Advice from a Bypass Buddy

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Dear President Clinton: welcome to the confraternity of the cabbage (that's slang for "coronary artery bypass"). The first thing you've noticed is that it hurts. It feels as if someone with the best intentions has shot you in the chest. Discourage people from telling you jokes; don't laugh. Stay still; when you walk, do it carefully. When Henry Kissinger got out of bed after a bypass years ago, he remarked, "Diss vass a bitch!"

There are millions who bear the marks of membership — the zipper scar down the center of the chest, another long scar worming along the inside of the leg where the tubing was stripped out to jury-rig the heart's new plumbing. (Over the years I have had two multiple-bypass operations, done in the same hospital where yours was performed. My last operation was 11 years ago. I played squash last night for an hour.)

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Jan. 17, 2004

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The operation is routine--300,000 performed every year. If you are the patient, however, it does not feel routine to have your chest cracked open and, after a period of pleasant blackout that seems to last an instant (and that later makes you think it's what death and eternity must be like), to come swimming back up into consciousness shaking uncontrollably from the cold. (Your body has been packed in ice for the procedure.) A coronary bypass is routine for the surgeons but memorable for the patient.

I trust that you have recovered from the usual dignity-nullification — the hospital gowns that part in the back and so on. As a former President, you were doubtless entitled to nurses who knew how to find a vein on the first jab when drawing blood. The rest of us took our chances with new interns, who made random, increasingly berserk needle stabs while we lay there struggling to keep still, thinking that this is like watching a freshman philosophy major trying to slaughter a chicken.

Home proves more difficult somehow than the hospital. The house seems an empty shell. It surprises a strong, active character to find himself feeling weak in a way he never has before — flatline exhaustion, the descent of an Ice Age. You shuffle like an old man. You feel light as a leaf — a breeze would knock you down. The body's resources are busy repairing damage and do not have time, so to speak, for you.

The man with a bypass — a primitive but miraculous piece of work — has had a premonition of death and now entertains a fragile sense of rebirth: bad news and good news mixed up in a disconcerting way that you have to get used to. You have the metaphysical sense of having become a different person (you have certainly, at least for a time, stopped being a patron of Burger King), and you may sense that the rest of your life is borrowed time — an extension purchased by surgical slice-and-splice. Your life feels provisional and may be canceled at any time. You wake in the night listening for the burglar downstairs, the noises of your now alienated heart, wondering if it is going to tiptoe up the stairs and kill you in your sleep. It is a lonely business.

In a week, sharp-stubble chest hair is growing back over the livid Frankenstein cuts that the surgeons made. After a while you will absentmindedly rub the chest scar and feel the rough place where the bones rejoined, and your shirts over the spot where you rubbed will be pilled and slightly discolored — a sign of the brotherhood, like the mark on the forehead of a pious Muslim made by touching the ground in prayer.

But your body has become a stranger to you — as in film noir, when intimates might betray each other for the insurance. It is, forgive me, like an episode of adultery in a marriage; it hurts a lot. Trust must be re-established. Things will never be quite the same because both your mind and your body will remember what happened that time. (The body has its own kind of memory.)

You may find yourself falling into illogical depression and inexplicable rage. We all should be grateful for this gift of time, but for some reason the operation lays one emotionally low. Watch it. But most of these things — the weakness, the rage — will pass. You will probably start eating burgers and using salt again, and entertaining the only slightly chastened idea that you are immortal. You will think yourself bionic. Strength will return. The adaptable heart will develop what they call collateral circulation (clever new paths of blood flow), and you will find yourself thinking about rafting down a wild river or climbing Everest (don't do it, not enough oxygen), in order to road test your wonderful new coronary gizmo.

A bypass operation, in any case, turns the Comeback Kid into the elder statesman of the baby boom. In a new leadership role, you march, each day with springier step, at the head of your generation as it embarks on the next chapter of its saga — pushing on into the unexplored territory of the golden years, a vast army of refurbished geezers.