Tag: vascular surgery

What is a miracle?

is it something improbable or impossible?

My line of work is in investments. I lean into history, try to learn from it, and use it to understand probable outcomes in the future. There is no way to know for sure if there is going to be a recession or if the current state of high inflation will be persistent. We can take the variables from the past with the understanding that the current situation also has new considerations, and apply them to understand the probability of different outcomes to set reasonable expectations.

Whew, okay, done with the shop talk. Why did I just write all that? Because anticipating a range of possible outcomes and understanding their probabilities is at the core of what I do all day, every day. So when I think about what happened to Jeff, I marvel at the extremely slim probability of the final outcome. Truly a far out “tail event” in statistical speak. And I’m not just talking about that giant clot that ultimately saved his life (and yes, that in itself was a tail event!). I am talking about the probability of a string of decisions and developments that had to occur precisely in such a way that we could get Jeff the help he needed just in time for him to live. And I want to string them together to paint a picture of this unlikely outcome and why we feel that it was God’s hand guiding us, both in decisions we didn’t know we were making towards this favorable outcome, and in things that were completely out of our control, but in God’s brilliant design.

After Christmas of 2020, Jeff said to me in passing that he sometimes drives around the town of Bath (Ohio) and looks at different houses. We lived in Richfield at the time in a wonderful home that we built in 2013, and frankly, we thought we would live there for a very long time. What Jeff didn’t know was that Maris and I had also been exploring Bath while driving to and from various nature trails in Northeast Ohio. Both Jeff and I (and Maris, haha) love nature and quaint living environment. Richfield already has that (we had 2 acres of woods), but after being cooped up at home during the first year of the COVID-19 pandemic, we were ready for a change.

The problem was that there was no home that would work for us for sale in Bath. So we expanded our search to different parts of NE Ohio, actively trying to avoid the busy-ness of Cuyahoga County and the urban feel of the “East Side.” After many weeks of doing this, Jeff found something on Zillow… it was a home in the county we were actually trying to avoid, but the house was right. The design was right. the size was right. It was a model home, so after meeting with the builder, we decided to buy and finish a partially built house that was not even in the location of our original intent. What we came to realize was that our desire to live in a quaint environment spoke to our internal poets but did not jive with the busy schedules we kept. We came to love the idea. We sold our home in Richfield, finished the new house, and moved in on June 28th of 2021.

What we didn’t think significant at the time was just how close the neighborhood was to Hillcrest Hospital (the Cleveland Clinic). Eight minutes by car, if you’re just leisurely driving and hitting lights. I could shave off two minutes if I’m speeding a bit and with green lights. During the fall of 2021, I really learned the ins and outs of getting to the hospital because I had to get a lumpectomy (don’t worry, the tumor was benign and it was out of precaution), and then I had multiple appointments afterwards due to not serious but strange complications. Back and forth, back and forth. The thing is that I am really bad with roads and have no sense of direction. Now I look back and realize that God was perhaps making me practice driving the fastest route confidently for when it really came to matter.

When I think about it, that move was a crucial component to Jeff’s survival. If we had still lived in Richfield, I know that I would have probably taken him to a more remote ER. They would have had to transport him to either the Main Campus of the Cleveland Clinic or to Hillcrest anyway, and it would have just delayed everything. This was a decision made for unrelated reasons that proved to be so crucial.

There were other choices that were made for unrelated reasons that proved to be vital in the succession of events. Me working from home, randomly deciding to work in the living room instead of my home office that allowed me to notice that something was off; canceling the morning meetings because everyone was on top of things but it freed me to take Jeff to the ER; Or even taking Jeff to the ER because I thought it might be a kidney stone, but of course, it turned out to be something much more serious. These were decisions made without deep insight, and I cannot tell you that I had some sort of hunch or a feeling that I had to do these things.

And then there were things out of our control. The aneurysm had been there for many years that it grew to be the size of a baseball – it really could have burst at any time. When the aneurysm started to dissect, it didn’t happen all at once – it happened in small tears, which meant that blood started to leak out slowly, giving it time to actually clot and plug the hole. Again and again for nearly a week. And the fateful moment when the dissection became untenable, it happened during the day when I was home. If that dissection took place a few hours later in the evening, Jeff would have been driving a 3 hour road trip to Bowling Green, probably on I-90 West, alone in the car, far from the world class healthcare available at the Cleveland Clinic. That the aorta decided to rupture during that small window of time… we do not view that timing as a lucky coincidence.

When we think about how easily that clot/plug could have come undone, it sends chills down my spine. We had used a vibrating massager on Jeff’s back when we thought he twisted a muscle (yikes!)… that was a really bad thing to do to the aneurysm! What about the violent vomiting? Every time he lurched forward to throw up, the clot could have dislodged. And of course, further delay would have also meant that the outcome could be different.

All these things had to work together and with right timing. The clot itself was of course, statistically unlikely. A tail event. A black swan event (but with a positive connotation). But also at each decision point, when we thought we were making decisions that were independent of each other, it turned out that there was this beautiful design to how they were actually related… and each played a small but important role in contributing to Jeff’s survival. And in some of those decision nodes, we actually made the unlikely, less probabilistic choice based on our original intent. For those of you who have calculated the probabilities of multiple events and outcomes, you know that when you have multiple unlikely events stringed together, you end up with a really really low probability.

So, okay. Something with a low probability, even if the odds are only 0.000001% in your favor, is technically possible. So is it really a miracle? Isn’t miracle something impossible becoming possible? like turning water into wine? This is where I have to stop thinking with my head and listen with my heart. This is where I don’t want to lose perspective, the meaning of the big picture, the opportunity to experience God’s grace… all because of some technical point. When something happens, which in turn changes your perspective on life, brings more love between two people, and brings us closer to God, I consider that in itself a miracle. No matter how high the probability. And maybe it had to take such a tail event to pound through my data-driven, rational skull that only God can string events together, move hearts and minds, and put us in right places in order to bring us outcomes that are inconceivable to our human imagination. Furthermore, that we, as rational beings, would choose to accept this outcome not as low probabilistic “luck” but as God making His presence firmly known in those moments, that we should choose to see it as God’s grace, as His love, and as His gift to us… that in itself is the greatest miracle for me.

Sunrise: a daily “miracle” that lifts my spirits!
Marriage: a miracle of two very different people spending a lifetime together

A battle scar

And a reminder of grace

In order for Dr. Rizzo and his team to perform the vascular surgery, they had to create a very long incision down Jeff’s abdomen. During those first days in the Cardiac Surgery ICU, the incision was bandaged up, so we didn’t know what it actually looked like… yet. After a few days, they removed the bandage, and there it was, a 20-inch scar. I was surprised to see that they used metal staples to hold the skin together at the surface level. I don’t really know what else I was expecting.

For a long time, we had to tiptoe around it and couldn’t do normal things. At first, he couldn’t use his ab muscles at all so he couldn’t even move an inch without wincing. But he kept sliding down the hospital bed! So they had to move him around with the sheet that was underneath him. He couldn’t sleep on his side. He also couldn’t cough or sneeze – the staff gave us a firm, pillow-sized and -shaped block, which I would push against his abdomen to support and stabilize his incision. I was so scared to put any pressure on his tummy, but I quickly learned that I needed to put nearly all my weight down to counter the force as he cleared his lungs. After a while, we had a routine down: Jeff would suddenly sit up “I’m gonna cough!” and I would shoot up from the chair, run to the bed with the “pillow” and put all my weight down. But the worst of all was that Jeff couldn’t laugh very hard… at his own jokes. He was really disappointed.

The incision was healing beautifully, but the staples had to be in for about a month. It was uncomfortable for Jeff even after he came home and was able to do regular activities because the incision site was very tender (still is two months later), and the metal pieces bothered him. Wearing a seatbelt was very unpleasant because the belt would dig into the staples. Sometimes, a sheet or a blanket would get caught on the staples and cause discomfort. I examined it from time to time to make sure that there was no infection or anything suspicious, but I could tell they were really bothering him. One night, I decided, well, maybe we just need to embrace the staples – I said “they aren’t going to be in forever, so let’s get to know them before they come out. We’re counting the staples!” I counted them one by one, all the way to forty. Wow, 40 staples. “This is your battle scar.” Then Jeff opened up about it and told me that he dreaded seeing his incision for the first time. He thought “oh God, it’s going to be so ugly.” But then he said, “but I would rather have this ugly scar than the alternative.” Yes, a thousand times YES! This is his battle scar and a reminder of the grace of God that was showered on us through that most valuable clot, the temporary plug that held everything together for just the right amount of time. It represents the time when we felt God’s hand firmly in our lives.

Near the end of April, it was time to get those staples removed! While we were waiting for Dr. Rizzo, a really kind nurse came in. I remember her Russian accent and her beautiful hair… not everyone can pull off side-swept bangs! She was so seasoned – she saw that there were quite a few staples so she made small talk with Jeff. Oh, it was so easy, small movements with the staple remover. Jeff later said that it was mostly painless except for a few that felt like bug bites. And before he knew it, she looked up and said, “I am done!”

Everything looked great to Dr. Rizzo, and we were cleared to go home again. I brought a list of questions to ask, like a taskmaster. He probably found me annoying! Among a string of questions, the one that made me most happy was “Will he be able to go on TCO’s European tour late summer?” to which he replied, “oh yeah.” This made me really happy for Jeff – back to normal life if he can manage all the stresses of a European tour! The one that made Jeff most happy was “When can he play golf?” to which Dr. Rizzo said, “I’m okay with mid to late May.” We both left the doctor’s office really happy, even if for different reasons.

Removing the metal staples was a really big deal. Jeff was able to move around comfortably and not be in fear of the healing incision. That evening, I saw a familiar expression come over his face, one that I have seen thousands of times since we met in 2007. It was one of mischief – I knew that he had a joke coming, and it was going to be epic. “I had 40 staples… now I have 80 holes!” Then he went on to laugh and cackle at his own joke, just like old times.

Jeff and Maris pretending to be giants descending upon the Christmas Village people
Jeff pretending to be a freshly hatched baby dinosaur (Tucson Zoo)

The world’s most valuable clot

to plug a giant hole

Dr. Rizzo is a man of few words. After the surgery, he just said, “the surgery was successful.” I’m like… how? what happened? I need details! I asked him, “what held the rupture together?” He said that the hole was the size of a baseball, but the torn fringes were inflamed and swollen, which helped to reduce the size of the hole. But it was really the giant blood clot that formed and stuck between the front side of his spine and the aneurysm that kept the plumbing intact. Jeff had been on borrowed time because it would not have held for much longer. “Actually, here, I’ll show you the photos.”

Later I would tell Jeff that seeing his empty abdominal cavity and the front side of his spine brings new meaning to our marital intimacy. The photos were incredible. His aorta was completely shredded, tattered. Then Dr. Rizzo showed us the new synthetic aorta that would be a part of Jeff’s vascular system for the rest of his life. It was a gigantic, Y-shaped single piece that graced the back of Jeff’s abdominal cavity from top to bottom, and into his hips. Incredible. “Oh,” Dr. Rizzo casually added, “he didn’t need any blood.” Jeff went through one of the most invasive vascular surgeries around and didn’t need a single drop of blood. Miracles continued to pile up.

As we caught up, I saw a bed rolling by. It was Jeff. After they set him up in his room, Dr. Rizzo got up and said that I could follow him into the CS ICU. There was staff transferring all his bags of fluids and tubes to the ICU equipment. Jeff was still under anesthesia, intubated, hooked up to so many things. I was afraid to touch him because I didn’t want to mess anything up. I sheepishly touched his left hand and found it to be so swollen. I looked at his face and realized that his entire body was swollen. Dr. Rizzo read my expression and told me that they had to pump him full of fluids for the surgery and that the swelling would go down in time. The night attending at the ICU was a very nice female doctor who said that he would sleep all night, and they would watch him. She encouraged me to go home… the ICU closes to visitors at 9pm anyway. I knew he was in good hands, so my friend drove me home.

I slept soundly but woke up early, around 5 am. I thought immediately, “what if he doesn’t wake up?” The nurse had given me the ICU’s phone number, and I called. They told me that he did well during the night and that I should come around 9am when they hope to have completed the extubation. It felt like forever from 5am to 8:30am – I just couldn’t wait anymore and drove to the hospital. When I arrived, they were still extubating him. I kept a little distance because I didn’t want to get in the way of the staff. There was a lot going on!

The same attending from the night before walked over by my side and told me that he was already breathing on his own, and that he looks really good. As I conversed with the doctor, Jeff must have heard my voice. Jeff’s nurse turned around and said, “he wants you to come over.” He can hear me! As I walked closer to the ICU bed, I saw his right arm, gesturing me to come to him. He is awake and alert!! When I got to his bed, I saw that the tube was still down his throat, and he was in a lot of discomfort. He held my hand and tried to spell something. I was so nervous that I would not quickly understand him and that might frustrate him more. “G”… “A”… “G,” he wrote the letters in the palm of my hand. “Gag?” He nodded affirmatively. “You have a tube down your throat. it’s supposed to be uncomfortable. But they are taking it out.” It didn’t matter what I said. He still looked so miserable.

It is so hard to watch your loved one suffer. I had never watched an extubation process – it looked completely miserable. It seemed like forever, but the tube was finally out, and he was trying to talk to me. He can talk! he can form sentences! All the things that we take for granted in our daily lives, I was so relieved and grateful for them.

Those first few hours of him being awake, me being by his side watching him breathe with wonder are some of the most precious memories I will carry with me for the rest of my life. We had passed the most harrowing part of the journey, but we were not clear of all dangers. I knew that we needed to continue to pray to avoid post-surgery complications. The hard part may be just beginning. I was so grateful that I was ready for anything.

How big is a baseball?

It depends on the situation

I will never forget the moment when the ER doctor rushed back into our room. He just started talking. There was no easing into the topic. He said “there is a baseball sized aneurysm in your aorta.” He reached over Jeff’s abdomen and made a baseball sized air-ball with his hands. He then pressed Jeff’s abdomen with his fingers and said that he could not feel a pulse where he normally should. “I’ve already called the vascular surgeon, and he is on his way.”

Wait, what? I know an aneurysm is bad, but he’s sitting up and talking to us. Couldn’t you repair the aorta? I guess there is going to be… a surgery? Okay, calm down – Jeff is still sitting up and talking to us, and there is no better place to have an emergency than in a hospital. Okay, the surgeon is on his way, and we will get this fixed. My job until then? Keep his blood pressure down.

At this point, we knew that all the weekend obligations had to be canceled. “Jeff, you just relax and stay calm and think of happy things. I’ll make the calls.” I stepped out of the room to call the orchestra to tell the personnel manager that Jeff would not be able to play the rest of the weekend. I made calls to his students to let them know that weekend lessons would be canceled. Jeff was supposed to teach a masterclass about 3 hours away on Saturday, and I had to cancel that for him, too. Taking care of business… that’s my job.

When I came back into the room, the lead surgeon had arrived, along with two other surgeons. Dr. Rizzo said that he wanted another CT scan with contrast. This time, there was no waiting – he was wheeled out right away for the scan. In the ER room, Dr. Rizzo, another surgeon (I will call him “Will” because I cannot remember his real name), and I stared at the first CT scan. As he scrolled through the scans, I could see Jeff’s aorta expanding from one film to another. How big is a baseball? At that point, too big. It seemed the size of an ocean. Just too vast, too large, too vulnerable. Dr. Rizzo said that the aneurysm had been there for a while. I asked, “what is ‘a while?'” He said, “years.” I stared at it and said, “Jeff is a wind player,” thinking that they would know what I meant. Both of them turned to me and asked, “what’s that?” “Jeff plays oboe for The Cleveland Orchestra. He’s played the oboe since he was nine years old… he blows into a very small reed to make sound and there is a lot of pressure.” I’m not sure if that was significant to them – Dr. Rizzo proceeded to tell me that he saw something that looked like inflammation or an infection in the artery. He would find out once he was inside.

Jeff came back from the second CT and he was in great pain. They gave him more painkillers to calm him down. A few minutes later, the original ER doctor rushed into the room and said that the aneurysm has already ruptured! But is somehow contained… what?? This was when I really started to panic and reality hit me over the head. I knew what that meant – how is he still alive? How did Jeff not bleed out already? Suddenly there was a whirlwind of activity, people coming in and out, voices being raised at the nurse to get Jeff’s blood pressure down. The surgeons were in the room looking at Jeff who was clearly sitting up and talking with us. How could this be if a baseball sized aneurysm has ruptured? What is holding this man together? “Will” explained the procedure to me and Jeff, and while I listened attentively, I had tears streaming down my face. In the middle of his explanation, he stopped, looked at me, and said, “don’t worry, it’s okay. We are going to fix it.” I will never forget those words of assurance and the comfort they provided during those moments of chaos.

As the staff was preparing to take Jeff away, we waited together in that room. I was listening to everything that was going on, and I tried to comfort Jeff who was very serene (was it the painkillers or just his nature?). I had my mask on, so he could only see the top half of my face, and I tried to put a brave face on – I didn’t want Jeff to know that I was crying. I am not sure why… I didn’t want him to worry about me? I should be comforting him, not he me? Or maybe I wanted him to believe that everything was going to be alright, and my crying would not support that cause. I still haven’t figured it out.

Whatever the case, I waited until he was taken out of the room and on his way to the OR before I burst into tears and wept out loud. It was surreal. Because I never cry. I heard myself wail, and it was like an out-of-body experience, like watching someone else cry. The ER nurse who was left behind came over and gave me a hug and I wept into her shoulder. Then I cried as I walked out of the ER and to my car. I backed out of my parking spot and started driving, only to park again a few yards out because of the tears. Somehow I drove home, sat on the couch and cried. Who knew that I had an abundance of tears? I had assumed that they had dried up during all those years of being on “survival mode.” To survive my childhood/adolescence, even my adulthood. From somewhere unknown, tears just poured out as the reality of the situation burst open the dam I had built brick by brick, layer by layer for decades.