A doctor's heart beats

Apr 29, 2013

What happens when the most confident and capable man you know finds out his heart is about to burst?

In the greater Cleveland area, my brother-in-law, Michael Shaughnessy, MD, is the go-to eye doctor if you need cataracts removed, especially for patients with difficult cases. Once, he let me sit beside him and peer into a microscope as he carefully cut into a patient’s eyeball, take out the diseased cataract, and replace it with a synthetic lens. While Mike’s hands were steady and precise, inside him parts of his heart were slowly disintegrating. In late 2011, he learned just how dire his condition was.

Just before Mike went under the surgeon’s knife himself, I helped him start a blog at ShaughnessyMD.com. We thought it might be a good outlet for him to chronicle his recovery from open-heart surgery. It’s been more than a year since then, and Mike is back to operating on 13 patients a day, and running and living life to the fullest.

I asked Mike to answer some questions about his experience as a heart patient and new blogger.

Michael, I’ve admired you since I first met you (when I was dating your little sister), and it’s an honor to introduce you to the readers of my blog. Will you please tell us about your career path. How did you get to where you are now, a highly regarded ophthalmologist with a specialty in cataract surgery? What’s happening in your field that the rest of us should know about?
Thank you for the kind words. I have had a less than the “straight arrow” path to where I am now, but it has been well worth the sidetracks. From very early in my life, I think around sixth grade, I had envisioned myself in the medical field. My grandfather was the old-school family practice doctor. He made house calls, did surgery, delivered babies, and treated a lot of kids in the neighborhood. He was an inspiration to me. When he died, while I was in eighth grade, he left his doctor’s bag for me. Later on, my grandmother passed on his microscope as well.

I started high school focused on science disciplines. I had always been pulled that way. I took all the right courses and received all the right grades. I started college at Miami University as a Microbiology major. Most Pre-med students took the path of biology, or zoology, a more direct route for the medical school admissions teams. Microbiology was a new major with exciting opportunities in molecular genetics. It allowed me a summer internship in San Diego performing genetic research for a private firm. I applied to medical school in the 1989-90 school year. It was one of the nations highest applicant years ever. After several interviews, I wasn’t accepted. Many of my friends who also suffered the same fate turned their attention to other career paths. I applied to the National Institutes of Health in Washington and got a job as a molecular biologist at the National Eye Institute. After two years of research and several papers, I reapplied to medical school, had a lot of interviews and was accepted to The Medical College of Ohio. I was considering ophthalmology, but during first year I got more focused on pediatric surgery. I was president of our pediatrics club and thought that was the direction I would go. I received excellent recommendations from some of my surgery mentors. And then I did my Ophthalmology rotation beginning of 4th year. I realized quickly that this was the career for me. It offered high-tech surgery, patient care, difficult problem solving and a fairly normal lifestyle. Patients were routinely happy after your interventions, whether it be new glasses or new vision following cataract surgery. I was hooked.

I focused on getting into a good Ophthalmology residency program and started at Case Western Reserve University. I went on to complete my fellowship in Cornea, External Disease, and Refractive Surgery at the University of Texas. I started my private practice back in Cleveland in 2002 at University Ophthalmology Associates, where I remain today. I couldn’t be more happy taking care of patients and applying my skills and knowledge for the people of Cleveland. I perform about 1000 surgeries a year, mostly cataract surgery. It is an exciting time for patients with cataracts. It is one of the most common and most successful procedures performed on the human body. People can realize improvements in their vision, often better than they’ve had their entire life. If anyone has been diagnosed and is contemplating the necessity of cataract surgery, be sure to visit an ophthalmologist experienced in all the latest technological advancements in our field.

How did you learn about your heart condition and the need for a surgical intervention? How did you choose a surgeon and then figure out the best approach to fixing your condition?
When I was a first-year medical student, I was in my cardiology class listening to my heart. We were all new at this part of the physical exam. My heartbeat had a strange flutter at the end of the beat, very loud. I was diagnosing my heart murmur. I had the professor teaching the course listen to me that day. We got an echocardiogram the next morning, and I learned that I had a bicuspid aortic valve. A call to my mom revealed that a murmur had been diagnosed at an early age, but she was told I would grow out of it. The advice now was direct: get regular echocardiograms every few years and report any symptoms. From that day on, I ran, played sports, studied hard and never had a symptom.

Twenty years and eight echocardiograms later, a new cardiologist looking at my old films and my latest films (October 2011) saw a worsening aortic valve and something suspicious with my ascending aorta. He sent me home with instructions to return in one year. Thankfully, his suspicions got the best of him and he called me the next day to suggest an MRI of my aorta. Not feeling his message to be urgent, I scheduled my MRI for my next day off four weeks later. It was a Friday; the test went fine. I was told results would be available in a few days. I was out for a five-mile run Sunday and came home to a voicemail from the cardiologist. I called back, and he told me not to run or do anything strenuous because I needed to see a heart surgeon right away. I began to feel disconnected with myself, and I hung up the phone and stared at my wife, Kathy. I am sure there was utter disbelief on my face as I tried to calmly deliver the words that I had a deadly aortic aneurysm beating in my chest.

At almost six centimeers wide, the aneurysm was of such a size that the likelihood of dissection (tearing open) and death was close to 98% without intervention. I had never missed a day of school or work in my entire life for sickness, and now I faced the ultimate danger.

I saw the recommended surgeon, Alan Markowitz, MD at University Hospitals in Cleveland. He was kind and deliberate, and I knew he cared about his results on an individual basis. I told him I was getting an opinion from the Cleveland Clinic two days later. I feverishly researched all I could that week about options, results, mortality, etc. I contacted the quality officers of both UH and the Cleveland Clinic. My interview with the Clinic doctor and the results of my quality questions all but made the choice for me; I would have my surgery with Dr. Markowitz at University Hospitals. Dr. Markowitz performs the surgery differently than the Clinic in two critical ways. First, he essentially bypasses the heart bypass machine with a catheter through the right subclavian artery, which continuously and uninterruptedly maintains flow to the brain throughout the surgery. He and others feel that this almost eliminates the possibility of intraoperative stroke. When I asked the Cleveland Clinic surgeons why they don’t do this procedure, the response was an abrupt, “We work fast.” And, Dr. Markowitz offered me the Freestyle aortic valve, a pure porcine valve without manmade struts or attachments. It is very similar to the innate human valve. Longevity has yet to be determined, but some of Dr. Markowitz’s former patients are 14 years out from their surgeries. The Clinic offered me the St. Jude valve, a biosynthetic valve made of artificial and porcine parts, very unlike the innate human valve. It has been around for more than 30 years, and the stats show a longevity of 7-10 years. I was 43 years old.

I know you to be a creative, generous and hyper-competitive individual with a really soft spot for your friends and family. What was your strategy for recovering from open-heart surgery? Where did you find the strength to bounce back so quickly and with such determination?
I freely admit that I entered this surgery without a plan. I knew that I would fight hard for my family, but I was as scared as anything I’d ever faced. Your idea of the blog was definitely an inspirational tool going in that weekend before the Monday morning surgery. Being a doctor was probably a weakness, because I knew that even straightforward cases don’t always work out as planned. Having my family and friends around me that morning was as motivational as you can get. My strength following surgery came from those loved ones who wanted to see me succeed and from areas of my life that I didn’t expect. As soon as that first day after surgery, my wife, Kathy, an occupational therapist, had me walking the halls of the hospital’s Cardiac Care Unit. She was my Chief Operating Officer who put me to work in those first few critical weeks when failures might have gotten the best of me.

What was the lowest moment? What was the most triumphant?
I feel like I had many low moments in the process of this surgery. My lowest might have been the night before surgery. I was very worried that this would be the last time I saw my family, my children. I wrote them farewell letters just in case. These hours were the hardest of my life. I drifted in and out of sleep that night before, wondering about my future; how had I come to this. As I said goodbye to my wife and rolled down the hall to surgery, I don’t think I have ever felt more frightened and lonely and desperate.

The triumphs came in all sizes. Waking up from surgery and realizing that I was alive ranks pretty high. I certainly didn’t expect to run down the hallway, but I was in a LOT of pain. Eating my first bite of food and walking without help were little victories. Stepping out of my house for a run four weeks after surgery was definitely a success. (It wasn’t really a run from an outsiders view, but I was racing through the winter wind in my heart). Making it to my buddies’ golf outing in Florida three months to the day after the surgery was a HUGE goal in my early recovery. I played pretty bad golf, but it was a great success anyway. In June 2012, I ran about five miles with my brother, Dan, in Hilton Head; just six months after surgery. That was a definite high point. I have run several races since my surgery, finishing in the top 10% in all of them. My running and fitness has become my most powerful motivator.

How are you living differently because of what you’ve been through?
As I have been alluding to, physical fitness has become by biggest change since surgery. I always enjoyed working out, playing sports, and doing whatever I wanted to do. When the surgery took all that away from me and I felt weak and fragile, running became my source of strength. A few friends kept me motivated as I increased my speed and miles. I needed no gym or trainer or special equipment. I ran for me. In the past,I ran simply to stay fit. Now I run to live. My heart was reborn on 12/5/2011 and I challenge myself daily to cherish that the big and little moments are not guaranteed.

You used a blog at shaughnessymd.com to chronicle your recovery. What did you learn in the process of sharing your experience online? In what ways has this changed the way you think as a physician? How will it change the way you help patients communicate and comprehend their own experiences?
The blog was an amazing tool for sharing information to those around me, but it also was a mirror for me to discover and research those feelings of uncertainty and exhilaration on a daily basis. I have shared both my site and the idea of doing it with patients, with very positive responses. I think we all could use this tool, even if you blogged privately for yourself to chronicle the uncertain road of illness. As I wrote in one of my posts, the hardest part of recovery for me was letting go of my own control and letting others be part of the process. The blog definitely allowed me to realize that even on the loneliest of days I was never alone.

Who are some of the people – family, friends, mentors or colleagues – who have molded you, and what are some of the lessons they taught you?
This question could take a book itself to answer. How can we define who we are by a short list of people? I am often moved to change a habit or thought by someone I hardly know. My father and mother, my family, my teachers and students, so many mentors and colleagues have all contributed greatly to the doctor and man I am today. I try to live the path of challenge and intellectual curiosity, to take some risks but protect my most cherished values. I hope to learn from those around me, but question constantly those around me. I hope to never be satisfied.

What’s your proudest achievement to date? What do you still hope to accomplish in the years ahead?
My proudest moment to date is to be able to tell my story with sound mind and body. There is no value to place on my life. I would surely give up all my accolades, diplomas, monies, and more to be able to embrace my wife and children. Being here for them has meant more than any other sacrifice or struggle I could have gone through. I hope to see my children succeed in their own right, to follow their own path. I hope to continue building a successful practice in the face of an uncertain health field. I plan to ride in a 100-mile bike race in August this year. I don’t think it would have entered my mind prior to surgery. I hope to see tomorrow as optimistically as I see today.

Anything else you’d like to share with my readers?
I would hope no one has to face their own mortality in such a direct and terrifying manner, but if any readers are or do in the future, my advice is to take a deep breath and dive forward. There will be no solace in feeling sorry for yourself. I realized very early on that there was nothing I could do to undo what nature had done to me. There was no place in my recovery for pity. It was very hard work and I am not looking forward to the possibility that I might have to start all over again, but I won’t feel sorry for myself. Test your limits; we may never reach them.

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Anton Zuiker

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