Rubin: A change of heart, 5 years on

Neal Rubin
The Detroit News

The colors were different than what you’d expect when you peer inside someone’s chest.

Working with nurse Jen Sheroski, surgeon Nicholas Tepe harvests an artery during a bypass operation at Beaumont Hospital.

Carl Friebel’s lungs were pink, just about every shade of it in the crayon box. But his heart looked yellow — even before it stopped beating.

Friebel, 81, had triple bypass surgery last Monday at Beaumont Hospital in Royal Oak. It was a standard operation, the second of the day for a team that did five for the week at a hospital that will see 750 open hearts in 2016.

I watched his because I’d been in no position to see my own, and I wouldn’t have wanted to anyway.

Five years ago today, I underwent a quadruple bypass in the same hospital. I was oddly unconcerned at the time, with an optimist’s faith that I’d be fine and no particular interest in the details.

Over time, I grew more curious about what I’d missed — which is how I came to be masked and hatted in the North Tower, second floor, operating room No. 3.

There was a surgeon in charge who starts his morning with exactly 8 ounces of run-of-the-mill coffee — no more than that and no Starbucks, because you can’t sew tiny vessels to one another with shaky hands.

There were two physician’s assistants, harvesting 20-plus inches of vein from Friebel’s inner left leg in a procedure that seemed almost as much like snaking a drain as performing a medical marvel.

There was a nurse named Holly Wood who still shivers in the chill of the operating room and who dialed the visitors’ lounge every hour or two to give updates to Friebel’s family.

There were as many as four other teammates, each quietly doing something invaluable. And there was the heart, saddled with damaged arteries, still and vulnerable and no, not really yellow.

“There’s a layer of fat that makes it seem that way,” said Charlie Larnard, the assistant who threaded the auger up to Friebel’s thigh.

They all look like that, mine included.

Mine was hampered by a 91 percent blockage in the artery ominously known as “the widowmaker,” and enough trouble lurking in three others that simple stents were not an option.

Someone showed me a rudimentary outline of what would happen — a photocopied picture of a heart, with some lines drawn on it — but I barely gave it a glance.

They do these operations every day, I told myself. They’re good at it. It’s a dance routine, and they know the steps.

That’s true, it turns out — and also woefully incomplete.

Of hearts and heroes

Friebel is a former General Motors engineer from Troy who hasn’t used a computer since he retired.

Like me, he arrived at Beaumont thinking he might get a stent or two and wound up days later with his breastplate wired shut. Also like me, he had occasional chest pains that he ignored and that his wise primary physician pounced on.

He shared a room before his surgery with the man who underwent their surgeon’s first operation of the day. “He’s practicing on you,” Friebel told him.

The surgeon, Nicholas Tepe, was well-practiced already.

Tepe, 61, grew up in Delaware in an era when “heart surgeons were heroes”: Denton Cooley, Michael DeBakey.

He went to Harvard with future Chief Justice John Roberts and an eventual dropout named Bill Gates, attended medical school in Philadelphia, and moved to Michigan in 1987 because he had a sister here and Beaumont offered him a job.

Since then, he has worked on some 5,000 open hearts, most of them in need of a bypass.

At this point, “It’s like piloting a 747 to Paris,” Tepe said. “Something always happens — but nothing can happen that you haven’t seen before.”

Under the breastbone

Tepe has a collection of colorful, nurse-made surgical caps, the closest thing in an operating room to Hawaiian shirts.

For the morning surgery, the pattern was autumn leaves. For Friebel, it appeared to be the old west, but it was hard to know for sure because of a bulky headpiece that reminds Tepe of the Creature from the Black Lagoon.

Made of gray plastic, it’s fitted with a spotlight, a camera, and protective glasses with a high-powered magnifying loupe in the middle of each lens.

By the time he walked in wearing it, Larnard was tunneling through Friebel’s leg and Friebel was unrecognizable.

His body was swathed in Ioban, an antimicrobial drape that made him look like an orange-tinted mummy. His face was covered by sterile blue fabric sheeting the consistency of a picnic tablecloth.

For the next three hours, he wasn’t so much a person as he was a series of challenges.

Cut the breastbone with a power saw. Peel back the ribs with a hand-cranked stainless-steel retractor.

Activate the heart-lung bypass machine that removes carbon dioxide from the blood, adds oxygen, and pumps the blood back into the body, doing the heart’s job while the heart is otherwise occupied.

Attach the grafts that will circumvent the blockages, connecting passageways 1/10 of an inch in diameter.

Turn weeks of life expectancy into years.

Surgery soundtrack

Conversation in the operating room was muted and minimal. Thirty-six minutes after Tepe began with a delicate vertical slice, he said, “Vein, please,” and it stood out as a long sentence.

There were no instructions. When Tepe held out his right hand, surgical technologist Jen Sheroski put an instrument in it. When Tepe threaded wire through the incision, Larnard snipped it.

Tepe likes to work to an ’80s soundtrack, “but you can only listen to the ’80s for so long,” said Wood, who decided when she married that it was better to become Holly Wood than to remain Holly Staperfenne. Sheroski chose the music instead, via Pandora, and it was country.

There was none of the chaos you see on television, and minimal blood: a few drops on Tepe’s gloves, a splatter on the leg of assistant Bob Johnson’s scrubs, another odd splash on the floor.

Tepe ran through 39 of the 18-by-18-inch gauze cloths known as sponges, often using them to check what spots still needed to be tied off or cauterized, but the crimson seemed contained even as Sheroski tossed the sponges into a plastic tub.

Occasionally, there was the smell of burning rubber, though it wasn’t rubber that was being burned.

Then it was over. Friebel’s heart began beating again. Larnard and Johnson finished closing the gash with black thread that turned red as it pushed through tissue and muscle.

“Was it kind of scary?” Tepe asked. “Can you see yourself going through this?”

In order: No. Somehow, it was fantastically ordinary, more reassuring than frightening. And: ideally, not again.

Looking to future

Five years after I woke up swatting at the ventilator tube forced down my throat, I have a narrow, 71/4-inch-long scar on my chest and a happy cardiologist.

After 50 years of eating like a pirate, I have embraced vegetables, or at least some of them. If I eat a burger, it’s turkey or low-fat Piedmontese beef. Fish is my friend.

The Schwinn Airdyne in the basement has become an exercise bike again, rather than a coat rack, and I’m down 25 unnecessary pounds. I have some numb spots on my chest where nerve endings never reconnected, but I figure that only matters if I get hit with an arrow.

As for Friebel, he took his first walk down the corridor of the ICU on Thursday morning.

He was sitting in the chair in his room later with a pillow clutched to his chest and stitches showing above the top of his hospital smock. His 58th wedding anniversary is Tuesday, and he’ll spend it on the cardiac floor or in the rehab facility where he’ll be sent to get stronger.

Earlier in the week, “I didn’t have a good heart rhythm,” he said, but that’s why bypass patients have two slender electrical wires sticking out of their chests. A quick jolt with an external pacemaker set him straight.

Breakfast arrived: a bagel, vanilla yogurt, coffee. The TV was on, but the sound was down and he was ignoring it. The program was a talk show called “The Doctors.”

Three days earlier, I had seen his heart. Now he was sore and tired and hoping someone would bring him an electric razor, but sunlight was streaming through his window and he was thinking about tomorrow.

Twitter: @nealrubin_dn