Walking the Long, Red Hallway (preparing for open heart surgery)

The month before I had open heart surgery on Oct. 30 is mostly a blur to me now, as I write this 60 days after the fact. The feeling I recall is that of a procession down a long hallway with crimson rugs and no light at the end. During that time, I made a point not to dwell on a future that couldn't be avoided. I wanted to savor the beautiful fall days as best I could, knowing my physical ability would be very limited for at least three months after surgery. I climbed. I hiked. I partied my heart out. Then I would go to bed and try to sleep easy, but of course that became more difficult. I'd lie on my back and imagine the foreign experience of being put to sleep, knowing my chest was about to be sawed open and that there was a small chance I wouldn't wake up. That sounds dramatic, and it is. Rationally, I knew two things. First, I had no choice about the operation; the doctor said I would die in a year otherwise. If you're dead for sure not far down the road, it's easier to accept a small chance of it happening during surgery. Second, even though hearing that I had "a 1 percent chance of death" sounds scary in any context, it was in fact a very small chance – the odds were in my favor. A 1 percent chance of death was small potatoes compared to the odds I faced while commuting winter highways to work for four years.

I decided I didn't care what would happen to me once I went to sleep on the operating table. That was out of my hands. I had the most trouble sleeping about two weeks out from the surgery date, and once I made up my mind not to care and to trust the surgeons, I actually had better sleep in the week leading up to it (or at least I felt more restful).

But I'm getting ahead of myself.

My fiancée and I were initially giddy after meeting with the surgeon in late September.

"Yup, it's time," said the doctor, pulling out his calendar and writing down the date as if it were a flight to Phoenix.

It was a relief. Up until then, I had been having constant underlying chest pain, like an internal cigar burn, or as if someone were pinching and twisting the trunk of my aorta. At that time, I was rock climbing up to 5.13d two or three days a week, still believing open heart surgery was at least two years away, like the docs had predicted. However, my heart condition was deteriorating faster than anyone guessed. When they first noticed the problem during a routine physical three years earlier, the prognosis was a valve replacement in 10 or 20 years. The next year, it changed to five or 10 years, then two or three years. Ultimately I had the surgery 10 months after the last prognosis of "two or three years."

Truly, September was the scarier month because there were so many unknowns. All I knew was that my heart was in constant pain, and even then it took me a couple weeks before I admitted it out loud to Mandi. The next step was to see a doctor as soon as possible. No small feat, since I had left my previous cardiologist for professional and personal reasons (quite a story in itself), and was in a medical no-man's land. The one thing that really saved me time was the fact that I had bothered to research and find my heart surgeon well in advance. I'd almost put it off, believing my operation was still years away. So when my heart pain started in August, I at least had that key resource lined up in Denver. The weeks before seeing my surgeon were frightening. Intuition told me I needed a new heart valve sooner than later, maybe by Christmas, and in the meantime, I wasn't sure if I might drop dead from an aneurysm or something.

"No, you won't drop dead any time soon," said the doc. "You might pass out if you're exerting yourself too much, though, so be careful about situations that would be bad if you lost consciousness."

Mandi and I walked out of the hospital laughing with relief. It was great to be assured that my exact condition was known and measurable, and we were set to fix it. 

"It'll get harder before it gets better," Mandi reminded us as we celebrated in the car on the way home. It did.

The reality took a couple weeks to set in. I arranged for time off work and we figured out how Mandi would take care of me once I came home, but it still didn't feel real. Then I started lying awake at night. One thought that kept me up was the memory of having my wisdom teeth removed when I was 19. I have a distinct memory of waking up slightly during the operation, as they cut into my jaw and pried the teeth out; I remember feeling sharp, cutting pain but being too far away, too drugged, to do anything about it. I worried I might experience something similar during open heart surgery. (I didn't, and there really was no need to worry.) The thing is, there is nothing like a quiet, dark room to let the brain wade into the muck of imagination. Apprehensive thoughts about the impending procedure would pop up, and it was all I could do to dismiss each one. It was a meditative test to focus on the simple and positive aspects of my immediate living situation.

That's why, in spite of the risk of passing out, I continued to rock climb all the way up until the week before surgery. I mitigated the added risks by informing my belayers, and by controlling my environment as much as I could. I only climbed in Rifle Mountain Park, where all the routes were well bolted, mostly overhanging (I wouldn't hit any ledges if I fell) and close to the road. I sure as hell wasn't trekking into the middle of the desert to climb tall, crumbly towers, though it was a tempting idea with the awesome weather we were having. Most importantly, a significant portion of my mental awareness was dedicated to monitoring my heart condition as I climbed, being careful not to push myself too hard. This prevented me from climbing at my highest level, but there's no question that I had as much fun as ever, onsighting up to 5.12+. I was powered by unquenchable psych, literally enjoying every minute outside.

Three nights before my pre-op appointment in Denver, I ran out of ways to ignore my fate. I did my best to not think at all and just put one foot in front of the other. Everything was already decided. Might as well stay in the moment. This is where it was very helpful to have friends and family at my side. I was even lucky enough to have a close cousin who lived five minutes from the hospital. David and his wife, Chea, took us in on the nights leading to the operation, which provided a great deal of comfort and laughter.

Another thing I did to prepare myself was to make a five-hour playlist on my iPod, which my surgeon said I could listen to while I was under the knife (they let me listen to it until I was knocked out and then removed the earbuds to keep them out of the way of other equipment). I didn't just slam random music on the playlist. I selected everything very carefully. I included some Pink Floyd songs, which can get a little dark, but generally everything was more upbeat than not. I put in a lot of classical music as well as Madonna, Elton John and Creedence Clearwater Revival. Though I didn't get to listen to much of the playlist during the surgery itself, it proved invaluable in several ways, the first being that it was a good to way to think about my impending experience and come to terms with it emotionally, since I was investing hours into the music. It also helped me go into the operating room feeling happy and ready, and came in handy again during the first night in the ICU, in which I was not really awake and not really sleeping; I was just "floating on morphine," as they say, and the iPod gave my brain somewhere to go outside of the room and all the IVs and machines.

Anyway, back to my pre-op appointment, the physician assistant (PA) gave me two things after all the preliminary blood tests and CT scan – a breath incentivizer to practice with before I was required to use it during recovery, and a biohazard bag that contained a plastic container with powerful, red liquid soap. The PA told me to wash myself with the soap before bed that night and the next morning before my operation. This is where my emotions really came to a head.

Pouring the red, burning soap over me in the dark hours of the morning – my hospital check-in was at 5:30 a.m. – added to the feeling that I was preparing myself for some kind of execution. I imagined what a death-row inmate must feel like as his head is shaved for the electric chair. In the shower, while everyone else was still sleeping, it was as important as ever to turn off my thoughts and reduce all mindfulness to the action at hand, even telling myself out loud that the surgery was going to go fine and that I was going to be so much better down the line.

When we checked into the hospital, Mandi was the one having trouble. She'd broken down in tears while I was driving us to Denver, too, and I had to be strong for her. It would be unnatural to not expect loved ones to have their own challenges as they try to support you. Everybody holds everybody else up. Be ready for those emotions. Don't pretend like they aren't there, or who knows how they might come out.

There was one last moment in which I almost broke down before surgery. I'd been prepped, with IVs in both arms, and a nurse started my iPod while Mandi held my hand and we stared at the clock ticking toward the fateful hour of 7:30 a.m. The first round of drugs entered my system with AWOL Nation's song, "Sail," ringing through my head, and suddenly tears welled up behind my eyes: This was really happening. I was about to enter a great unknown, departing from the life I knew before, never to be the same again. I breathed deep to keep myself together for Mandi, and just then the anesthesiologist came in. I paused my iPod to shake his hand. Turned out I knew him from when he used to climb at Rifle back in the day. We talked climbing for a few minutes and cracked some jokes. Everything suddenly seemed fine. I was ready.

The clock struck 7:30 and the nurse pushed my bed into the long hallway just as Pink Floyd's "Learning to Fly" came on. The lights streamed past overhead and I might as well have been floating into the huge, silver room.

Whatever it takes to feel happy when that moment comes – however many hours of editing music or mentally letting go of all the control you wish you had – it's worth it. That is the moment you're preparing for. The rest is in the doctors' hands for the next three to five hours.

Note: This is the second entry in a series about my experience with open heart surgery. The next installment will focus on what my family went through in the waiting room during my operation.