Archive for February, 2015

About a month ago, my 74 year old father underwent open-heart, (aka coronary artery bypass graft or CABG, pronounced like “cabbage”), surgery to bypass 2 critically clogged arteries in his heart.  He was offered open heart surgery to save his life even though he had no symptoms of chest pain, dizziness, palpitations or shortness of breath.  Amazing, considering that the 2 critically clogged arteries (the left circumflex and the right coronary arteries) supplied 2/3 of the blood flow to his heart.    The events and decisions leading up to his surgery happened quite quickly.

He went in on a Friday for a ‘routine’ angiogram to further elucidate an abnormal stress thallium test from 6 years ago that he and his prior primary care doctor chose to ignore.  His cardiologist found the 2 critically clogged arteries that had ample collateral blood vessels (hence, he had adequate blood flow and did not suffer any chest pain or discomfort).  He was scheduled for bypass surgery by the following Monday, on Martin Luther King holiday.


In dad's case, his left circumflex was 90% blocked and his right coronary artery (RCA) was 80-90% blocked.

In dad’s case, his left circumflex was 90% blocked and his dominant right coronary artery (RCA) was 80-90% blocked.


My father, a busy businessman who continues to work harder than many people half his age, seeing clients 6 to7 days/week, meanwhile playing tennis several times a week, felt he did not have time to waste in indecision, waffling between which hospitals to have the procedure done or which surgeon to do the big operation.  He trusted his Vietnamese, IV League trained cardiologist, Dr. K, implicitly.

Dr. K has been his physician for over 15 years.  Nowadays with people switching insurances and primary care doctors so often, for me, it is a beautiful thing to bear witness to their sacred doctor-patient relationship.  It gives me hope that in the future we will still be able to preserve that level of intimate trust between patient and physician.  Being a very intelligent man, my father would always listen very carefully to what Dr. K had to say and if Dr. K’s recommendations made sense to him, he followed Dr. K’s orders.

To get to the heart, surgeons have to crack the ribs, and cut open the heart sac or pericardium.

To get to the heart, surgeons have to crack the ribs, and cut open the heart sac or pericardium.


So when Dr. K told my father that his 2 critically clogged arteries were NOT amenable to stenting and that he needed bypass surgery, my father (the busy, businessman, former Green Beret/Vietnam War vet) was unshaken.  He did not want to get a second opinion from a fancier cardiologist across town, in a more expensive zip code.  He simply entrusted Dr. K’s choice of cardiothoracic surgeon and he put his life/health in God’s hands.

His surgeon would be an Egyptian whose first name sounds like Allah but spelled Alaa which means “great one.”  I would call Dr. Alaa the great communicator because his best sales pitch to my father to have surgery was his spending close to an hour explaining his medical conditions and what he hoped to achieve with bypass surgery.  At the bedside, with several of us adult children in the room and my mom, dutiful by my father’s side, at every turn, Dr. Alaa explained everything so clearly and with confidence that my father had no reason to doubt he was making the right decision.

But before surgery could be done, dad needed leg vein mapping (so they could harvest his saphenous or leg veins); he needed to have his carotid arteries checked to make sure there wasn’t severe blockage.  He also needed a chest Xray, arterial blood gas and lung function tests given his remote history of smoking 40 years ago (but for 17 years when he was in the military, before he had 4 children).  All these tests Dr. Alaa coordinated in 1 day so that dad could go home for Saturday night to get 2 night’s good sleep in his own bed, only to come right back for the surgery on Monday.

Sure enough, his 7 hour surgery went well without a glitch on MLK Day.  “Free at last, free at last…daddy is free of clogged coronaries, at last?”  But his irregular heart rhythm (atrial fibrillation) and his labile (erratic) blood pressure would keep him in the intensive care unit for 3 more days.  Through it all, our beloved maman or mother sat by his bedside for most of the 8 hours during the daytime, everyday.  I would come to visit for an hour or so after work was done or after I had put Nam-Uy to bed.  It was on his second night in the ICU that we had a bear of a time trying to get his blood pressure down.  The diligent and capable nurse was on the phone with Drs. K. and Alaa throughout the night.

Mom and Dad snoozing off, while they wait indefinitely for the doctors to round .

Mom and Dad snoozing off, while they wait indefinitely for the doctors to round .

It has been 3 years since I did inpatient or ICU care.  I cannot say I miss the intensity of it all.  I CAN say that I am ever grateful for my father’s competent and meticulous physicians and ICU nurses.  As a practicing physician, I know way too many things that could go wrong in the hospital.  It makes me a bit anxious overseeing my father’s care.  And yet, I have to say that the lesson I learned from my father this time around was to have faith in others.  (It’s hard because having trained in the County system, and working in the third world on medical missions, I have witnessed many mistakes made or things left undone by clinical staff).

However, my father’s unwavering faith in his own cardiologist, surgeon and the nurses is infectious.   It would serve me best to adopt his unflinching faith in the healthcare system and staff.

As for mom, she is love incarnate.  Since dad has been home (5 days after his surgery), she has slept on the couch outside his makeshift downstairs bedroom (because he is not yet strong enough to climb the 2 flights of stairs to his bedroom).  When he gets up at night (due to insomnia or needing to urinate), she gets up to attend to him.  She has bathed him, tended to his wound and pain, and made him home-cooked meals that are low in salt and low in carbohydrates everyday for almost a month.

I don’t want to misrepresent my parents’ relationship.  They have been married almost 50 years.  They can be cranky and unpleasant towards each other but there is no doubt that their love is enduring.  It’s the gritty, I-don’t-say-“I love you”- kinda love.  Theirs is the rugged kinda love that stands the test of war, displacement as refugees in America, time, grown children and yes, even cardiac bypass surgery.

On this Valentine’s Day, I have so much to be grateful for.  Mostly, I am thrilled that my iconoclastic father is alive, with new pipes for blood vessels that will hopefully bring freshly oxygenated blood to his vibrant heart so that he can live long into his 90s as he wishes.

More so, my respect and admiration for my mom–her quiet patience and gentle kindness–is ever deepened.  And lastly, I have fallen in love with the art of medicine all over again.  My appreciation for all the men and women who dedicate their lives to tending to the sick is somehow greater, having had to advocate for my dad.  Being in and out of the hospital, then to the doctors’ follow up appointments for this past month, I am reminded of just how much we as clinicians and caregivers do to tend to the cajillion issues that patients present with.  The art of medicine is really a beautiful thing… and oh boy, am I glad that my father has some really skillful and caring medical artists on his team.

His overwhelmingly positive experience makes me less nervous about the next time we will have to return to the hospital or face a serious health problem.  For invariably as our parents age, they will be back in the hospital.

But rather than dread having to be the ‘doc in the family negotiator’ with the unenviable task of mediating differing siblings or family members, I am now more prepared and comfortable to navigate the next adventure…for many years to come, ‘God willing’ (as Dr. Alaa likes to say).


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