**The following article is re-printed from the Spring 2011 Martha Jefferson Magazine. **
Seven years ago, at age 34, Dr. John Zakaib, now a cardiologist and director of electrophysiology at Martha Jefferson Hospital, spent his days studying medicine, learning alongside the best as the chief cardiology fellow at the Cleveland Clinic in Ohio. He performed hundreds of cardiac procedures and ablations — difficult operations reserved for only the most skilled physicians. But in an instant, everything changed for him — both personally and professionally. In the blink of an eye, Dr. John Zakaib became Mr. Zakaib, a patient in his own hospital.
** The following is an excerpt from a talk given by Dr. Zakaib at the Heart to Heart support group about his personal experience with a cardiac event. **
The day was unremarkable. It may have been a Tuesday or a Friday; I can't remember. It was like any other day, though, that's for sure. I was completing my general cardiology fellowship at the Cleveland Clinic and was working in the Cardiac Intensive Care Unit (CICU). The day took a radical turn, however, when a sensation I thought was nothing turned into an actual something. I began to experience continuous palpitations and a strong pulsing sensation in my neck, and I felt quite unwell. Although I'm not sure how he knew, a colleague of mine sensed something wasn't right and came to help. The next thing I knew, I was taken off duty as the on-call doctor for the night, and my colleagues, the people I typically work beside every day, began evaluating me as they would any other patient. They asked me to lie down in one of the empty rooms so they could run a few tests. I thought the tests would certainly be unrevealing, but since I didn't feel quite right, I agreed. I had no idea at that moment that I was about to embark upon one of the most dramatic experiences of my training — and my life.
The first test, an electrocardiogram (EKG), just like you get in a doctor's office, was completely normal. After that, the fellows decided to perform an ultrasound (echocardiogram) of my heart to look for a structural problem with the heart muscle or the valves that might explain the symptoms. The goal of these tests was to be sure there was no cause for alarm. As my colleague obtained the images, I noted his expression changed, but I could not see what he was seeing on the screen. I was used to obtaining and evaluating the images myself, but since I was the one on the table, I just tried not to worry about it and just let him finish the study.
Phone calls were made. Soon four staff cardiologists were in the room reviewing the pictures and talking back and forth. Finally, one of my mentors said to me, "John, we think it's probably nothing, but we are going to get a CT scan just to be sure."
After a few more calls, the scan was arranged, and I walked downstairs to the scanner room with a colleague, who did not want me to go alone. I was in disbelief that there could be any question of a real problem. I thought there was probably some inflammation around the heart or something else that was likely inconsequential, and that the scan was almost totally unnecessary. Still, these were highly specialized cardiovascular imaging doctors, and they were concerned enough to order the scan, so I went along with it.
They started an IV and hooked me up inside the scanner, and a computerized voice instructed me on my breathing while I moved though the scanner on a table. The CT scan was quick, and I knew the images would be flashing up on the monitors in the control room even before I was unhooked from the IV. As I sat up and the tech removed my IV, I looked through the glass window into the control room. I could see several of the doctors still paging though the images on the screens, but several others were looking straight back at me. I recognized that look. Something was wrong. In that instant, I knew I had become a patient. It was one of the most transformative moments of my life.
Things moved very quickly after that. Over the next few days, there were myriad other tests, including a cardiac MRI, a PET scan, a heart catheterization and pulmonary angiogram, and a transesophageal echocardiogram. My partners explained to me that I had a tumor on my heart that needed to be removed. It was discreet, but it was in a very difficult area to approach surgically. … There may be some bleeding. … It was pressing on the aorta and the left main coronary artery. …
Now that they had found it, however, the goal was to move quickly. I was scheduled for open heart surgery a week later. In the meantime, my worry and anxiety set in. When you realize something is wrong with you, there's an emotional and spiritual process you go through. First it was, "I don't have time for this." Then I began to wonder, "Why me?" The feelings of fear and anxiety crept in, everywhere I went. I knew I had to have surgery to remove that tumor and that there were many potential complications, and there was even a very real possibility that I could awaken from the surgery with a diagnosis of cancer.
Although I wish I could say things got better with time, they didn't. The morning of surgery I felt sheer panic. My family and friends had gathered in Cleveland to be with me, but I couldn't escape those inner fears. I thought about every possible thing that could go wrong, in part because I had seen every single complication that could happen, and in part because of the realization that they could now actually happen to me. The preoperative unit was a whirlwind, and the next thing I knew, I was in the operating room with my friends and colleagues looking down at me on the table. …
I regained consciousness in the OR after the surgery, but I had not yet even opened my eyes after they removed the breathing tube when I distinctly recall a woman's voice whispering in my ear, "It was benign." I do not to this day know who said that to me, or if it was even a person at all. I felt a sense of peace that I had not known since the moment of that first symptom in the CICU two weeks before. …
Several hours after transitioning to the Cardiothoracic Surgery ICU (CTICU), still groggy from all the medications, I felt a bit more relaxed than I had the past week, and I enjoyed spending time with my relatives who had gathered in support. But my relief would only be temporary. My experience as a patient was far from over.
"Though I Walk Through the Darkest Valley"
As night came, the ICU became quieter, and I eventually found myself alone in my room. My visitors had gone home to get some rest, but my wife and family were in the waiting room, vigilant. I was in and out of consciousness through the evening, but I awakened to a profound sense of fatigue around midnight. I was short of breath, and my arms and legs were burning with a searing pain that I did not understand. When I looked up at the monitors beside my bed, I recognized a big problem. My blood pressure was far too low, and my heart rate too high. I called on my medical team, and after their quick action and investigation, it was determined there was uncontrolled bleeding around the heart, and I needed emergency surgery.
As they rushed me from the CTICU to the operating room, I vividly remember trying to say the 23rd Psalm. I had to work to speak, because I just couldn't catch my breath between words. There had been so much blood loss, I didn't have much hope.
As I awakened from anesthesia for the second time in 24 hours, still intubated and back in the darkened ICU, I became aware of my surroundings. I immediately sensed I could breathe … and that's when I knew I had survived.
The Road to Recovery
I was relieved to be back in the ICU again. Lying in the bed hour after hour, I became aware of everything. The beeping sounds and tubes that surrounded me. The hustle and bustle of doctors and nurses as they were in and out of rooms on the unit. Through the lens of a doctor, these were things that barely registered with me before. I had worked day and night in that very ICU for years. As a patient, though, all that activity and noise was distracting and very disconcerting. It was just one more reminder of what it's like on the other side.
When I was finally able to leave the hospital, the road to recovery didn't get any easier to travel. It was hard to do things I had done easily in the past. Walking around, breathing, opening doors. I had this desperate wish that I could take those things for granted once again. But, as it turns out, things would never be exactly the same. My experience as a patient fundamentally changed me — and now, looking back, I believe for the better. I got to step out of my white coat and gain a sense of the fragility of life that I never got when I was the one doing the procedure on someone else. I think that may just be the thin pane between sympathy and empathy — the difference between an insight into and understanding of someone else's experience and the very human realization that it could just as easily be happening to you.
Making Changes on the Front Line
Six weeks after surgery, I was able to gradually return to work. I probably shouldn't have gone back so soon, but maybe in some way it was a relief to feel like a physician again. My daily schedule was similar to before and was filled with procedures I had done so many times in the past. But there was a difference now that I couldn't seem to escape. I had a new perspective on the way I wanted to practice medicine, and it was guided by a newfound insight into the experience of being a patient.
As I finished my time at the Cleveland Clinic, I thought hard about where I ultimately wanted to practice medicine and where I could deliver the kind of care as a physician that I would want as a patient. Practicing at Martha Jefferson, I feel like I am not only able to deliver the best treatments for my patients, but I'm also able to care for each patient as a person. After my own experience as a patient, I believe that there is so much more to providing good cardiovascular care than just managing the heart problem or disease. Providing the best care is critical to a good outcome for the patient, but it is only a part of the process of healing and recovery for the person.
When it comes to the actual procedures, for me it's not just about how can we minimize the risk and maximize the outcomes. I want to make sure we provide the absolute best outcomes, and that starts with treating the patient as a person. As for the interactions I have with my patients, I think the most important thing I do is spend time with patients, and I'm not sure that's something I really emphasized as much in the past. I understand that many of my patients are worried about their future, worried about the possibility of complications of their illness or their procedures. I understand that people worry about the unknown, because that's what I worried about when it happened to me. One of the most important things I feel I can do is to keep my patients and their families well informed and offer insight into their problems and the potential treatments.
I certainly could not have recovered without the love and support of my wife and family. I found that the loneliness and uncertainty of critical illness could be oppressive. The support and encouragement I felt from my friends and family was such a source of strength for me as I recovered. Part of the reason I wanted to share my story with the Heart to Heart group is my strong belief that the support the group provides for patients living with heart disease, and the opportunity the group offers to learn about heart disease and its therapies, are an incredible resource for heart patients. But it also serves as a venue for sharing experiences with one another and gaining a sense of community with others who are experiencing heart disease and healing as well. I think the group is a real asset to the community and a great resource for people with heart problems. It was a privilege to be invited to share my story with the group.