Take It from Me: Heart Surgery Is Best Avoided

On Monday the hospital discharged me, although I was still in considerable pain, when I wasn’t doped up on oxycodone. At least there was progress, and by Thursday I was able to switch to 500 mg of acetaminophen to dull the pain. Still, the reduction in pain was not a step back to normal. Seven days after the surgery, I found myself wondering if I was ever going to be able to write, code, or even read again. The depth of anesthetic required to perform such a dramatic operation causes mental confusion that can last for days or even weeks. I will not try to drive a car for at least two weeks -- yet another piece of dependency. I am only now reaching the point where I can write an article like this, and prepare to teach history classes in the fall. It is still some weeks before I can return full-time to my day job as a software engineer.

And let me emphasize: I got off lucky. Many of those in the cardiac ICU were having procedures that require cracking open the rib cage.

Readers in their 50s who have been through this tell me that two years later they are still in pain when they move. If you need a cardiac bypass surgery (where they graft a blood vessel from elsewhere to go around a blocked cardiac artery), you are almost certainly going to get your chest cracked. My employer’s human resources department tells that instead of four weeks unable to draw a paycheck, I would have been looking at three to four months of being unable to work. This is not a paid vacation: disability pay is far less generous than you might think, at least in states like mine where adults are in charge.

As I write this, it is now ten days since the operation. When I got up yesterday morning, I briefly felt energetic enough to shower and dress myself. For the next three hours, I had enough energy to watch television, and that was it. Even getting up from the couch for a snack was a major planning and motivational exercise. It is going to be weeks before I am fully recovered. I shudder to think of what a ribcage opening would have been like.

Are you now afraid of heart disease? You should be. This is serious business.

The economic costs to our society are huge: U.S. heart disease costs for 2010 were $444 billion. Your out-of-pocket costs for any substantial heart surgery are breathtaking: hospital admitting estimated that the total bill to my insurer would be about $60,000. I am fortunate that my health insurance plan caps my out-of-pocket expense for the year at $3250.

Economists talk about the insurance problem of “moral hazard,” where people take risks because they aren’t going to be paying the costs of their stupidity -- the rest of the insurance pool will. There are certainly parts of the health care public policy problem that fall into this category: people engage in risky behaviors because the immediate pleasure is large and the long-term costs are diffuse and distant. Every 925 calorie burger contributes only a tiny portion to the risk that you will need one of these $144,000 operations … someday. It is no surprise that many people just don’t take the risks seriously enough.

But that’s just looking at the economic costs. I suspect that if most Americans realized that enormous physical suffering that heart disease is going to bring them in twenty to thirty years, this might be sufficient to get them to start paying attention. Trust me: this hurts.

It is not the government’s job to tell you to stop smoking, or to increase your exercise level, or to control your eating. It is the job of an adult to do so for himself -- to demonstrate that he has the self-discipline to think about a future twenty years in the future, instead of today’s 1500 calorie lunch. Please: find the time and the money to hit the gym a few hours a week; reject the glorification of gluttony that ad campaigns like “Go Big or Go Hungry” promote; stop smoking. You don’t want to go through an experience like I just had, and certainly not the much worse chest-cracking procedures.