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One man struggles with a life and death heart condition

by Michael Walsh
Exchange Feature Writer

     Nicholas Palumbo lays flat on his back in a bland operating room.  His heart beats rapidly, but his breathing begins to slow.  A man standing above him counts back from ten.  He looks around one last time, nine.  His fear subsides, eight.  His eyes close, and the world becomes a cross between consciousness and dream.  Nicholas was having surgery to attach a defibrillator to his chest, a preventative measure, in case his heart stops beating.

     Nicholas visited his primary doctor for a routine health-check.  He suffered from high blood pressure, and heart disease, which was prevalent in his family.  Doctor Gabay, his regular heart specialist, conducted all the procedural checkups.  He suggested that Nicholas see a heart specialist, because he detected what, he thought, might be some damage in the ventricles of his heart.

      "I wasn't very keen on Doctor Gabay," Nicholas said.  "He was the man who told my cousin, Sam, that he was fine even though he was complaining of chest pains, a week later Sam had a heart-attack.  I stopped trusting him then, but I kept going to see him because he was the closest specialist to me."

     After some coercing from his wife Betty, he went to New England Medical, to see a specialist named Doctor Estes.

     "I knew he needed to get this checked out," Betty said.  "He didn't trust Dr. Gabay anymore, so this was an opportunity for him to see a new doctor and get his heart checked."

     Dr Estes confirmed that Nicholas had some damage in the ventricles in his heart.

      "I remember them telling us that two ventricles were damaged," said his daughter Jill Walsh.  "The doctor explained that he had probably already had two heart attacks without even being aware of it.  They are called silent heart attacks, and since his heart was only working at fifty percent now he was at risk for a more serious one."

     Nicholas was faced with a decision.  Since the surgery was not a necessary course of action, he could choose not to have it done, and let everything run its course.  If he went with this option he might have lived out his life without any problems.  That was the best case scenario.  Worse case, his heart stops beating, and he dies before the E.M.T's have a shot at getting to him.

     The other option presented to him was to have the surgery.  It was a preventative procedure that if successful would give his heart a shock if it did stop.  It is like having his own personal E.M.T. that is always with him.  Unlike with Doctor Gabay, Nicholas developed a bond with Doctor Estes.  He explained to Nicholas everything that would happen if he had the surgery, giving him the reassurance he needed, and letting him know that he would be fine, but still he was not quite sure.

      "I felt a little more receptive to the idea of surgery after leaving New England Medical, but the fact of the matter is at my age I didn't know if I wanted to go through another surgery," Nicholas said.  "I guess I was afraid of dying, but I also didn't want to go through all the after surgery pain."

      He spent the next few weeks reading about the procedure.  He sought out the opinions of his family, and they brought him printouts from the internet with facts that ranged from past outcomes to certain side affects. 

      "At first, I was thinking he shouldn't have it done, because I know the way he reacts to things," said a concerned Jill.  "He would think that he was sick.  By having this put in it would tell him that there was something wrong, and he would act accordingly.  But after I talked to doctor Estes, and found out that if he did have a problem the E.M.T's wouldn't be able to make it there to save his life.  I realized that it was more of a safety precaution, and a good thing that could help save his life."

     Surgery is always a scary experience, but for Nicholas it was a procedure that he ultimately knew he would need, to save his life, in the event that his heart stopped beating. 

      "I pondered this question for a while," said Nicholas.  "I didn't like the idea of surgery, but I, even more so, didn't like the idea of my heart stopping.  I would always worry that it might happen while I was driving.  My heart would stop, and I would pass out, and I would crash my truck.  I wouldn't want to run the risk of hurting other people, because I suffered a heart attack at the wheel."

     He continued to struggle with the question.  This was one of the toughest decisions he has had to make, but in late November, he went back to New England Medical to have the surgery. 

      "After consulting with doctors, friends and family I decided the surgery was my best course of action," Nicholas said.  

     The day of the operation Nicholas was quiet.  He was driven to the hospital by Jill, and was accompanied by Betty.  The ride was low key, aside for some small talk.  Any signs of anxiety from Nicholas were held tightly inside of him.  He sat in the front seat looking straight ahead, occasionally answering one of Betty or Jill's questions with a simple yes or no answer.

      "Having served in the Navy and having gone through a few surgeries I knew how to keep my emotions in check," Nicholas said.  "I was nervous, but I knew what to expect, so I was not a wreck.  I think the most unnerving time was when I had to sit in the waiting room, because we got there early.  I had too much time to sit around and think about it."

     Finally, the nurse came out and asked Nicholas to follow her.  The procedure would not take long, about an hour.  It called for a wire being fed down his vein, from his shoulder, through to his heart.  The defibrillator itself was implanted under the skin of his shoulder. 

     The surgery was a complete success, but Nicholas had to spend the night in the hospital as a precaution.  He takes Cumadin for his high blood pressure, which thins his blood.  The hospital has a machine that test the level of Cumadin in his blood.  The acceptable level is between two and three.  If there is too much in his system his blood thins to an unhealthy level, and it will not clot.  If the level is too low his blood with clot, and he will have a heart attack.  After the surgery he was in that safe range, but it was a little high, so they decided to keep him overnight to be safe.

     "I could tell he was nervous on the inside, but on the surface he was calm," Betty said.  "After the surgery I knew he was relieved, and not the least bit down."

     Nicholas left the hospital feeling a little soar, but for the most part, in high spirits.  He had made a choice that was difficult, but he felt content with. 

      "I was really worried that this might affect my everyday life," Nicholas said.  "But I came to find that I can still do all the activities that I love.  I can work in my garden and go for walks with my daughter.  I feel safer now than ever before, and that is a way I didn't expect to feel."