Dr. Jessica Zitter

Psychology Today

Linda was a friend of a friend. As a doctor who practices both critical and palliative care medicine, I am frequently invited into the lives of people I may not know by desperate loved ones. I never met Linda in person, only through an impressive email journal her husband John wrote during the ordeal of her illness. Our mutual friend had forwarded me the journal, with John’s permission, in the hope that I might be able to help.

Linda was born with a bad heart valve, which had required replacement and a pacemaker a few years back. But the delicate replacement valve had gotten chafed by an errant pacemaker wire, and scarred slowly down over time. It was a subtle undoing, not enough to be obvious, but enough to cause nagging health problems. A deformed valve can’t do its job, which is to prevent blood that has been pumped forward from sliding back. And the results over time can be terrible—rising pressures from blood backing up before reaching the heart cause swelling and dysfunction of organs, and the ineffective pumping of oxygenated blood out of the heart robs organs of the oxygen critical to life. Linda’s liver, a critical organ which can get permanently scarred by high pressures over time, had been found to have cirrhosis on biopsy, a serious and often life-limiting condition in and of itself. Medications to help the valve function better would never be effective enough to turn things around—only the surgeon’s knife might restore her heart function and prevent her liver from continuing to scar down. But her poor medical status made heart-valve surgery very risky. And the surgeons wouldn’t even know if surgery would be technically possible until her heart was open on the table. Her cardiologist recommended that she go across the country to a highly respected institution in the midwest that specializes in such surgeries. Their cardiac surgeons were considered the A-team for managing problem valves.

Her husband John, a civil engineer, possessed all of the traits of an excellent advocate. First, he was completely devoted to Linda and her recovery. A photo he sent to his readers shows him at the head of Linda’s bed smiling and dressed in a T-shirt that reads “Linda’s Advocate” in bright red capital letters.

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