Patient: Please tell me why I need this coronary bypass operation, Dr. Brenner. Also, tell me what you’re going to be fiddling with, while you’re working inside me.

Dr. Brenner: Let’s start from scratch. The purpose of the operation is to improve the blood flow to the heart. By doing that, also decrease angina pains, decrease the chance of a heart attack decrease the chance of congestive heart failure, and, above a’. decrease the chance that the heart will stop suddenly-which, r: course, can mean instant death. So, by increasing the blood flow to your heart, we give you a chance fc: longer life and, at the same time, ” ease your fear of sudden heart attack

Patient: Can you tell me exac.. how you’re going to bring about , these good things?

Dr. Brenner: Sure. The basic icc is to build a bridge around the block. artery or arteries. In effect, we give t blood new channels to the area of ~. heart that has been deprived. T bypass graft simply provides a p .•. around the blocked artery.
Patient: I’m interested in ~ mechanics of this. You know, I fe. little like a broken watch who’s talking to the watchmake: mean, I have a real interest in the parts you’re going to put in how you’re going to rig them.

Dr. Brenner: Sure you do. It’s your body. Well, here’s a c, forting fact to start with. It stays your body. To be sure, we’ll to help it a little while you’re under anaesthesia-for instance, with a ventilator that helps you breathe. But the material for the bypass path (sometimes we call it a “tunnel”) is one of your own veins. Usually we take it from the leg. Once I have the vein, I attach one end to the aorta-that’s the body’s biggest arterywhich carries blood from the left ventricle of the heart to all the organs.
Then I fasten the other end of the bypass graft to the coronary artery-just past the blockage. So there we have the bypass. Now blood can flow easily past the blockage into the coronary arteries, to feed the heart the nourishment it needs in order to function properly.

Patient: Okay, that seems clear enough. Now maybe you can help me with this. When people talk about triple and quadruple bypasses, exactly what’s that all about?

Dr. Brenner: Well, the principle of the bypass operation is simple enough: to bypass what’s severely blocked. If two arteries are blocked, that usually means a two-way bypass; if three, a three-way bypass is usual. The more major arteries are blocked, the more bypasses I must do. But I bypass only seriously clogged arteries, and then, only if they are major arteries.

Patient: Yeah, well, that brings it down to earth. vVhen some friend wants to talk to me about their bypass operation, I guess part of me just doesn’t want to know too much. It’s as if by keeping ignorant I keep that bad luck away from my door.

Dr. Brenner: Well, I can understand that. When we’re afraid of something, we try to block it out, so we won’t worry about it. But look-I’m trying to be frank here. I wouldn’t want you to think that there was nothing to be scared of. You came to me because you were experiencing the symptoms a heart sends out when it isn’t working properly. That’s obviously something to take very seriously indeed. Now I’m recommending to you an operation that will probably make your heart work better and make your life safer. But let’s say, to use the national average, there’s 2 to 5 chances in 100 that I’ll fail-that is, that your heart will fail while I’m working on it. Finally, as if that’s not enough to think about, even if, as I expect and believe, everything goes well, I wouldn’t want you to think that your heart will be as good as new. It won’t be. It should be a lot better than it was when I fir: saw you. That’s all I can promise. That’s all I can try for.
Let’s step out of the dialog for a moment. You’re going to neec little time to take in what Dr. Brenner just said, and, as the case Bertha Turner makes clear, often that’s all you get-a little tir; How you take in the information will depend on who you 2. Calm and wise people react one way; impatient people re another way. There are macho ways and sincerely pious We selfish and generous ways, to respond to this situation. You’ll f your own because you must. We can hope and pray that we t wisdom and courage to handle this situation. Let’s go on.

Patient: Dr. Brenner, I’m as ready as I’ll ever be. I’ve talked it ‘ with my husband and my older son and we’ve agreed that I :to get this thing done. My next question is, What’s the drill?” should I expect between now and the time I wake up in the I’c . ery room?

Dr. Brenner: I’ve scheduled the operation for the day .
tomorrow, at seven in the morning. If the operation were late ask you to come in that morning. As it is, I’d like you to co; at one 0′ clock tomorrow afternoon. That gives us time to few last-minute tests and to provide some presurgical tea, But I’m going to work some of that teaching into the disc we’re having now. Ready?

Patient: Sure. I’m going to be your best student.

Dr. Brenner: Okay. Practices will vary a little from or c tor to the next, but here are the basics. I’ll have an electro: gram run on you, just to make sure that there have be. significant changes in your heart rhythm and heartbeat.have another chest x-ray done, to make sure your lungs are clear and there aren’t any abnormalities there. I don’t want any surprises in the operating room. We also need to type and cross your blood-that is, to make sure we get a safe blood match, because you may need transfusions during the operation, and sometimes we get the blood from the blood bank, where we know that it’s been tested and is safe. But, as a double precaution, we prefer to collect your own blood that is lost during the operation with what’s called a “cell saver:’ We then give it back to you in the operating room after the operation is over.

Patient: You guys are really into recycling, aren’t you?
Dr. Brenner: Yes, we are. We want to keep your body as close to the original model as we can. But let me tell you a little more about the blood tests. They will also tell us your electrolyte count-electrolytes are chemicals in the blood that keep your cells healthy-and let us check out your nutritional status. One of the blood tests will tell us if your red blood cell count is high enough to allow you to undergo
surgery.
Another kind of test we’ll have performed-and it’s a very important one-is a pulmonary function test-that is, a lung test. We need to know how well you breathewhether you have any lung problems.
If you do, the operation becomes a little more dangerous. An odd fact-don’t ask me to explain-is that African Americans who smoke fare worse after surgery than do white Americans who smoke.

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