When I had my tetralogy surgery in 1966 they told
me afterwards that I was good to go. And that while
I might not be running any marathons that I could
expect to live a fairly normal, healthy life.

Over the past few years I have discovered that view
was an overly optimistic one. While they certainly
did take care of a number of problems with my heart
back then, that was by no means the whole of it.
There were and are number of problems with my heart
that they just couldn't fix back then, or that they
didn't even know about.

The most significant residual problem with my heart
has been a severe narrowing of the pulmonary artery
and associated valve. Both the artery and valve have
been less than one-half the diameter they would be in
a normal adult. As a result there was a severe backflow
of blood into my right ventricle — what cardiologist
call "regurgitation." It was the strain of this backflow
that unbalanced my heart — so the left side of the
heart had to work that much harder to balance the
deficiency of the right side, which in the long term
led to Congestive Heart Failure.

Along with that I've learned one other interesting
fact that I never was aware of: Evidently the artery
leading into my left lung is only ten percent of the
normal diameter. In fact the artery was pumping so
little blood into the lung that I have been in effect
operating with only one lung my entire life. When
Dr. Garabedian did my stent/valve procedure last
March he told me that due to anatomical problems
dealing with that left lung artery and the insertion
of my new stent that he had been forced to make the
difficult decision of blocking the left lung artery
entirely, no blood flow. But given that the artery
was only working at ten percent anyway it doesn't
change things much. It was a good decision on his
part. There might be a possibility that somewhere
down the line Dr. Garabedian will be able to widen
that left artery and reopen the lung. But they don't
know for sure yet — they are sort of moving around
in the dark here with a flashlight, just as Effler was
so many years ago.

But of course the news was very surprising. Only one
lung my whole life long, and I never knew.

I hold no grudge against Dr. Effler or his team.
What they did back in 1966 was brilliant, cutting
edge stuff that saved my life and paved the way
for much work in the future. Finding out all this
new information about my residual problems didn't
exactly rock my world. I realize that there are
definite limitations on knowledge, and that at any
one point what we know is always far less than what
we don't know. But to have gone through four decades
thinking that a particular state of affairs existed
— good health — and then to find out that was not
at all the case is rather disconcerting.

And so there are all the recent fixes by my doctors.
Most likely coming up in the next few months, maybe
late summer, will be another operation. Dr. Garabedian
wants to go in again and put in the larger diameter
stent that he was a little leery of putting in last March.

Coming out of the Cleveland Clinic in 1966 they were
playing "Summer in the City" by the Lovin' Spoonful.
And for a number of years that song became a kind of
anthem for me. So what would my anthem be now, sitting
here with a new pacemaker and pulmonary stent and a
valve that came from a cow?

Chopin, Nocturne in D-flat Op. 27 No. 2

Up into the stars — but not quite yet.