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Signed: Love, God
By Harvey A. Elder, M.D.

My plans changed! Totally!

I knew exactly what I was going to do.  March 19th I would take the midnight flight to Miami and fly on to Santo Domingo for an invitation only conference on Christian teaching.  I would lecture about Biblical principles that inform the teaching of Medicine.  Integrating scriptural truths into teaching has been my professional passion for over 30 years. After returning home on the 26th I would re-pack and leave April 2nd for Africa.

As staff for a four-day value based AIDS prevention program I would help train educators and health care personnel in Nigeria and the following week in Ghana.  During the past 17 years God has blessed me with many opportunities to care for HIV infected people.  Because the pandemic continues to spread at an increasing rate, I teach HIV prevention wherever I can present a values based program.  CrossRoads developed such a program and tested it in Catholic, Muslim, Hindu and Buddhist countries.  Because we share common values and world-view I enjoy working with CrossRoads integrating Christian principles into HIV prevention.  Although busy I was happy, I enjoyed what I was doing and I was obeying God's call.  My spirit rejoiced! I was like a child going to three birthday parties! I looked forward to each one.  I knew schedule, how little did I know!

My health is an important priority.  During the last 25 years I jog 4-5 miles 4-5 times a week.  I do a little weight training.  About three years ago I dropped 50 pounds over a one-year period becoming the appropriate weight for my height and 68 years. Other than being male I had no "risk factors" for myocardial disease.  All relatives, not killed by trauma, lived more than four-score years.  I was proud of my health. As I jogged past younger people I reflected upon my good health and disciplined life.  It was hard to be humble when I was so healthy!

During the mild cold spell this southern California winter I noted a little chest pain that cleared with additional exercise.  This could not be angina pectoris!  I could not have coronary artery heart disease!  No me! Each time I forgot about the pain before I arrived home.  When I started to jog on Monday March 13th I began to "feel bad" as well as have chest pain similar to previous episodes and not typical of angina. I turned around and walked home by a different route so those who usually saw me wouldn't think I was shirking my jogging!

My internist, Dr. Ray Wong, scheduled a "stress test" for 10:00 a.m. March 15.  I had mixed feelings.  On one hand lecture preparation was behind schedule and on the other hand I was concerned and happy that the test would soon be done.  Dr. Gary Paul, the cardiologist who monitored the test, said that my "stress test" went well.  I had none of the symptoms I experienced on Monday.  My atypical symptoms and excellent stress test performance suggested that the test was "normal," despite a minor abnormality in the tracing.  However, to be certain, he suggested an ECHO stress test.  I agreed and he scheduled it for 2:00 p.m. I was a bit bummed!  I would waste more time chasing a "trivial" abnormality.  Though unhappy, I agreed.

The ECHO stress seemed to go well under Dr. Ramesh Bansal's direction.  I performed the same amount of exercise as in the morning and again no symptoms.  However, this time the ECG was seriously abnormal as was the ECHO! I was stunned.  Now what?  "You don't mean an angiogram, do you?"  Lecture preparation occupied my first priority!  Obediently I offered to come back in the morning for the "angio."  The cardiologists would not hear of it!  They intended to hospitalize me!  Ignoring my agenda, they hospitalized me over night.  I assumed that after the angio the next morning they would prescribe some medication and send me on my way without further interfering with my lecture prep plans.  I would be a mature adult patient; without complaining I would "roll" with their plans!

Pouting, I obeyed, but determined to use the time for lecture preparation.  I asked the admitting nurse, "Can I bring my laptop computer?"  She snorted, "Just a typical Type A!"  This hurt my feelings! Me, a Type A, no way!  I overcame my Type A behaviors years ago! A little self-talk calmed me down.  Later that evening, my angiographer, Dr. Marsa came by, examined me and discussed the procedure.  I told him that I was scheduled to fly to Santo Domingo on Saturday night.  "Will that be a problem?"  He thought that that was too soon.  Disappointed I called Dr. Rasi, the convener of the conference.  I simply said that I was going to have angiography and could not fly to Santo Domingo.  We discussed the possibility that I would fax the paper for another physician to read. A reasonable compromise, I thought.

At 10:00 a.m. Dr. Marsa called me to the Angio Lab. Without general anesthesia I watched the graphics.  I am "right dominant," ie, my right coronary artery supplies most of the blood to my heart and my circumflex artery is so small it provides only a minor fraction. Where my right coronary divides it is 90% obstructed!  My left coronary artery had several serious plaques.  Ignorant of the true facts, I was concerned about preparing a lecture.  Reality demanded I attend to the coronary circulation of my heart.  I had very serious disease.  I was a major heart attack waiting to happen.  If it were not fatal I would be a "cardiac cripple."  I was in very serious trouble.

Gently, Dr. Marsa began reviewing the angio results with me.  "Dr. Elder, I don't remember much infectious disease (my subspecialty) and I don't know how much coronary artery anatomy you remember."  I hadn't remembered any.  He explained the findings and added, "every cardiac center in the country would recommend bypass surgery."  I was speechless-dumbfounded.  He consulted with Dr. Razzouk.  Within a few minuets they reappeared with Eleanor, my wife, Mary Elssmann, my sister and Glenn Elssmann, her son.

Without drastic revision, this would only get worse.  Time, whether measured in days or months, was my enemy.  If a couple of blood cells "held hands" (so to speak) the obstruction could become complete. Oblivious to my anatomic reality, I had planned two trips.  I believed God had called me to go.  Without confidence that God had called me for those trips, I wouldn't have agreed to go.  When to undergo surgery?  Everything within me said, "do it as soon as possible."  Dr. Razzouk was able to operate in one hour (at noon).  A very efficient staff quickly arranged the many details.

During this time, Eleanor, Mary and Glenn called family members and informed as many as they could reach.  In itself, that was a formidable task.  As contacted, family units planned what they could do to help. Mary and Glenn provided crucial support for Eleanor as plans developed. Caroline (Eleanor's sister) and her husband, Don, packed quickly and drove from Ventura to Loma Linda. They stayed with Eleanor and supported her.  Cheri (our daughter) was able to phone me before I went "out."  Even though I was entering a cloud her voice comforted me. John (our son) and his family moved in with Cheri.  Early each day they drove the 25 miles from Fontana to Loma Linda.  Children played in the Medical Center's "day room," or at Larry's home (Mary's youngest son) when he or his wife, Tammy were home.  Facing this unknown was not my idea!  I don't like it when plans change, I want to do what I want to do.  (How's that for mature 68-year-old thinking?)  By the time they were going to take me to surgery, several things began to clarify in my thinking: 1) I was near death.  2) If God had not interfered, Satan would have accomplished his plans for my death.  3) I was at one of the world's best cardiac centers, to be operated on by one of their best surgeons.  I had not had to wait for an opening.  "Simply admit it," I told my self, "God has rescued you from certain death. Praise Him and worship Him." Praise I did!  My praise to God for His goodness was slowed by medication as I slipped into unconsciousness.

At 11:45 a.m. they wheeled me into surgery. Some of the surgical details that you may want to know:

1) Technically the surgery was very difficult.  My subclavian vein clotted off in 1980.  I have a small thoracic outlet. We were vacationing in Acalpuco; I got "turista" and dehydrated.  The genetic setting met the initiating event and my subclavian clotted.  My body made many collateral venous channels to return blood from my left arm and chest to the heart.  Many venous channels surrounded the Internal Mammary Artery that the surgeon used as a by-pass artery.  Surgical activity in my left chest frequently initiated bleeding. A lesser surgeon would have needed to transfuse me with many units of blood.

2) The arterial blockages were calcified, indicating that they were old.  There was no evidence of active vascular disease.

3) The decreased blood flow to my heart caused ischemia-"little blood flow" to the heart muscle.  The stress ECHO showed that much of my left ventricle worked poorly when I stress exercised.  Ischemia involved not only the pumping muscles but also the papillary muscles (which are supposed to keep my mitral valve working effectively).  Even at rest my mitral valve leaked blood (regurgitated).  With exercise, the regurgitation became extensive.  Following surgery I had no regurgitation-the ischemia was corrected!  Praise God!

4) The surgeon said that my heart "was the heart of a 40 year old man."  The tissue was strong and very healthy.  Despite the ischemia, I had not lost heart muscle!  Praise God!

5) They had hoped to achieve at least 80 ml./minuet blood flow in the left bypass.  They achieved 200 ml./minuet.  They achieved 170 ml./minuet flow in the right bypass.  The blood supply to my heart has been more than doubled! Praise God!

6) The anesthesiologist reported that my pulse and blood pressure were far more stable during surgery than is their usual experience!  Praise God!

I was taken to the post cardiac surgery ICU at 5:30 p.m. and my family was able to visit though I was still out.  About 1:30 a.m., Friday I remember they took out my endotracheal tube (the tube they used to keep my lungs expanded).  I felt I needed to urinate.  I knew I had a catheter in place, but still, it felt as it feels when I need to urinate.  After telling the nurses what I felt I needed, they replied, "It's OK you have a catheter in place, just go."  I replied, "I'm not used to urinating with a couple of ladies in the room!"

I awoke 5:30 a.m. Friday morning, had my vitals taken and sat in my cardiac chair. It was more comfortable than the bed.  There I could watch the sunrise, praise and worship God. God had done wondrously for me.  I love Him so.  I want the whole world to know how great He is. About 7:30 I called Eleanor.  I knew she was concerned!  I wanted to initiate the call, but not so early as to awaken her.  She was thrilled to hear me.  This was my gift to her. I have had very little pain and required pain pills less than every eight hours.  Praise God!

Saturday they removed the bladder catheter and said that if I urinated, they would not have to put it back.  Exercise would increase the likelihood I could urinate and narcotics would decrease this possibility so I walked without pain meds.  They didn't have to put the catheter back!  Praise God!  Saturday afternoon I wanted to walk to the day room.  My great nephews were there and I wanted to hug them and kiss them.  (These are powerful healing modalities-something you aren't taught in medical school!)  I couldn't!  My rhythm was atrial fibrillation and my rate was over 160.  When I got up I felt weak!  I was not pleased.  I looked at the monitor displaying this information and began to worry.  For the first time I was afraid.  Then this thought crossed my thinking, "Given who God is and that He has rescued you from Satan's hate-inspired attack, please describe the nature of your problem!"  I checked.  God was still on duty!  I gave my problem to Him and refused to look at the monitor (except once and I was caught!).  Nurses and doctors checked my blood, gave me drugs and within a couple of hours my nurse said that my rhythm was back to sinus and my rate was normal!  God did this without any help from me!  He has His people who know what to do and they did it so simply.  I just praise His name.

Sunday they removed my two chest tubes and Monday they removed the leg drainage (source of veins for the right coronary artery).  The fact of their removal made the unpleasant process of removing them tolerable!

Many of you received and sent e-mail, courtesy of John, our son.  These were very supportive and encouraging.  I appreciated them.  Many of you told me of your prayers.  Thank you so much.  Prayer does more than we can possibly imagine.  I was constantly bathed in the love of Jesus carried to me on the wings of your prayers.  I was graced by the awareness that I am loved, deeply loved by so many people.  My flesh could not imagine such love.  Confronted with this reality my flesh had to acknowledge the Holy Spirit's power and grace. I was loved, deeply loved by so many people-Only God can create such bonds of love.  God gave me the grace to hold and take in your love.  By His grace I am healing.  My spiritual heart has been infused with grace and love, its sings God's praise and pours out love and blessing to all who will pause and listen.

Some reflections: