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.

Let’s look at some of the questions that cross a person’s mind when he or she is first told heart surgery should be considered.
•    Is surgery really necessary?
•    Why do I need surgery when other people have
angioplasty?
•    What will happen if I decide to delay surgery?
•    Am I strong enough to undergo surgery?
•    Might the surgery itself increase my risk of heart
attack?
•    How bad will it hurt?
•    How long will I be laid up?
•    What can I do afterward?
•    When can I go back to work?
•    Will I be on permanent disability?
•    Just how did this happen to me, “when I’ve always watched my weight and diet and taken good care of myself?
•    How complicated is this surgery?
Heart surgeons hear these questions often. But tl–se questions too often, out of fear and uncertainty, remain unasked. And sometimes, we’re sorry to say, as a result of the doctor’s haste or indifference, they remain unanswered. So, while we have Dr. Brenner around, let’s talk to him, patient to doctor, and see what we can learn. We’re going to imagine you as the patient.

GENERATIONS OF STRONG and successful African American men and women can testify that faith in God and a solid understanding and knowledge of the matter at hand can conquer any fear and move any mountain. In matters of heart surgery, the more you understand in advance, the better. At the same time, on the surgical table, faith-whether faith in the Lord or faith, through knowledge, in the surgical procedure itself-can move mountains. Naturally, when it comes to having somebody cut you open to repair parts of your body that have never seLi the sun, you may not be up to hearing a lot about it in advance. In fact, the moment you learn your heart is in trouble is likely to be one of the toughest experiences you ever have to go through. It’s a moment when everything starts moving very fast, as your ordinary life comes to a screeching halt.

Trouble can come in a rush. Bertha Turner had been busy cooking her traditional Sunday dinner, looking forward to the gathering of children and grandchildren. It was the high point of her week. As always, she was doing it all herself, though her daughter and daughter-in-law asked every week if they could come over to help her. “Honey,” Bertha would always say, “when I can’t cook Sunday dinner without help from my children, well, that’s the time for me to check into the rest home.’ When she put it like that, the younger women just had to le: her have her way.
But that Sunday the same old pressure and tightness in he chest that she never talked about to anyone was back-so bac that she had to lie down. When her husband found her, he saic “Girl, something’s the matter for sure if you’re not in the kitche’: at 3:30 on a Sunday.” “Nothing’s the matter,” Bertha said, more worried about hir; than she was about herself. “Just that I feel a little tired and rr breathing’s not what it ought to be. Maybe, just to be safe, yc can drive me to the hospital for them to take a quick loo. Anyway, everything’s in the oven. No need to call the childre: We’ll be back before they get here.” Once they arrived in the emergency room, you know t. drill. The ER (emergency room) physician examined her, cali: in a cardiologist, and ordered blood work and an EKG (elect: cardiogram). All this was happening quickly, and by now BeL knew that she wouldn’t be home for her Sunday dinner. It die take long for the tests to clinch that. It was the cardiac catheterization that told the cardioloc Dr. Brenner, what he had to do. That test, a dye study of the he. showed that all the major blood vessels were blocked. Dr. Bren: showed the films to Mr. and Mrs. Turner. “What these pictures say to me:’ he told them, “is what you must suspect already. You need surgery, Mrs. Turner, and, though I wish this weren’t so, I can’t give you a lot of time to think about it. If we don’t do the surgery, you’re going to have a heart attack. That’s clear. That’s what you’ve been feeling-angina is the heart’s way of warning that it needs attention quickly. If you need to think about it, I can give you until tomorrow morning. All I can say is that there’s no doubt in my mind. Any heart doctor looking at these pictures would tell you the same thing I’m telling you.”
The Turners looked at the surgeon for a minute or two, unable to speak. Then Bertha broke the silence: “What are my chances of getting through the operation?” “Ninety-five percent, Mrs. Turner, if I want to be conservative:’Dr.Brenner replied. “But to tell you the truth, I’d put it closer to 98 percent.”
“Well, that’s good:’ Mr. Turner said. “Those are good odds.” But Mrs. Turner wanted time to think. “Odds are for horseraces,” she said. “If you don’t mind my asking, Dr. Brenner, could you tell me how many of these operations you’ve done and how they came out?” Dr. Brenner told her, and then he explained the complica-
tions that could arise-that is, he gave her a glimpse of what could go wrong and what could possibly put her in that frightening 2 to 5 percent. “You come back in the morning:’ she told the doctor, “and I’ll be ready to talk.”
But when Dr. Brenner left, she turned to her husband and said, “They’re not doing any heart surgery on me. I’m putting my life and heart in God’s hands only.” It was her daughter who finally persuaded her to have the surgery. “The Lord helps those who help themselves, Mama, and if you don’t let them do this operation, you’re not helping yourself.” When Dr. Brenner arrived in the morning, Mrs. Turner said. “Okay, then, you do what you have to do.” And her husband put his head down in relief.
“Tell you what,” Dr. Brenner said. “They’ll be here to get you ready in about an hour. If you’d like, I could come in just a little before that and you and I and your family could pray for you’ good recovery and my best skill. How about that?” That’s wha: they did an hour later. They made a circle and prayed to the Lore to take good care of Bertha and to guide the surgeon’s hand. Anc Bertha added a prayer that the Lord take care of her family if she: didn’t make it through the surgery.Before it was over, Dr. Brenner had pretty much remade the arterial pathway that fed Bertha’s heart-a coronary bypass times fiv(that is, five bypass grafts)-with no complications. Mrs. Turne was home, though not quite ready to cook, in five days. Lookir; ~ back a year later, during a checkup, she told Dr. Brenner tha: although she’d been scared to death, she was grateful to him fc a second chance at life. “It’s been better than the first;’ she said. “And I’ll tell you t.. truth, looking back-it wasn’t half as bad as I’d feared.” “You’d be surprised how many patients tell us that;’ I Brenner said.