Venetian Heart Surgery
2 October 2018
Since the end of our tour of duty with the U.S. Navy in Naples, Italy, in 1986, we have frequently longed to return to our favorite foreign country as much as possible. We miss the awesome food, the beautiful language, the delightful people, the landmarks, the history, the archeology, the unsurpassed art, the music, the grand architecture, and the creative driving. Nearing retirement age, we have been blessed with the means to travel in style as well as take exclusive tours that cater to those with high expectations.
What one expects in life can sometimes be far from what actually transpires, and in this case thereís no one to blame. Our usual travelogue is not possible for this visit to Italy.
Our first flight of this trip left Fort Smith at 7 a.m. on 21 September 2018. This was our 6th return to Italy since 1986.
In mid-2017, we were invited to participate in an exclusive dream vacation with a small group of tourists who had already seen the major sites of Italy. It was ideal for us. We paid in full to be included and we got some extra privileges by signing up so far in advance. The tour was led by Mark Story, the owner/operator of Story Land and Sea. We canít say enough about how helpful he was to Jeannie after our arrival in Venice. (Weíve been twice before to Italy using Markís tour company and we highly recommend him to those with the means to enjoy this kind of vacation.) We hadnít met Mark since he was about 7 years old and we were eagerly anticipating getting to travel with him. Mark was running around the house as young boys do when Michael and Jeannie first met at Markís cousinís house in Clinton, Arkansas, in 1974. Michael knew right away that Jeannie would make someone a great wife one day. We were just teenage country kids at the end of our first year in college. (Best we remember, we totally ignored Mark and most of the other guests, as well.) Michael really hopes there is opportunity to see the adult Mark someday.
How did a physician get himself (and his wife) into the disaster which is described below? More than a decade ago Michael was diagnosed with mitral valve prolapse after a heart murmur was discovered. Lots of people have this and it rarely amounts to anything. Michael should have followed the Cardiologistís advice and had an echocardiogram annually, but after having no change year after year (and thinking he had ďmore importantĒ things to do with his time and money), he didnít have another echocardiogram until about 3 years ago when he started having occasional irregular heart beats that were not really very bothersome. He followed instructions and started taking Metoprolol 25mg once daily and repeated the echocardiogram the next year. Since his heart seemed to be doing very well on the medicine, he returned to ignoring the annual testing. (You may have heard that doctors are not good patients.)
Prior to getting on the airplane in Fort Smith to begin this long-awaited trip, Michael felt no different than other trips where we leave home so early in the morning. He just felt tired and figured he could rest in Venice where we were arriving 3 days before our tour was scheduled to begin. Truly, the first sign that he might be stressing his heart occurred when he was unusually short of breath as he walked into the terminal at DFW. On the next flight (to Philadelphia) he noticed that eating lunch was difficult due to mild weakness. While sitting still, he had no shortness of breath. Jeannie had to carry his backpack through the terminal in Philadelphia from arrival gate to departure gate because by this time he didnít have the energy to walk, breathe, and carry the extra weight. We discussed whether we should cancel the trip. Michael was determined that he just needed to sleep. We would forever regret not continuing the trip if after 3 days he felt normal. At this time he took an extra Metoprolol, hoping it would slow his rapid heart rate without dropping his blood pressure. While waiting for departure, for an hour he sat working on patient charts on the computer and felt much better.
After getting aboard he decided to skip supper so he could have more time for sleep. Every time he would fall asleep, though, he would awaken to take several deep breaths after what felt like only a few seconds of sleep. At this point he knew he was in trouble, but it wasnít until about halfway over the Atlantic that he started experiencing his first heart pains, which at first would quickly go away by taking some deep breaths. When he told the flight attendant that he wasnít going to eat breakfast, she asked if he was all right, and he told her he would explain after she finished serving everyoneís meal. After informing Jeannie, he told the stewardess about 8 a.m. that he was having bad chest pain and that he would need to be taken to the hospital immediately after landing in Venice in about 30 minutes. After getting his permission, she announced that a doctor or nurse was needed. Within seconds a Cardiologist from Philadelphia (Dr. Howard Rosner), a cardiac nurse, and a surgical nurse were checking him out, giving him oxygen and starting an I.V.
A normal passenger would have likely promptly advised the person they were traveling with and the plane would have landed at the nearest city with a good hospital. Weíll let you judge whether Michael was courteous to let those hundreds of passengers get to their vacation destination on time or whether he was the chief among fools for taking such a risk of life. (Michael has absolutely no fear of dying, trusting the promise of a better abode in the Creator and Saviorís presence.)
Michael was unashamedly wheeled from the plane to an ambulance on the tarmac. At this point, we really didnít know how serious it was nor that his mitral valve was responsible. (And we are still not sure if the airplane cabin pressure was what pushed him into acute heart failure.)
We had prearranged private transportation from the airport to our hotel in Venice, which by some miracle (praise be to God) Jeannie just happened to spot as she went to search for a taxi. The driver took her to the emergency room, then he took our two suitcases to our hotel. Jeannie patiently waited 6 or 7 hours by herself with our two backpacks in the hospital waiting room.
Michael was on a stretcher in a big ward in the emergency room where someone gave attention to him about every 2 hours. Tests showed he was in atrial-fibrillation with a low blood oxygen concentration. His blood pressure was so low he couldnít stand. He was incredibly weak and short-winded. The chest pain had improved. A CT scan revealed some fluid in his lungs and an enlarged heart. No one was telling him much due to the language barrier.
When he was moved out of the emergency room, he still was not sure what was planned. Thanks to text messaging, Jeannie came to his side, where he was having an echocardiogram that indicated very severe mitral valve leakage between his left heart chambers and he was rushed upstairs to the cardiac intensive care unit (ICU). Doctors explained in English that, because this was a life-threatening condition, he would require mitral valve replacement or repair before he could leave the hospital. We both understood that surgery was planned in two days, on Monday. (It should not have come as a surprise that our health insurance company would cause a considerable delay before authorizing payment.)
After Michael was stabilized in ICU on Saturday evening, Jeannie met Mark Story downstairs. He took her to supper, then made sure she was safely taken to her (formerly, our) elegant room at the hotel in Venice. The following day, Mark made all the arrangements and moved her to a hotel closer to the hospital in Mestre, Italy.
Michael was not sure what all was being done to him in the hospital that first evening, but they were making him feel a little better. As an American physician, he felt everything was being done appropriately, equal to the quality of care he would have received in the States.
Our daughter (and angel) Angelique arrived Sunday night. She was a blessing to us beyond words to describe. She has traveled a lot in Italy with her husband. She can speak the Italian language more fluently than both her parents put together. Angelique thought it was great to suddenly and unexpectedly have an excuse to be in Italy again. She and Jeannie spent countless hours on their phones trying to get our health insurance company and our travel insurance company to get their acts together so Michaelís needed surgery could proceed without unnecessary delay.
Even though it can seem so expensive, we are so glad we bought trip insurance from Travelex. All of this would be an even worse nightmare without the insurance. We highly recommend that travel insurance always be acquired for any trip outside the country. Except for half the cost of our roundtrip airline ticket to Venice, we were refunded for almost every expense we faced in Italy. Michael's employer-sponsored health insurance, Blue Cross Blue Shield, paid most of the hospital charges. On 3 January 2019, we wired our share to the hospital for final payment, which was soon reimbursed to us by our travel insurance. Amazingly, 100% of our "vacation" and medical expenses between 22 September and 12 October were paid by insurance.
Michael and Jeannie always use an upcoming trip to Italy as good incentive to brush up on the language. Jeannie continued to study till we left home. Michael stopped the lessons a couple weeks before, sure that we probably would not have opportunity to interact with anyone during our tour who wouldnít know English. That turned out to be a big mistake for him. Most of the nurses knew few words in English. Michael generally could understand two words in each sentence that a nurse spoke. Google Translate app came in handy several times. Fortunately, the language barrier did not cause us any major problems. All the physicians spoke English relatively well.
Michael found the daily afternoon visits by Jeannie and Angelique to the ICU were a blessed relief. Otherwise, the monotony was unbroken as the days started to run together. Eating while lying flat was quite unpleasant. The bland diet was barely tolerable, especially in a country known for delicious meals. Bed baths and bedpans were totally new experiences. Michaelís usual high productivity level had ended abruptly, and when his ability might return to accomplish anything at all was an unpleasant unknown.
Eleven days after admission, on Tuesday, 2 October around 8 a.m., the surgery began that replaced Michaelís mitral heart valve by the Chief Cardiovascular Surgeon, Dr. Domenico Mangino, at Ospedale dell'Angelo in Mestre, Veneto, Italia. Heart function was fully restored to normal. Discharge from the hospital would be 9 long days later.
Before the surgery Jeannie & Angelique moved to a hotel closer for walking daily to the hospital. They didnít mind the shopping mall midway. The train station for 30-minute trips into Venice was also on their path to the hospital. They took advantage of a few opportunities to play tourists. Angelique returned to her family in Texas the day before Michael left the hospital.
The long-awaited day of discharge came on Thursday, 11 October. Our travel insurance company, sent Angie, a nurse (and angel) from the States, to accompany us from the hospital to our hotel. She accepted our invitation to go with us to a nearby Neapolitan-style restaurant, Rossopomodoro, for a delicious evening meal, where Michael had his one and only truly Italian dining experience on this trip. (Rossopomodoro is an Italian pizza restaurant chain, headquartered in Naples. Jeannie and Angelique ate there nearly every day.)
Early the following morning, Angie escorted us to the Venice airport. She made sure he had a wheelchair at the terminals and sat next to Michael throughout the day, frequently monitoring his vital signs. At the Fort Smith airport, Angie was astonished at the crowd who welcomed us home. Our nurse stayed with us till we were safely inside our front door the evening of Friday, 12 October, three weeks after we had left home for an adventure. It was fitting to be back from Italy on the anniversary of the arrival in the Americas of the Italian explorer, Christopher Columbus.
In spite of considerable weakness, lightheadedness, shortness of breath, and post-operative pain in his sternum, Michael quickly returned to refilling prescriptions and other tasks for his patients that could be done from his home computer between frequent rest breaks. We were thrilled to be in worship with our friends on Sunday morning, just two days after getting home. He was evaluated by a Cardiologist on Monday and a Cardiovascular Surgeon examined him on Tuesday. Both physicians confirmed that excellent medical and surgical care had been provided in Italy.
Walking for exercise the length of our street and back a few times daily was a challenging routine, initially very slow and unsteady, requiring Jeannie's assistance. Jeannie had to take charge of driving till 4 weeks post-op. When needed, we took advantage of handicap parking for several weeks.
On Monday, 5 November, Michael started working half days in his clinic, seeing four patients each morning. Two weeks later, he was working full time with an eight-patient limit per day. On the first Monday in December he began a late afternoon 12-week cardiac rehab program three days a week at the hospital fitness center. Though chest soreness continued and he was not fully back to normal strength, Michael joyfully returned to a full patient load at work ninety days after his open-heart surgery.
We praised God regularly that healing progressed as anticipated, without complications of any kind.
With a healthy heart, we eagerly look forward to our next overseas trip.
Michael & Jeannie Cole