What is something that isn’t a masterpiece?

I have discovered the joy of change in my life. I was not a lover of change in the past, but now I am looking forward to it. Amy is changing things in her life too. She is leaving the Big Company in Redmond at the end of January.

We will be working for ourselves in some form or fashion as we move forward. That is a big change.

In some ways, I expected to be more nervous about.I am suprised that I’m not. However, I am pleased to be adjusting well to this. The peace of mind is, I think, the result of a lot of so-called inner work. For me, that means a combination of talk therapy, what I learned in therapy, and my own exploration of my complex of emotions. Also, a lot of walking.

Now that no one will have any specific working-for-the-man obligations, it opens a scary box of what do you actually want to do? The past two years of working for myself have provided me with a lot of time to think about that too. The results are amazing: I still don’t know.

I have decided that the important fact there is the indecision. Facing the fact that I don’t have clarity of purpose tells me something on its own. I have liked the work that I’ve done recently. In particular, I like working with non-profits. You feel really good helping them (for free or for pay). I also like that size of business. Mostly they have clear problems and the solutions are within the framework of typical business.

I would have thought I would feel more drive to “create.” I really love creating. I love seeing other people do it and doing it myself. And I like doing. Doing soemthing isn’t always an act of bringing something to the universe. It is a contrast to the act of watching TV. But practicing an instrument, a craft, even making a puzzle is a level of engagement that feels good when you do it.

Creation comes in many shapes and sizes too. When Zuckerberg created Facebook, it was a simple act of creation. No one could possible anticipate that it would be come the Facebook we know now. It is essentially a piece of social infrastructure and that is laudable. But he did not conceive of it beyond his college experience.

Facebook has become something that scares me too like TV. I don’t want to depend on it. I want less Facebook in my life and more music. That doesn’t diminish the awe I have for Facebook. I also have awe for nuclear fission. That can be scary and powerful too.

In order to keep an certain amount of optimism in my life, I need to limit the effects of nuclear fall-out and Facebook. One is relatively easy and the other is surprisingly hard. With nukes, I’m just hoping for the best. With Facebook, it is a conscious act of keeping that addictive thing at bay. Not eliminated but also measured exposure, because it creeps into the cracks and suddenly takes my attention from other things.

Maybe it’s music. Maybe it’s writing. Maybe it’s just stillness by a pond. Either way, I am trying to create some space for those things without a lot of expectation that I need to create the next Facebook-level masterpiece.

Change is coming and that’s my intention at present.

We might not make it

I have been “separated” from Microsoft for 18 months. It feels longer. I have forgotten so many of the little things like the phone number I had, peoples email addresses, etc. This is all reasonable and unsurprising.

I have also been working for myself for long enough and with enough variety that it feels normal. It is still a much less regular life. And considering what happened in that 18 months, it surely wasn’t “regular.”

Working for myself has been gratifying, but certainly it has not replaced my salary. Fortunately, I have been willing to forego some of that in the hope that I am building something that will sustain us in the future as our lives continue to change and we approach our 7th decade.

It is very clear to me, now, that nothing is to be taken for granted. There are fewer years in front of me than behind, and that is motivating too. I don’t have a bucket list mentality, but I do have a clear picture of what I don’t want my day-to-day life to be.

Given the current political climate, and also the regular climate, I recently had the thought that I don’t think mankind is going to make it. Funny enough, it didn’t bother me. We are in an age called the Anthropocene: the age of humans. But all good things come to an end. For all of our celebrated brain power, we don’t have what it takes to continue. And you can’t really feel bad about that, can you? It’s like hating whale because they can’t walk. They just can’t.

Chomsky said that there are two big, human-created changes that push us closer to doomsday: the invention of nuclear weapons and the human impact on climate change. The nuclear weapons thing is easy to understand. Everyone understands on the potential devastation of nuclear war. The lack of agreement on global climate change is the proof that humans are, on average, not smart enough to continue to be the dominant mammal on earth.

That might seem pessimistic, but I move from the extremes inward. There is little that I can do about either thing. Sure, I can and will vote. But that’s a tiny drop in the bucket. And I can pick an issue or two and advocate on that. Personally, my preferred issue is an end to the electoral college. I prefer the idea of a popular election because it is more democratic. If we are going to go down in a fight, I’d rather it not be on a technicality. None of the arguments for the electoral college make sense when cast in the light of democratic outcomes.

I like Robert Reich and I don’t like neo-liberalism if you want to know where I stand. Climate change is real and caused by humans. It is not hubris to think it is human caused, as religionists would have you believe.

Beyond that, it seems advisable to live a life where you are trying to minimize stress. Creating stress is not hard. And yes, some stress is necessary in order maximize one’s long term outcomes. The story the grasshopper and the ant comes to mind.

I’m not setting aside dumb luck either in my thinking and conclusions. I was lucky enough to have a good paying job for a long enough time that I can even ask these questions and take this time to think about it. I’m not starving and living a life of just surviving. But failing to see the stress that was in my life and not changing course, as I was doing, also seems quite dumb in hindsight.

Minor changes to fix some unclear points and mistakes from ealier – July 10

Figuring it out

Right now, I am in a period of transition in my life. Generally, I don’t like that. Generally, I like to control my environment. Some might say over control it. Transitions create a challenge to that control or the illusion of that control.

When I was in music school as an undergraduate, I thought I was pretty smart. In fact, I was told I was smart many times in my life so I believed it. Why wouldn’t I? I also found that if you stick to the plan that someone lays out, most of life’s events unfold as expected. I preferred that to certain things I experienced in my home life where unexpected things happened. It could be hard to predict.

(I am not a “program guy.” That will mean something to some people. I do find aspects of the program to be useful. And that means avoiding bringing other people into your nightmare.
However, if “the program with the secret meetings” means nothing to you, then you will think I’m being vague. I am. You will have to piece it together. But the goal is to avoid blaming other people and also to not “out” people for perceived transgressions. I’m just telling my side so that vagueness is to protect the possibility that I only have one side of the story.)

When I was 19 years old, I was a sophomore at U. Mass-Lowell (then called U. Lowell), in the music school, which was a separate college. The music college was more or less modeled after a conservatory. You studied Solfege, Harmony, Piano, and your instrument. You played in ensembles and you practiced. If you were smart and driven, you practiced a lot. The school primarily produced music teachers as opposed to orchestra players. The schools in Boston were full of people with those aspirations. But we had plenty of serious people trying to do serious things in music too.

At the same time you were doing this, you also were taking liberal arts curriculum. You had psych 101, college writing, etc. In the end, you would have the highest amount of required credit hours because of the ensembles and instrument load, which were extra compared to a normal liberal arts student. That meant you spent a fair amount of time in Durgin Hall with your peers.

During my sophomore year, I had a “come to Jesus” moment when I figured out that there was minimum amount of credits I could take. Why was I taking more than the minimum? I’m not a sucker so I signed up for the minimum. I was still not thinking on my own. I was relying on the idea that if there is a minimum, then there must be a plan. Stick to the plan.

What I didn’t figure out was that, at the minimum, you only stayed in school. You got your financial aid; you stayed on the meal plan; you lived in the dorms. What you don’t do is graduate in 4 years.

Looking back, that’s embarrassing for a “smart” kid. At some point, I did get the clue and increased my credit hours. At the same time, I was realizing that even being smart wasn’t going to fix this problem. I needed to be creative too. I had friends around me who never did things “inside the box” and I really admired them for that. That was completely new to me. I began to completely break down the fact that I always colored inside the lines and began to color outside the lines in some good ways and some bad ways.

I still hadn’t engaged why they did it. They did it because they wanted something. I wasn’t used to thinking that way. What do I want? I had no idea. I almost never expressed myself in that way or any other way.

You might think being a musician was about expressing yourself. Mostly, it isn’t. It is more about mastery of skills that help other people with their expression. You don’t improvise in the orchestra. You play what is written. Interpret it, yes, but the bigger goal is for the ensemble to express something even bigger.

Even in Jazz, which began to take a more dominant place in my musical life, I developed the skills to be a solid member of the rhythm section. That helped me to be in places where I wanted to be, where I got some praise for those skills. I liked that.

Looking back, the only places I really expressed myself were in poetry and song writing. I didn’t expose either of those to large audiences because that is risky too.

During my junior year, I figured some things out. I wanted to finish school so I had to catch up somehow for the courses that I hadn’t taken. And because I didn’t really know where I was going with all this, I took a semester off. I worked for my uncle, with my cousin Jim. I learned a lot there.

I went up to the school once a week to play a group that I thought was cool. I couch-surfed at my friends, mostly Mark, Tom, Paul and Don’s place. They were so cool about it. We didn’t even call it couch surfing but that is what it was. I also took French Conversation and Philosophy at Worcester State College to fix my transcript. That was an adventure because I hadn’t taken anything but French 1 before. Thanks to my grandmother I did ok. She would help me and answer questions and at least try to understand me when I tried to speak French.

It was tough, though. Mostly it was tough because it was all on me to figure out and I wasn’t used to that. That’s how it feels now.

Second week at the Weird Gym

I am happy to say that my real class at Cardio Rehab is nothing like my first visit for orientation.

Mostly, it is like going to a real gym. It is still a lot quieter, and you have an older population than 24 Hour Fitness. My class is mostly men and they wear gym clothes. They sweat. Well, mostly. They know how to work the machines and in fact, most of them, exercised quite a bit in their lives.

My class consists of 10 or 11 people. One day there were three women in it but most days there are two.

I have only met one other person who had a similar procedure as me, valve replacement. Talking to Meg ,she had many complications. I don’t want to scare anyone but it made me very happy for myself and very compassionate toward her. She seems fine now, but it has taken quite a long time for her to get back on her feet. She now has a mechanical valve that seems to be working, and she can once again care for her 3 year old. I think that gives her a lot of peace of mind and it is easy to root for her.

The others in class can be divided into open heart for by-pass procedures, people who have had a heart attack, and people who have not had a heart attack yet and are there to try to avoid one.

We don’t talk much about what happened that brought one here because it can easily turn in to “I can top that.” (If so, Meg would win and I mean crush.) Everyone just supports each other and treats all cases as equal. It is true we are all working toward the same thing. Getting our lives back to normal in a healthy way and learning how to deal with the new reality we face. For me, this is just getting back to normal in a gradual way. For others, it is learning new things.

The class also has a lecture one time a week. This week’s sessions was on anger management and how to control stress in your life. The lectures are optional. So far, I have not attended mostly because it would add an extra hour of waiting to whoever is driving me. Next week, I will drive myself so I might attend. Most of the classes do not pertain to me. My diet is pretty good. I understand a lot of what to expect because this is not my first time around. I already treat my mental health, for example, because I was depressed the first time. Now, I have a lot of resources for building my own resiliency.

I look forward to the class and got my heart rate up to 135 in my third of fourth class. That felt good and safe. I still have sternal precautions until next Wednesday so I’ll be able to use something other than 3 pound dumbbells.

I am off all my medications. That proved to be something of a roller coaster. I am having a bit of something like withdrawal from the beta blocker, mutoprolol. As a result, my heart rate is somewhat elevated at rest and a bit sticky. If I raise it, I have to really sit down and get calm for my body to slow it back down. And, my BP is hard for them to measure. At first, they freaked out a bit. They ended up taking it with a Doppler so they can really hear where the pulse changes.

After a bit of a tense day, and several calls back and fourth to my cardiologist, it appears to be a temporary condition that some people have and perhaps just a idiosyncrasy in measuring my BP.

My heart is loud. Other doctors and nurses have remarked on this too. It probably won’t change much and that’s just my physiology. I certainly can feel that my pulse if faster than normal. That did get my attention. However, I have been assured that it is normal in some percentage of people when they stop this drug. In the meanwhile, we keep tabs on it by measuring a bit more often, and I know what the numbers are when we call someone.

Talking to people in the class is good for me. Mostly it is just what you might expect. Guys who are a little bummed to have needed a bypass but grateful that it was caught in time. These two guys both look healthy and were athletic. One guy was actually riding his bike to prepare for STP when he noticed going up hills was a lot more labored. The other guy had a similar observation while hiking. So you never know. Keep tabs on it. Get check-ups and if you feel weird, go get it check out.

Both guys are not anything you would call fat. Both guys are in their 50s maybe early 60s. Neither is challenging about this. They both want to get back to normal and start doing things they did before and will work hard in class.

Some of the heart attack and heart disease people (non-surgical) are overweight but not all. They are not all as chipper about being there. I think it is a wake-up call and maybe a bit embarrassing but they do the work. One guy worries me. If anything he works too hard and occasionally is told by coaches to throttle it back. I don’t get it. There is some kind of denial going on there.

I will be a bit happier myself when my body works through the withdrawal. Then I’ll have a better understanding of where I am. And next week, maybe even 5 pound dumbbells.

First day at weird gym

[I hope this isn’t viewed as me making fun of “old” people. After all, I’m old in the eyes of my kids, nieces and nephews. It is more of an observation on a particular set of people who happen to be older than I am.]

I went to the first day of Cardio Rehab yesterday. It’s a very nice facility, filled with fancy tread mills, stationary bikes, and steppers. In the middle of it all is a rack of small dumbbells and some fancy medical equipment. Plus, around the perimeter, there are screens showing the Today show or some other day time TV. In contrast with a real gym, it is fairly quiet. No Zumba classes; no blaring music. No voice over a microphone saying. “10 more…and 9, 8…”

Just off to the side, is a circle of chairs. It looks like a nice gym that surrounds an absentee kindergarten class.

The other difference is that the people at the gym average 83 years old.

Almost none of them are wearing gym clothes. And not a single one looks like they are sweating. In fact, I don’t think they look like they can sweat.

There is one man. He is wearing blue chinos, a checked flannel shirt, white undershirt and blindingly clean white sneakers. They look brand new. His hair is white, full and combed to the side as if he is taken a shower and gotten dressed to go out in the world, not the gym. The only tip-off is that he has the Nikes on his feet. And for some reason, they look like they weigh him down. They look huge and heavy. They are tennis shoes, not running shoes and they look like they are somehow too big and heavy for his frame.

He has a walker so when he goes from the stepper to the circle, it takes 5 interminable minutes. I had the urge to get of my machine and just carry him to the circle.

M, W, Th are heart days. On T and F, it is lung day. It’s Friday and these people all had some kind of lung surgery or treatment. I didn’t see any oxygen tanks. Lung issues are not good. I’ve concluded this from my unscientific observations both here and in the hospital.

My job today is to give my medical history and learn how to use the equipment. Therefore, I’m just getting a private tour in the middle of a normal class. I’ve been shown how to put on the heart rate monitor. It isn’t like the Polar- one strap around the chest. It is like the hospital: four individual leads and a fairly large (think older, heavy cell phone size) transponder. You put that in a neck holder that you wear. Each person has one and there are stations where they monitor your ECG the whole time you are there. At the stations, you can see a list of 10 different ECGs.

I’m riding a recumbent bike for 10 minutes. The level was 2. I pumped it up to 3 and the therapist yelled at me. Ok. This is going to be a slow progression. She also takes my blood pressure three times, beginning, middle, end. They want to be sure that you don’t pass out or have some other issue. This is all my “base line”.

I also do a three minute cool down, which is hard to distinguish from my workout. But they are just showing me how it is going to go each time. This follows a long conversation about my heart history. As usual, they expected a much worse case. That means, most cases they see of AVR are worse than me. They deal from experience. That means, even though I don’t feel it, I’m the lucky one. I didn’t need my valve replaced because of some other big problem, which is more typical. As a single case, I don’t know that.

During the 13 minutes I am on the bike, I mostly get to see the class do their strength training. It is soooo funny. One lady looks like Madea-meets-Hillary-Clinton. Her hair is nicely done up but looks a bit like a gray helmet. She has giant glasses. She’s short but healthy looking except for the glazed look on her face. She never stops smiling but is the face of someone who looks a tiny bit lost.

Most of the exercises are seated. The teacher is younger than me. She cajoles and has a very pleasant way of leading. But if I were to take away your view of the class, you’d swear she was talking to a pre-school. Everyone looks almost surprised to be there. No one looks like anyone you see at a real gym. No one is in charge of their workout. It looks more like field trip of unwitting participants who had no idea that their destination was the gym. They go through the motions pleasantly but as if they find it more amusing than anything else. “Look Martha. I’m making circles with my arms!”

I don’t know if they just don’t have any experience at a gym or doing exercise for some meaningful reason or what? As time passes, I begin to think they all look like marionettes. They aren’t in charge of their actions; it’s the people who are pulling the strings. And it’s all just a beat too slow. And there is a noticable lack of eye contact with anyone. They don’t look at the teacher or really each other. Eyes are down or looking out the window in bit of far-off stare.

I finish up and remove my monitor. I don’t know what my class is going to be like. It should, at least, be amusing.

Two weeks, one day post-surgery

I remember this last time too. I cannot regulate my body temperature. I sweat like a pig at night. I’m cold other times. I sometimes go out in 4 layers and it’s in the 50F range.

Both my kids were here last weekend. And now both are gone. It was great to see Marc and Nathalie. Marc was here for the weekend and did some “lifting” for us. Nathalie was here from Friday to Wednesday. They helped out around the house. Nathalie took me on my first outing, then lost me in parking lot. I was walking around looking for her with two coffees in my hands and not knowing if I set them down would I be able to pick them up again. Eventually she found me.

It was great for Amy to get some relief after a tough week. Paul, Amy’s brother, was a great comfort in the hospital. Amy was there for hours each day. Paul came and spent several hours on different days just hanging out.

I get better everyday. And that feels good. I think I might be slightly ahead of where I was last time. I don’t know what that means but thinking about last time, we must have gone to the tulips a month or so after the surgery. I still couldn’t drive, if I remember correctly. I don’t remember being tired but I do remember not being 100% either.

I did better with the pain management this time too. But compared to brain surgery, this looks easy. You don’t actually have a lot of nerves in your sternum because it is where the nerves terminate. I get a weird pain in my leg that is referred pain from the “cut-down” where they attached the heart/lung pump to a vein in my groin.

I am only taking Tylenol now and at a fairly low concentration. But it still helps. If I forget or try to stretch too, too much, I feel it. And then it is tough to catch up for a while.

I have a cough, too. Also normal.

I feel good most of the day until about 8:00. Then my shoulders, neck, chest start to get a little achy and I really want to go to bed so I’m in bed by 10 and up at 6 or 6:30.

Today I thought I would see the surgeon for the final follow-up. Instead, I saw the nurse practitioner. That’s ok. I had my final sutures removed. And everything looks good. Therefore, I am “released” back to the care of my main cardiologist. I see him Oct 17 so not quite 2 weeks later.

This time, I’m going to do one thing different. I’m signed up for cardio rehab. I will go to some therapy where they get me on stationary bike and, with a lot of supervision, help me get back to some level of exercise. My doctor told me that I didn’t need to do this last time. He said that my exercise program would be good enough. I should insisted because I spent too much time thinking my heart would explode. In other words, the main point is to help you get over the mental hurdle that you are indeed healthy and that you can TRUST your body. That really took a long time last time.

The soonest I can start that is October 24. And that should go for 6 weeks. I also have been cleared to drive two weeks earlier than originally planned so that should make some of this easier.

I think this might be my last direct missive on the subject of my heart. Might be time to get back to my other giant thoughts. I think I’m gonna be fine, knock wood.

Nurses

I don’t know if this is different from last time, but nurses care for you. There are plenty of Nurse Practitioners, Nurses, and Care Assistants (Nurse Techs). Most of your contact in the hospital will come from a pair of people who will dispense your medications and help with bodily fluids over a 12 hour shift.

For the most part, you might see a Nurse Practitioner once a day; they make the plan. The nurse carries it out. The care assistant fills in gaps.

Nurse practitioner removes the chest tubes. The nurse practitioner is paired with a team. Nurses removed the v wires for the temporary pace maker I had. Usually they would assisted by another nurse.

A nurse or nurse tech would/could remove a failing IV line after 4 days. They might also give you a bath.

I also dealt with Occupational Therapy and Physical Therapy. Occupational comes form activities that “occupy” your day, not from the usual sense of your job. OT taught me to wipe my butt a new way to conform to sternal precautions. And how to shower. Very helpful young man named Henry.

PT checked that I could walk up stairs. Gave me a light exercise program. Reinforced the sternal precautions.

https://www.verywell.com/sternal-precautions-2696084

In ICU you have one nurse who stays with you, more or less in your room, at all times. They seem super capable. My day nurse is in training to become a Nurse Practioner, which in WA, as of 2014, requires a doctorate degree.

Compassion

I told a friend about this. He is studying nursing. He said they are trained to be silent and dignified. Never have two words captured a professional ethos, in my opinion.

And I needed it. I felt bad when I destroyed a bathroom and needed someone to clean my backside. In fact, I was quickly reminded that I was the one making it a big deal and my assistant was just there to do his job.

I encountered a bunch of specialists too. Phlebotomist, xray technicians, even transporters. They were all cordial, unflappable and a big help. I thought, “everyone here is smart. How is that possible?”

One Week post surgery

It is officially one week post-surgery. My days are pretty good. Though, like other people I know who have had big surgeries, the end of the day is the roughest. I am happy when my head hits the pillow; I feel the best when I get up. Showers are possible and good too.

After surgery, you have chest tubes that drain any fluid from the cavity that houses your heart and lungs. You can imagine there is minor bleeding for example. These three tubes press on your abdomen and diaphragm, making eating unappealing which means pooping is not happening. They are long tubes that take up a lot of space.

Each day, my first activity was a chest xray in my bed. This was to verify that my lungs were expanding and not full of fluid. The second thing was a visit by Chris Burke, U of M grad who was Dr. Verrier’s resident or a fellow. His hand was in a cast. He said he broke it and a bone in his neck and/or back in a motorcycle accident. He might be 30 years old but that’s crazy. Get off the motorcycle. Very nice guy who always called me Mr. Langlois.

I was at my psychological low point on Saturday when he told me that my tubes could not come out. They were still draining too much in two of the three. That meant I was there at least until Monday. It was now obvious that I would need to adapt to hospital a bit more in order to get some rest. Hospitals are not restful places. I knew that I would be better at home for sleeping and eating but that was not possible for another couple days. That sucked the wind out of me.

Surgery Success

I lived.

I am at home recuperating from AVR (aortic valve replacement) with re-do Sternotomy. It was a helluva a couple days in the hospital following nearly 6 months of jockeying around with an insurance company.

I won’t say I feel great. But considering how bad I did feel, I am really happy to be home with normal smells, tastes and the possibility of some more consistent rest.

I am in some pain but not much. I have an incision in sternum and an in my groin. The sternum is wired together as it will be for the rest of my life with either these wires or ones from another operation. I have had those other wires for 13.5 years. You have an initial period of limitations followed by none as long as you follow the program and not overdue it.

Basically you cannot move any more than 5 pounds in each hand for 6 weeks. And you can’t swing a golf club, do pull-ups, or swim for 3 months. I can manage all that.

Mostly I am tired. Your body is apparently smart enough to put it’s energy back into repair.

This is my second sternotomy so I know what to expect but the reminder that everything will make you tired is a bit of distant memory.

I am emotional. I’m reading Boys in the Boat and I get all weepy. Every little tiny human gesture makes me blubber, a bit and say “that’s humanity. that’s beautiful.” This happened before too but it feels a little more uncontrollable right now. I know this my mother’s revenge on me. Good one, Noreen. I never saw it coming.

Energy

The willingness to sit here and type this is minimal. I could not give a shit about “work” or really anything more indirect than the pure joy I get from a piece of fruit.

I also remember that feeling and my docket is pretty clear. In fact, if it took me three days to write this, what do I care?

The feeling of a supportive family and friends is a wonder and I’ll take what I can get. Just don’t expect much in return right now.

Time in the hospital is broken into 12 hour chunks. And Surgery is separate from Hospital. You are in surgery then you are in hospital. Nurses just want to know what day you are in. Second day post surgery might be one way to say it. When you say, “it’s my third day.” They say, “It’s only your second.”

It’s one of the first places you see them making things easier for you. I was in ICU Wednesday, following surgery. By late in the midnight, out came my breathing tube. Worst part of the whole thing.

Thursday, I was still there in “Day 1”. Before I could move, I had to have my Foley catheter removed and that means getting up to pee yourself. I got a reprieve until noon thirty. You are full of fluids so you will pee. But now, it’s on you to get up.

Friday I was downgraded form ICU to floor care. You get a different nurse, who have more patients and cannot pay as much attention to you, because you are not as ill. When a bed is ready, you get moved.

By Friday afternoon, I was moved to a cardiac care floor, out of ICU care.

I walked all the way from 5 South to 5 North, following me with a wheelchair. I got a sponge bath. I was soooo happy.

After that, I knew I was on a checklist. ~~Pee~~, poop (which means eat) , wires, tubes. Walking. Wipe my own butt.

Walking

My first attempt to walk was back in ICU. It was with a PT. I did everything right and in due time. Then I just passed out. It made a lot of people nervous. I just found myself back in bed with about 4 or 5 people over me looking really concerned. Probably dehydration.

I am now walking at home for barely 6 to 7 minutes at a time. This is one of those sober up moments. You can’t do more.

And that’s brings me to the end of today.

Schedule is set

This is the old good news, bad news routine.

Good news – my heart surgery is scheduled. Bad News – it will be the open heart variety that is invasive, not the TAVR that would have been minimally invasive.

The date is Sept 21. Why not? I’ll be 54 by then. So in thirteen years, I’ll be 69 when I need maintenance if this new valve lasts as long as the last one. And then, I’ll be older and the TAVR will probably be the magic bullet. So instead of waiting until my almost 70 to have a sternotomy, I’ll do it now.

The other upside is that I will get the maximum size valve now allowing for even more room in the future and good ejection rate now.

The downside is that the surgery is rough and a long recovery. I’ve waited about 3 months for something to happen so I’m glad something is happening.

On May 26, my original surgery for May 27 was cancelled. The insurance company, Premera, denied coverage for that surgery. Since then, I have been going through an appeal process. This has been tough but in the end, unsuccessful.

Because this TAVR procedure has been performed mainly in people in the upper age range. (average age is 86), the results are a bit skewed. They don’t really know how long the valve will last (called a performance characteristic). So the questions of cost, how long the valve lasts, the recovery time in the hospital (apparently this is a large chunk of the costs), this is all more heavily influenced by the older population receiving the valve.

In the older population, the average stay for TAVR is 5 days; The average stay for SAVR (so-called open heart) is 7. Not that different. So the cost doesn’t turn out to be that different. In my case, the stay would be 1 night with the TAVR barring complications. But no one really wants decisions based on one case. Otherwise that works for the insurance companies too. They could force you to have the cheaper option. What’s good for the goose is good for the gander.

The net result is Premera will pay for a sternotomy (crack the chest) surgery SAVR and not the TAVR.

Most likely that will also mean that future TAVR valves will be a no brainer option. They will advance in 15 years and the technique will become the norm. Plus, if I’m lucky enough to be alive then, I’ll be older. I’ll be chasing down the population in which the valve is the preferred option.

I had accepted this possibility a couple weeks ago when we were sent the official denial letter. It seemed inevitable that I would have the big surgery. But hearing it from the doctor was very different and a little bit tough. However, I’m glad I won’t wait to long. They said, “how bout next week?” Which was kind of amazing but also a bit too soon.

I hope to be out of the hospital by around Monday, Sept 26th. I can’t lift anything heavy for 6 to 8 weeks, including a tuba. Around Thanksgiving I’ll be back to being more like myself.

After I get out, I’ll let everyone know that I lived.