has nothing to do with it." As I read further though, my question was answered by another quotation from Loyola, "Man is created to praise, reverence, and serve God our Lord and by this means to have his soul." This is the meaning of life according to the founder of the Jesuits.

The principle of searching our emotions for our deepest and truest desires is based upon the belief that we have the Holy Spirit of God in the deepest place within us because we were created by God. Another implication is that we must shed our superficial desires and find and focus on our truest desire. I pray that the Spirit will lead me to see this more clearly in the planned month of daily examen to follow. I realize I have lost all of my readers by this point, but it was a good spiritual exercise for me either way.

I find myself in a place where I haven't in a while: a reshaping of my foundational truths. It doesn't feel comfortable or steady right now; but it feels really really really good to be moving again.

Blessings and peace, readers.