I am strapped onto the bed. The room is out of the Mad Scientist. I am wishing they had put me to sleep for this. They don’t put you to sleep for catheterization because there are times when they want you to cough and hold your breath. All they can do, I suppose, is make your mouth dry.
“One thing before we start,” said a nurse. “If your nose itches, don’t try to scratch it. We want you to lie still. If your nose itches, ask me and I will scratch it for you.”
Why did she have to say that? My nose hadn’t itched for years. As soon as she said not to scratch my nose, it started itching. It itched during the entire two hours of the procedure.
You can get somebody to scratch your back. You can get somebody to scratch your head. Your nose is something else. Only the person who owns the nose can adequately scratch it.
The catheterization. They deadened my right arm with shots of Novacain before making the incision. There are no nerves inside the heart, so there was no pain involved with the tubes. I felt the shots all the way down to my fingers.
The dye.
“This is going to burn a little,” said the doctor.
“For God’s sakes, go easy, man,” I said.
I thought about cursing but there were ladies present. I made a horrible face as the intensity of the heat from the dye reached its peak at the precise point my friend had indicated.
“Your nose itch?” asked the nurse.
“It’s not my nose, and it doesn’t itch,” I answered.
All this time, they are taking picture of my heart and my arteries.
“If you look on the screen,” said the doctor, “you can see what’s happening.”
Doctors, of course, enjoy seeing a man’s heart being tugged and pulled like it was a strip steak about to be flung upon the grill, but I close my eyes even when I get a haircut. I didn’t choose to see what was happening.
I must admit there was very little actual pain involved with the catheterization, save the moment the doctor yanked the last tube down my arm and out through the incision. It felt like he was bringing my entire shoulder with it.
“Oops,” said the doctor when I howled in anguish. “Oops” is not something you want to hear a doctor say.
They rolled me out of the catheterization room and into another room where the doctor took four stitches to close the incision in my arm. I had a tremendous desire to use the restroom at this point. The dye had gone to my bladder.
A nurse brought me a small, pitcher-like container. I was supposed to hold it under the sheet and go to the bathroom in it.
Something I didn’t know. It is impossible to go to the bathroom in a small pitcher-like container while lying on your back while somebody is sewing up your arm and your nose itches.
The doctor finished my arm, and they put me in a wheelchair and took me to my room. I was finally able to relieve myself, drink a cold glass of tea, and fall into bed.
I spent the rest of the afternoon watching old movies on the television above me and answering calls from wellwishers.
The doctor who had performed the cath came in after dinner.
“We’ll look at the films together tomorrow,” he said.
“I’d rather not, if you don’t mind,” I replied.
“You should look,” he said.
I guess they teach that sort of thing in medical school—how to say a lot by saying very little.
The films. They were in black and white. It cost nearly a thousand bucks to have cardiac catheterization. The least they could do, I was thinking to myself as I sat in my doctor’s darkened office, was to put these flicks in color.
First, we looked at movies of a normal heart. I didn’t like it when the doctor said that first, we were going to look at pictures of a “normal” heart.
The normal heart looks like an air bag. It fills with blood. Then it collapses and becomes nearly flat, as it forces the blood out into the rest of the body.
Next, we looked at movies of my heart taken the day before.
It was big. It was fat. It labored. It looked like a stuffed grapefruit about to drown in its own juices.
“It can’t go on like this indefinitely,” the doctor said.
I could see that for myself now.
All the heart could do, said the doctor, was get larger and larger. The heart muscle, said the doctor, was like a rubber band. Stretch it far enough and stretch it for a long time, and it will lose its elasticity, its ability to return to a normal size.
Surgery was no longer the question. The question was when to have surgery. My doctors conferred. Two schools of thought emerged:
Do the surgery now. The patient is relatively young and otherwise healthy, an excellent surgical risk. Although there are no overt symptoms and the heart is doing its job now, deterioration of the patient’s condition could come quickly. “Plus,” said one of my doctors, “it’s a good time of the year to have an operation.”
“A good time of the year?”
“It’s easier to recover in cool weather. It doesn’t itch as much when your hair starts growing back.”
They’re going to shave my head to operate on my heart? More on this later.
Hold off on the surgery. The patient’s condition is not critical at this point. Put him on medication that will take some of the work load off the heart and watch him closely for the next few months and make a decision on the surgery later.
“We’re not exactly talking about taking out your tonsils here,” said one of my doctors. “You can die from heart surgery, you know.”
On the other hand, it was a good time of year to die. Nobody roasts from the hot weather at the funeral.
I put the final (excuse the term) decision into the hands of the eldest of my doctors, a respected and honored man with graying temples, who stands tall and erect and speaks softly, yet directly, the kind of man you want in the cockpit during a thunderstorm.
He looked at my cath films again. He studied my X-rays, and my EKG, and he listened to the sound of my heart.
He called me into his office and he sat me down on a couch in front of him.
“Now,” he said.
“Now?”
“Now,” he continued. “Do the surgery now. We are talking about replacing your aortic valve. We are talking about your heart returning to its normal size after the surgery, and we are talking about returning you to a normal life, and you should feel very fortunate about this.”
“Fortunate?”
“Very fortunate,” said the doctor. “Just twenty-five years ago, there was no such operation as this. We couldn’t have even had this conversation because there would have been nothing we could have done for you.”
“Now,” the man had said. No more putting it off, no more thinking there might still be an escape hatch in this thing after all.
I was given a list of names of surgeons.
“They’re all quite capable,” I was told, but the choice is up to you.”
“Is it possible to spend a week living at each one’s house?” I asked. “I’d like to get a little drift on their lifestyles.”
This of course, was out of the question.
“Then give me the one with the best won-loss record or anybody nicknamed ‘Fingers’,” I said.
I finally chose a surgeon.
“Great hands,” they said of him.
“Personal habits?”
“Married. Kids.”
“Won-loss?”
“Leads the league.”
All that was necessary after that was to find a date both the surgeon and I could be available for our little appointment.
I checked my calendar.
“Anytime January ’85 is fine with me,” I said.
We compromised, and settled on two weeks from the
following Wednesday.
3
The Hog and I
How the hog, one of God’s most interesting creations, got involved in the surgery on my heart is a long story. After we had set a date for my appointment with the man with the knife, the doctors sat me down to discuss one remaining question.
We know we want to put in a new aortic valve in your heart, they said, but we don’t know which type.
Which type? You mean this is like going into Baskin-Robbins and trying to decide between almond toffee and chocolate marshmallow? I wouldn’t know an aortic valve if it walked up and bit me on the leg. What is this business with types?
I had a feeling when the discussion began that this little matter wouldn’t be simple. It wasn’t. I will attempt to decipher for you what the doctors attempted to explain to me.
In the first place, valve replacement isn’t something that has been going on for years as my senior doctor had explained when I was trying to weasel my way out of having the operation in the first place.
Twenty-five years ago, the man had said, they would have put me on some pills and then we all would have sat around and waited for my heart to get the size of my head, which would have been around the time it would have stopped beating, a situation terribly hazardous to one’s health.
Finally, somebody did invent an artificial heart valve and procedures whereby it could be inserted in place of the one the patient came with. The first valves were mechanical and were constructed of totally artificial materials, such as plastic.
They were better than no replacement valves at all, but there were problems. Patients with the mechanical valves faced the possibility of such complications as blood-clotting, which could lead to such unpleasant situations as strokes. So, it was necessary for patients with mechanical valves to take anti-coagulants to avoid the clotting, but thin blood isn’t such a terrific idea, either. The biggest plus for mechanical valves was they were durable.
There obviously have been improvements in mechanical valves over the ensuing years, but the dangers of clotting and stroke and the matter of taking blood thinners indefinitely have remained.
“Little boogers will last just about forever,” one of my doctors said, “but if we put one of those in you, I’d hate to see you dragging a foot around because of a stroke somewhere down the road.”
I can understand doctors when they talk like that. Dragging a foot around isn’t exactly my style.
Fortunately, I had another choice. A decade or so ago, researchers had the bright idea of attempting to develop a valve made from animal tissue. In the beginning, I suppose they tried taking valves from all sorts of animals and testing them to use in the human heart.
I would have started with elephants. When is the last time you’ve heard of an elephant dropping dead with a heart attack? I would have stayed away from nervous animals like those monkeys you see at the zoo who can’t sit still and make those awful screeching noises.
I probably would have never thought of hogs. Hogs make all sorts of noises, too, like they’re having trouble breathing; they don’t get out of the mud or away from the food trough long enough to get any exercise; and then there is the matter of their smell.
When I was growing up in Coweta County, Georgia, a lot of people raised hogs. You could always tell which of your classmates had hogs at their house by noticing if there were empty seats around them in the classroom.
The Rainwaters raised hogs. Nobody would ever take a seat next to a Rainwater child in school because it was difficult to pay attention to what was the average per annum rainfall in Ethiopia and fight off the distinct odor of swine at the same time. Claude Rainwater, who was in my class, even had a pet hog, which he occasionally rode to school. The hog’s name was Lamar. Claude would tie Lamar to a small tree in the school yard and Lamar would wait patiently until school was out and then Claude would ride him home again.
One day, Claude came to school without Lamar. He was in tears.
“What’s the matter, Claude?” the teacher asked him.
“It’s my pet hog,” said Claude. “Daddy won’t let me ride him to school anymore.”
“Why is that?” the teacher continued.
“Daddy said he was going to have puppies.”
Perhaps they should have told us less about the rainfall in Ethiopia in those days and spent at least a little time on why hogs don’t have puppies, and even if one did, why it certainly shouldn’t be named Lamar.
I was very surprised when my doctors told me my other choice for a new valve was one that would be taken from a hog. Only they didn’t say “hog valve,” they said “porcine valve,” which is the same thing. Hog. Porcine. They both grunt and eat things the dogs won’t touch.
The advantage a valve taken from a hog would have over a mechanical valve, they explained, was the hog valve reduced the possibility of dangerous clotting and also required no blood thinners. Hog valves and human valves, they said, were very much alike.
I waited for the catch. The catch, they said, was the question of the durability of the animal tissue valve.
“It won’t last as long as a mechanical valve?” I asked.
“How many fifty-year-old hogs do you know?” was the answer.
Specifically, the porcine valves have been in use for something like ten years, and those implanted in the beginning have exhibited a tendency to wear out.
“What happens if one wears out? I asked further.
“A second operation for a new one.”
I did some quick arithmetic. I’m thirty-five. I plan to live out my years. I’ll take seventy-five and call it even.
At one operation to put in a new valve every ten years, that’s four operations to go. At that rate, I could wipe out a small hog farm like the Rainwaters’ by myself.
Plus, there was the consideration of something out of a hog being placed inside my body. I mentioned some of the things that worried me about hogs, their snorting and labored breathing, their diet, their acute laziness, and their smell.
Despite all that, however, I have always had a voracious appetite for barbecue and even fancy myself as quite the expert on the subject. What would happen to me with hog in my heart?
Every time I’d pass a barbecue restaurant, my eyes would fill with tears?
Barbecue. My thoughts raced back to the integral part it has played in my life.
There was the annual Fourth of July Barbecue in my hometown. The churches went in together and bought some hogs and then the menfolk would sit up all night before the Fourth and barbecue the hogs over hickory smoke in an open pit, which doesn’t take a great deal of work once the hogs are cooking, so the menfolk had a lot of time to sit around and talk, mostly about the Bible.
They would talk Revelation for a time, which always spooked me, and then they would get along to something like Deuteronomy.
The Fourth of July Barbecue drew people from as far away as Newnan, LaGrange, and Hogansville. One year, a man from North Carolina was passing through and stopped in to partake.
He asked for cole slaw.
“What for?” somebody asked. “There’s plenty of stew and light bread.”
“I want to put it on my barbecue,” the man from North Carolina said.
I learned my first rule about barbecue that day. You don’t put cole slaw on it. I think that’s in Deuteronomy somewhere.
Somebody pulled a knife on the man and he got back in his car and went back to North Carolina.
After I left home, I roamed freely about other parts of the country, and I can to understand several truths about barbecue:
— The best barbecue is served in the state of Georgia. In Texas, they barbecue beef, which isn’t barbecue at all, and neither is goat, which is stringy. I wouldn’t even put cole slaw on barbecued goat our of respect for the cole slaw.
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— The best barbeque is found in family-run operations. Harold Hembree, who runs Harold’s Barbecue in Atlanta, can’t even count the number of cousins and nieces and nephews working for him. There are three generation of Sprayberrys cooking and serving at Sprayberry’s in Newnan, Georgia. Sweat’s is a family operation in Soperton, Georgia, and it was Jim Brewer’s father-in-law who first started Fresh-Air in Jackson, Georgia, fifty-one years ago when he served off a sawdust floor. “When it’s a family working together,” says Jim Brewer, “things get done right.”
— If there are religious posters on the wall, you can usually count on the barbecue’s being good. Harold’s is a perfect example.
— Good barbecue restaurants rarely serve beer, as good as beer is with barbeque. “Mama won’t allow it here,” is why Harold Hembree doesn’t serve beer at his place. “You’ll lose your family trade,” says Jim Brewer of Fresh-Air.
— If a restaurant specializes in something besides barbecue, the barbecue probably won’t be any good. You can serve other things, just don’t brag on it. Jack Sweat in Soperton is still amazed at the time a family of Yankees headed for Florida stopped by his place and ordered fried shrimp.
— Georgia barbecue restaurants are careful what kind of bread they serve with their meat. Normally, it’s thin buns for sandwiches, and white bread for plates. Harold’s toasts white bread over an open flame for sandwiches and serves cracklin’ cornbread with its plates. I think Harold will go to heaven for his cracklin’ cornbread.
— Brunswick stew is too complicated to get into. Everybody has a different idea about how it should be cooked and what it should contain. “We even get ’em who complain unless the stew’s been cooked in a hog’s head,” says Jim Brewer.
— Sauce: Ditto. In Georgia alone there are hundreds of varieties of sauces. If the meat is good, the sauce will be, too.
— It is important to put up a sign in a barbecue restaurant that says “No Shoes. No Shirt. No Service.” That will add class to the place by keeping out people from Texas and North Carolina.
They Tore Out My Heart and Stomped That Sucker Flat Page 3