Here is Part Two of my surgery adventure, this one containing my observations, what I learned, what I will do next. This new learning is consistent with what educators would describe as the “experiential learning model”. We have an experience, we process and reflect on it, and it helps us make changes. The evidence of all learning is a change in behavior, so how will I learn and change? I am hopeful that these reflections will guide me. Medical competencies in Dallas/Ft. Worth—I read somewhere that San Francisco has the most restaurants per capita in the U.S., something like one restaurant for every 200 people. What this means to the restaurateur is that you have to be good to survive, and that as a restaurant frequenter, you can probably walk into any restaurant and have a good meal. Tough competition creates a market in which only the strong survive. That is natural, and a good thing. It may have seemed to you that I got this done pretty quickly. Certainly we had many decisions to make: who performs the surgery, what kind of valve, where is the surgery performed, to state just a few. But we are lucky to live where we do. Years ago people had to fly to some other city for a procedure like this. There may also be only one good hospital in your city today. But down here it is great. I know of many major cities where the hospital has a great national, if not world reputation. Our Dale works in one of them. Baylor Grapevine is a great facility, and was just 20 minutes away. Imagine how much easier it made things for the Saint and others to visit. One day you may face issues like this. Where will you go? Fortunately the research is so much easier to do today. We were very fortunate. A salute to every nurse out there—You know that many of my clients are banks, and there is a curious phenomenon in this industry. No matter how knowledgeable the bank manager, lending officer or senior officer is, thousands of people will fall in love with their local branch because of one engaged, friendly and helpful teller. Yes, the teller, the one who makes the least salary. I was blown away by how good the nurses are. I expect great knowledgeable doctors, but expected the nurses to be nothing extraordinary. Instead, they were awesome, often more impressive than the doctors. Of the many nurses I had, all but one of them was deep in subject matter, highly responsive and a joy to work with. (I’ll tell you about the poor experience later.) When something goes wrong in the middle of the night, it’s the nurse who has to get the doctor on the phone, often out of bed. The doctor relies on the nurse making a useful initial observation, asking the patient the right questions and often suggesting what the difficulty is. Mine were quick, efficient, correct, and never once frightened me. I mentioned this to my cardiologist, who said, “That’s one of the reasons we like to practice here.” I had two Respiratory Therapists (Sharon and Sherree) who got me to breathe into that plastic device. Their ability to teach me the value of this exercise, kid with me and sit there while I did it, was just superb. They had knowledge and skill and a great way with people. I loved having them come into the room. Two nurses, Maureen and Tracy, who helped me in the Catheterization Lab a week before this surgery, came to visit me in the ICU when they heard I was in. They didn’t have to do this. Imagine how it made me feel, to know that I had friends in the hospital. So for Rosie, LaTortuga, Mariposai, Deez4boys and you others who are nurses, you are awesome. Laughter really is the best medicine—I just can’t help it; I like to laugh and see humor in almost everything. It’s a natural way to cope with fear, and it seems to defuse difficult or awkward situations. But I also know that not everyone sees it my way. Some people just have no sense of humor, like that Captain in “Good Morning Vietnam.” They are not funny themselves, and they don’t see the humor in anything or anyone else. I always feel sorry for people like that. Do you realize that on our running forums we have dozens of people who can write or do standup comedy if they chose to: tomwhite, Tramps, Mustang, SS, the Pro, MC and many more I can’t think of off the top of my head. Now take this wonderful gift and transfer it to Baylor Hospital. Think it fits? I am happy to tell you it does. One morning my nurse has me stripped of everything and she’s washing me. I said to her, “You know, I was just reading an article in the Journal of the American Medical Association on why women go into nursing. It listed the number one reason as the opportunity to check out the private parts of very old men.” Let me tell you that the average nurse has a hundred war stories about silly patients being squeamish about these situations, and this gag just lit them up. It flew around among the nurses and they laughed as hard as I did. On Friday I was pushing my cart full of blood buckets and tubes around and around the ICU. I saw a nurse at her station and said to her, “You look like a very attractive woman. Any chance we might go out to dinner this weekend?” Without a pause she replied, “What is your plan for all these tubes?” I said we could just put them on the front seat of the car. She said, “Nah, call me when you get them pulled.” I said “Deal!” Then she gave me a dazzling smile and we laughed. In short, every smart-alecky remark I make to women on the running sites, I did in the hospital and we just had a ball: “Hey, I bet you can’t wait til tomorrow.” “Oh, why is that?” “Well, you’re getting better looking every day!” And of course they loved Mustang’s newspaper parody. Humor became the lubricant that relieved tension, smoothed over the fear, and helped create a personal bond. I can’t imagine going through a procedure like this again and not be able to have my sense of humor. Moral: keep your sense of humor, try to look for the humor or irony in some situations. It will keep you relaxed. You must stay positive—No matter what it is you are trying to achieve, you will do it best if you stay optimistic and focus on your vision of success. Henry Ford once said, “You believe you can or you believe you can’t. Either way, you’re right.” In my professional work, I coach many people and the first thing I help them to see is the power of the affective domain of the brain, where our feelings are a far more powerful driver of performance than our cognitive, or rationale domain. Every big decision we make comes from the affective domain, driven by our feelings, attitudes, preferences, fears and opinions. So it would seem that if we can help people to choose to feel positive, we can influence a favorable outcome. My surgeon told me an interesting thing: “I often have people come in to schedule surgery and tell me that they have a premonition they are going to die. I tell them that I won’t schedule them, and ask them to come back and let’s talk about it when they feel that the surgery will be right for them and they are committed to getting well and then they will.” On Monday I was walking around the ICU and a family came in to check it out. I knew this was part of their pre-op “course.” One of the nurses asked me to go speak with the dad. He looked scared, a sheen of sweat on his face. She introduced us and I asked him about his surgery, what he was expecting, what he had learned. His wife and son were there and they too looked frightened. So the man talked with me a bit, and I said that I imagine he had heard a bunch of conflicting information about the surgery and he said he had. I said I had one tip for him. “All three of you decide right now that you are going to sail through this and you are going to get better, because if you believe that, the force of your will will make it so,” and I told him the Henry Ford quote. At once the three of them smiled like the weight of the world had been lifted from them, and I knew they now had something to focus on, something simple and good. Later, the hospital formally asked me if I would volunteer to counsel surgical patients pre- and post-op but I declined. I told them I was too busy but in reality I declined because I cry too easily. So what would make me cry? I actually did, on two occasions. I praised a woman who had had lung surgery, for getting out of bed and walking around. She was so happy to get some praise but she told me her husband thinks she’s a “screwball,” and how her surgery has inconvenienced him. I heard another story like this too and both times it upset me greatly. The conversation about pain management is critical and rarely handled well. Of the 8 or 10 nurses I had, only one handled this critical conversation well. I teach critical conversations, so I watched this with interest. I expected something like this: “There is no getting around the fact that you are going to have some discomfort, so I would like to talk with you about it, so we can work together on a plan that will allow you comfort, permit you to do the activities that will help you get well, and also not do you any harm. Since I have some restrictions from your doctor on what I can give you let’s discuss how we make this work, especially the timing of relief. If you have had surgery or some medical procedure in the past where you felt discomfort, can you share with me what that was?” (I would respond that my bouts with kidney stones were the most painful experiences I ever had. That would be my “10.”) The idea is that this should be a facilitated conversation, one in which the patient is encouraged to talk freely about preferences and fears. The difficulty for the hospitals is that they have two objectives: get the patient well of course, but also have positive patient feedback to drive sat scores, get referrals and improve financial returns. So there is some pressure to make the patient happy, rather than partner with the patient and teach about pain relief. Doctors and nurses told me that it is very difficult to have this conversation with many patients. “They don’t believe they should ever be in discomfort and won’t work with you.” I contend that the right approach is not being used, and this is something that can be taught. If I ever do any volunteer work for the hospital, I will do it in this area. The nurse I did not have a good experience with me told me, “You must have a very low threshold for pain.” This almost sent the Saint into orbit. I have a recovery plan. First of all, I have to allow the sternum to knit. There is a lot of information out there on how long this takes. One factoid I heard is that the sternum is 80% healed after one year. This seems extreme. We read on another website you can water ski after 3 months. That seems extreme the other way. Mustang asked a great question about recovery. As runners we know that rule about one day of running to make up for every day missed, but it’s different for a cardiac patient who has what I had. My surgeon said one day on a respirator requires a week of recuperation to return to previous condition. That seems fair. In any case, I will do little other than walk for two months. Walking is wonderful for you, gives you aerobic work and strengthens the musculo-skeletal system. I go back to work October 1st, and around October I may be ready to do some easy jogging for the rest of ’08, but there is no rush, and I will see how I feel. Keep in mind that for all my high-flying optimistic words of wisdom, I am often afraid and sometimes lose my confidence, so I must always readjust and be careful. My ultimate goal is to race well during the second half of ’09. I take racing very seriously and only run to race. When I line up at a race, my goal is to kick as much butt as possible, “and I will strike down with Econo-like ferocity and furious anger those who try to outrun me in a race.” When you view racing the way I do, you take your time to get prepared. And of course, now that I have a great partnership with my doctors, I will ask them for help if I am in doubt. Best of all, and maybe more powerful and influential than the medical profession, I have all of you as watchdogs on my activities. I won’t be able to sneak anything by you. You are a great group of people to have watching my back. Spareribs

Another great installment Ribs. Thank you! I was struck by and yet not surprised by the consulting similarities. I often tell clients that "emotion outpulls intellect". Most donors don't really care about how many volumes are in the college's library, they want to know and feel impact. The greatest gifts come from the heart. I still correspond with the ICU nurses who took care of my father years ago. They are true goddesses and took care of all of us with grace, skill, humor and infinite kindness. I am glad you recognized them. I daresay that The Saint might be making a call after three hours! We've got your back and won't let you fail. Karin

Hi Ribs, Thank you again for an excellent, powerful, sensitive and well-reasoned and well-written report. Your insights into how each of us can and should help manage our medical care with questions, attitude and understanding is something that everybody can benefit from - especially when we then realize that that same learning can and should carry over to how we live our lives every day. Thanks for taking the time to write and share this. And enjoy your walking! Jay

SR: Another incredible post on a potentially unnerving experience. I am so moved by your outpouring of love and caring for others that you embody. You are a gift to all you touch... I remember someone telling me at the Philly Marathon in '04 how much energy I may have wasted by cheering others on after the turnaround at mile 17 or so. They had said that I might have finished with a much better time had I not "exhausted" myself. I think back often to that experience as having a totally opposite effect on me. I believe it empowered me to finish strong! Ther is no doubt that you are a very strong man and person, a good person! Chris

Great Chapter Ribs! You really know how to make lemonaid from the lemons you're given! I bet those nurses were sad to see you go! Steve

Great job being kind and sweet while you were in the hospital Ribs! I sure you were very popular and made many folks happier and more at ease while you were there.

hey Ribs, you da man . You sure had a lot of things figured out during your stay in the hospital. I am glad you are out and about. Be nice if TheSaint is still cooking your meals.

It's good to see you up and about Ribs!!! Bless every one who helped you on the way. And you for reaching out to others. Good form.