Need some opinions!!

[kfay]

I was doing some surfing last night on the internet and came across an article for a conference that is going to be held in England a couple of days after my surgery. It is actually on what I have which is Ebstein's anomaly and my surgeon is the keynote speaker. So even though I requested a surgical date that would have him in town for a full week after my surgery, this clearly isn't the case. I called his secretary and she confirmed that he would be leaving town on Saturday after my Thursday surgery. The other congenital heart surgeon at the mayo will be there to cover for him. Now for my question: Would anyone else feel uncomfortable with this? I have never heard of this other guy. So, I told the secretary I might want to change the date. She told me she would have my surgeon call me. He called me about 2 hours later and told me that he has complete confidence in the hands he is leaving me in, but if I would prefer to wait he was good with that as well. I know though that this could very well happen again if I postpone. But then came the disturbing part to me. I asked him what post op complications I was most likely to incur and when were they most likely to happen. He said "in the first 24 hours EA patients can experience complete heart block. Since your right ventricle is already so enlarged and so poorly functioning, there is a good chance I may leave your chest open for 24 to 36 hours. Of course I would close it before I left! Are you kidding!!! He then went on to say the next complication that can start anytime in the 2 weeks after surgery is rhythm issues and then of course an infection of the wound. Those last two I am prepared for, but not the leaving open of the chest stuff. He also said there was a good chance I would still be in the hospital when he got back (which would be 8 days) and that he would see me then or in the out patient clinic if I were out. We have booked tickets to fly home before then! So, now here I am a couple hours out from that conversation with a massive migraine headache underway. Anyway, I just wanted to know from the peanut gallery how you would feel about your surgeon leaving so soon after your surgery. Oh and by the way, the beach is beautiful and unbelievable 80-85 degree weather!

Kim

 

[Phyllis]

Kim, under normal circumstances with no added risks, I would not hesitate to keep the date. Dick's surgeon "dropped in" every day, but the majority of his care was given by the staff and his assistants. But, from what you describe, I think I would seriously consider changing the date until you could be assured that he would be there the entire time.

 

[alpha 1]

wow, i cant believe that the doctor said that he would be here and then be leaving without telling you that is crazy, i just dont know that i would want to be in someone elses hands that didnt do the surgery, i have talked to the doctor on the phone and he seemed very nice, but why would someone tell a person that they were going to be here, it is your decision whether or not that you would want to wait until he gets back, if it is not an emergency, so then who would it hurt. now you have me thinking because our dr is supposed to be leaving town on the 24, but someone said he was leaving on the 4, then the next person said oh no the 24, which is plenty of time, but how do you know who is telling the truth. it is really creepy. all of this scares the heck out of me. hope all goes well though.
alpha 1

 

[LUVMyBirman]

I would reschedule. The part about the open chest made my eyes pop open Concern. Would want to make certain that the original surgeon was not taking off!

Keep us posted.

 

[kfay]

In all fairness, my surgeon did not know I had made the request about him being in town for a week after my surgery. I had said that to the cardiologist who then passed it on to the surgery scheduler so until I spoke with him today, he didn't know that it was an issue. Also, about the open chest, I haven't spoken to the surgeon since my initial meeting with him in December. At that time, he did not have the results of my MRI or my previous surgical notes. Also, the cardio and him wanted to present my case to figure out what was the best path. I know that there are going to be several variables to my surgery that I won't know what actually is done until I am out. He explained that the skin will actually be temporarily closed but my sternum won't be wired shut because the right ventricle sits right under the sternum and I gathered that if they have to go back in for a shunt or pacemaker it will be "open". But I didn't know about that part of it and it was just shocking to me. I don't really like to go into the details of these conversations with my husband because I don't want him to worry more than I already know that he is. So bottom line is this, he is THE go to guy for EA and I trust his ability in the OR. I just really feel like he needs to be there.

Kim

 

[laynekulwin]

I'd Be Mad As Hell...

I'd Be Mad As Hell...

Well, I must say that as someone who is facing surgery in the very near future, I'd be livid and feel very deceived - as well as scared to death at the prospects of having OHS - and with my chest being left open after the surgery for 24 - 36 seconds - let alone hours... and my doctor out of town giving a speech.

Personally, I'd have a "coming to Jesus" meeting and clear the air. Be bold - be direct - be businesslike but most of all be there with all your questions, fears, doubts and demand some answers.

If this surgeon is that great - meaning you don't wish to change doctors at this stage of the game... I'd certainly expect to meet with Dr. Avis (he's number two ...but, he tries harder?) and have a frank discussion with him, as well.

Now - that I have that off my chest... I do note that it is possible that the opportunity to speak to this group may have come after the fact... and I don't believe that doctors have any better sense of remembering every promise that they make to their patients - unless it's noted in their records somewhere. And, as has already been mentioned, it is the support team that will probably be providing the lion's share of your care post surgery.

But, I'd still want some hard and fast answers to my questions. After all, he/she may have done hundreds of these surgeries and I really don't care because, I only have to do this ONCE and I'd hope we'd all get it right the first time.

Best of luck to you...

Layne

 

[Jkm7]

I'm so sorry you have to make such a decision.

If it were me, I'd reschedule but each of us knows our tolerance, boundaries and personal perspective. I would not cope well with possibility the issues you outline could materialize and my surgeon not available.

If you were to reschedule, do you have some idea how much longer you would have to wait? If it is only a week or two, the peace of mind would probably justify the wait.

I most certainly hope all goes very well for you.

 

[pamela]

The first fact is that your surgeon isn't going to be at the hospital 24/7 anyway. Second, he's not leaving for England until 48 hours after your surgery, so ideally you'll have been stable for 12 of them at least. Third, pacemaker surgery or an ablation are not the same surgery as the actual valve replacement. Fourth, you'll be in ICU and virtually unconcious the entire time your sternum is left unwired.

You have my best wishes that all will go better than possible as well as my hopes for a speedy and uncomplicated recovery. The chief resident under my surgeon was more than competent and had been a thoracic surgeon for two years and was learning the craft from Dr. Modrey. I actually spoke to and saw him more frequently than I did with both the surgeon and the cardiologist, sadly, I don't remember his name. I blame it on the pump .

Take heart,

 

[JAJ99]

I'm sorry you have to make this decision. As a former Mayo patient, maybe I can offer some advice. I saw my surgeon only twice following surgery. Each surgeon there (I believe) has an entourage of doctors and PA's. I saw someone from his group everyday. Each surgeon is very busy and I know they travel often lecturing and teaching others. I was amazed with the number of heart surgeries that are performed everyday. All of their surgeons are excellent and well trained. The entire staff is highly competent, otherwise they wouldn't be such a successful hospital. No matter who cares for you, you'll be in good hands. I would trust anyone there. With that said, you're the one who needs to feel comfortable. Please feel free to contact me if you'd like to discuss this further. You'll be in my prayers as you make your decision.
Jean

 

[Nancy]

Good Post Layne!

Good Post Layne!

Layne--

Wow! I really do admire your attitude!!!

I was a strong advocate for my husband during his long medical history, and found it very necessary to be as bold as you are talking about, and then some. I am afraid it did not make too many friends for me, but it did get results.

Please keep preaching this strength message.

Many folks are so intimidated by some people in the medical profession.

 

[kfay]

Thanks for all of your input and comments. Having been in the hospital close to 100 times for my heart alone, I don't have any problem at all speaking up for myself. It wouldn't have done me any good to go off on my surgeon however...he wasn't even aware of my request...the secretaries and schedulers were. When I was speaking to his secretary and realized she just didn't get it and started to get a little argumentative with me, I immediately told her that he needed to call me, which he did as soon as he got out of surgery. So, another big part of the issue is that I have two school age kids that I have made all of the arrangements for, my husband has completely rearranged his work and of course all of our travel stuff has been booked. We leave in just a little over 2 weeks now! Anyway, I have a call into my local cardio to get his thoughts as well as my cardio at the Mayo...so I'll see what transpires on Monday.

I have several very good friends who are Dr.'s and they are continually amazed at how many patients are referred to them who have no idea what procedures they are having done or even what their condition is!


Kim

 

[Bonzo Dog]

The bottom line is if it doesn't feel right, don't do it. You need to be mentally strong. If you are fretting about the competence of the other surgeons, maybe that mental strength won't be optimum.

However it's worth thinking about how crucial one man is in the scheme of things? When we are operated on by 'the surgeon' what part does he play. When we are comatose are they one man beavering away? My understanding is they are the team leader. They have an overseeing, management role in theatre. All the prep work, opening the chest, sawing sternum, hooking up to heart lung machine, will be done by team members. Often, I think the main man will be scrubbing up at this point. Then he will apply his knowledge and expertise in the sharp end surgical stuff. Sometimes a more junior team member will do the hands on operating under the guidance of the top man. Others close up and finish off. I'm trying here to wonder, if your surgeon has seen you through surgery and the few days post op, then isn't on the scene, what couldn't be sorted by others in his surgical team if needs arose?

That aside if you are not confident, don't do it.

 

[marie]

You need to be comfortable with whatever you decide to do.

I had surgery on Tuesday but certainly not to the extent that you're having. My surgeon was out of town on the week-end however the on call surgeon was the surgeon that assisted in my surgery so I was Ok with that. The cardio on call for the week-end was my cardio. I did go into A-Fib over the weekend still in the hospital. It was the middle of the night the nurses came in with an EKG machine, hooked it up and within minutes were seeing about that. I was OK with all of that but again YOU have to be comfortable with your decision. I had checked prior to surgery and was aware that my surgeon would be out of town and that my cardio was on call. Both the surgeon on call and my cardio checked on me daily.
Take care and let us know what you decide.
Earline

 

[ALCapshaw2]

Personally, I would NOT allow a Resident to do a High Risk RE-DO Opening and I would probably CANCEL if the Surgeon was not going to be available for the in-hospital After Care.

I once had a broken bone repair before a Holiday weekend. The Surgeon left for the weekend. It was the WORST in-hospital care I ever received.

'AL Capshaw'

 

[pamela]

Personally, I would NOT allow a Resident to do a High Risk RE-DO Opening and I would probably CANCEL if the Surgeon was not going to be available for the in-hospital After Care.

I once had a broken bone repair before a Holiday weekend. The Surgeon left for the weekend. It was the WORST in-hospital care I ever received.

'AL Capshaw'

Thankfully, post-surgical care is as varied as patient personalities and what is one person's experience is not someone else's.

As has been already said, do what YOU feel comfortable with. I'm sorry the booking staff didn't do their job adequately.

 

[geebee]

The one thing I would be concerned about is the rare possibility of needing additional surgery due to a problem. While it doesn't happen very often, if your surgeon wasn't around, where would that leave you?

However, it seems like there might be just as much of a chance your surgeon will end up having somewhere to go if you reschedule. A good surgeon can be very busy and who knows what might happen down the road. The other thing to keep in mind is that good surgeons surround themselves with good people. I would think your care would be covered by those people.

What it boils down to is you have to follow your gut. Temper that with the plans you have made, your mental preparedness for surgery now and your care-giver's schedule and you will come up the answer that works for you.

 

[kfay]

Gina, I just wanted to say it is nice to see you back and posting again...You have good insight that has been missed since you went MIA....

Kim

 

[terryj]

My husbands surgeon was leaving for a conference out of the country 24 hours after my husbands surgery. His surgery was on 9/11/01 and of course all flights,etc. were cancelled after the attacks. But, we only saw him twice the 8 days we were in the hospital and we were very happy with his associates who saw my husband twice daily.

 

[Bryan B]

kfay,

The one thing that jumped out at me...and this is only my opinion...is that the "other congenital heart surgeon" would be there to care for your surgeon's patients. Then I thought Mayo Clinic...surgeon that specializes in congenital heart surgery is on staff at Mayo Clinic...this surgeon is probably one of the best surgeons in the country. That would be my logic anyway. But I would definitely discuss with your surgeon your concerns and see what he has to say about the surgeon covering for him. You might even ask if you can meet him or at least talk to him on the phone before surgery. I'm pretty sure that it's common for surgeons to cover for each other...otherwise they would never have any time off. Usually it's another surgeon within their group...and usually when a group selects a surgeon to join their group they want the best of the best...especially at the Mayo Clinic.

So if it was me I wouldn't change my plans until I have had a chance to discuss it with my surgeon and find out more about the surgeon that will be covering for him. If you were going to a less prestigious hospital for your surgery I would be less likely to give this opinion, but you are having your surgery and will be cared for at the 2nd leading heart hospital in the country. That would give me some peace of mind that the attending staff are among the very best at what they do.

But I also agree that in the end if you are not comfortable about your surgeon leaving town then you need to follow your instincts and reschedule. I just wouldn't be to hasty making my decision until you get a chance to talk to your surgeon and find out more information on the surgeon covering.