2012-09-16

V. Guitberg

Dedicated to all those who are mentioned within this book.

From the author

When it became apparent to me that a heart operation is forthcoming, I tried to find any information that would help me to endure it. From various news sources I was already aware that cardiovascular diseases hold a prominence among illnesses affecting people. More and more people are subjected to complicated and life threatening surgeries. I was not interested in medical literature with detailed descriptions of the operation, on the internet I even found a detailed video of the procedure. I wanted to know how other people dealt with such a difficult life situation. As it turned out, I was only able to find two books in English wherein the authors shared their experiences.

The responses to these books shows just what a tremendously positive role the sharing of experiences plays for people finding themselves in similar circumstances. At the same time, the events described in these books happened several years ago, and much has changed since. It also occurred to me that in these books there was an overabundance of instructional material that each patient receives anyway during the preparation leading up to the surgery. And so I decided I would describe my experience in a more narrative form, and let the reader choose what they may feel is most useful.

In accomplishing this task I received much help from friends and relatives, who read, corrected and provided invaluable feedback to the drafts. I value their efforts, and am truly grateful for their help.

Fragile cup of hope

When looking back at an event, that held a great risk for one’s own life, and the enduring of which required much bravery and worry, then a particular viewpoint of these events is formed.

I awoke after the open heart surgery with the same reassured feeling that I went into it; that everything would end well. It was a happy realization that I was still alive, and at the same time a feeling of honest gratefulness to those who did everything necessary, to ensure I would not remain lying on the operating table. I hope this feeling remains with me until the end of my life. My happiness was intensified by the knowledge that, my family would not have to endure the pain of the loss of a close family member.

As soon as I got the strength, I began writing down everything that I could remember from before and after the operation, so that I could tell my family and close friends about my experiences, many of which I do believe will interest them. I turned out however, that this topic worried all, with whom I breached shared my experiences. No one is certain what avoided heavy circumstances, so I decided that I could help a larger audience endure a difficult period such as mine.

In offering my writings to the reader, I am trying not to offer any advice. I simply want to share my experiences thatwere obtained in a life treating operation, which was accomplished without my fully conscious participation. Those who are destined to walk the same path as I did, I hope you will make your own conclusions.

Anxiety

My and Tanya’s family doctor, Dr. Mark Beltof (Hereafter, the names of all medical staff and medical facilities have been altered), strengthens our family bond by always seeing us together for each appointment. All that we have time for during our short visits, is bring up that which happens to be bothering us most. We try not to trouble him with other problems, and as there are many other patients waiting, he doesn’t really give us the opportunity.

For a long time, health problems were mostly affecting Tanya. She went through many tests at different hospitals under the direction of the neuropathologist overseeing her. After receiving all the test results, the doctor admitted that could determine the cause of the sickness. Suggested returning for a follow-up visit in half a year if the situation got worse, in the meantime he prescribed only one medicine – more movement and walking.

I gradually joined the community of people afflicted by today’s more widespread cardiovascular diseases. Three years ago Dr. Beltof sent me to do a heart echogram, in regards to a increasingly common cases of arrhythmia. This has happened to me in the past, before immigrating to Canada, and was usually associated with various stresses, of which there have always been many. I never paid it much mind.

Clearly, cardiovascular weaknesses have a tendency to worsen, and could lead to operation. You know about this, but hope it won’t happen to you. Often, that is exactly what happens.

Dr. Beltof did not like the result of the echogram, and felt it necessary to consult with a cardiologist.

I and Tanya have gotten used to trusting our family doctor; he has shown thorough knowledge and an analytical approach towards our health. In a system based around family doctors referring patients to a specialist, he does not rush to send us to a consultation. Crucial here is the waiting time for the patient to see consultant, the speed with which the specialist can write the report, and how effective is the communication between the specialist and the family doctor. I’ve often heard from friends that the wait for a consultation took several months.

I’m reassured by the fact that, in most cases Dr. Beltof tries to make the decision himself, whenever it’s possible to avoid a consultation with a specialist. However, in my current situation, he did not want to take that risk.

This time he personally coordinated my visit, and I soon found myself in the cardiology centre under the consultation of Dr. Veshinski.

The cardiologist’s assistant, Galya, a young and friendly woman prepared my electro cardio gram (ECG) for the doctor. The Cardiologist saw me already having familiarized himself with the result of my echogram (I saw in his hands the paper from Dr. Beltof) and ECG. Dr. Nathan Veshinski is a large and respectable looking man. He gives off the impression of a self-assured specialist, not one to engage in idle banner with patients. He bluntly stated:

-          You have a faulty mitral valve; you must have a mitral valve replacement operation.

And then added a phrase with a dual meaning:

-          But, I think you can wait for 5 years, and check the dynamic. Considering your age of 70+, an operation might not be necessary. It’s always a risk. We won’t rush.

In conclusion he promised that we will meet every 6 months. He did not prescribe any medicine.

It occurred to me that the threat of an operation was postponed to a later date, which suited me fine. We’ll see later.

Two years past, during which I visited the cardiologist every six months. Before meeting him I first went into Galya’s office for an ECG. During the procedure we talked. She told me how she came here from Latvia, and how life there now isn’t so great. We remembered the Domski Cathedral in Riga, with its famous organ, and the fabulous concerts and liturgies held there within. I asked Galya about the qualifications of the doctor, and she confirmed that he’s a good cardiologist.

Usually about a month before the next visit, I receive a phone call from the registry of the cardiology centre, and a pleasant female voice informs me of the date and time for my next visit. This time, not long before the appointment, I received a phone call that Dr. Vishinski would like me to arrive an hour earlier to do an echogram. Apparently something alerted him.

The latest result of the echogram cheered him up even less. It was discovered that an aortal valve too had to be operated on.  Now the issue was two valves, in addition, according to the cardiologist, the aortal valve has a tendency to degrade faster than a mitral one. Hence as a cardiologist he considered that an open heart surgery to replace two valves was unavoidable, and should be performed as soon as possible. I wanted to agree immediately, and wanted to inform my family doctor of his decision. We agreed to meet again in a couple of months. There was still time.

There is time, but it must be used wisely. I began discussing doing the surgery with my family and close friends.

After a few weeks I visited Dr. Beltof. He had not yet received the report and conclusion of the echogram, so I personally familiarized him with the cardiologists diagnostic. We discussed the situation based on my wording of it.

When a serious operation is imminent, you try to consider all things for and against, to determine if it’s really necessary. And if it is necessary, and I’m fortunate to remain alive, will it affect my other, unconsidered ailments. Will I feel better, or will such a shock to the body bring about new complications? Is it possible to prevent it? I really didn’t want the operation to bring about additional problems. In this regard, I depended most of all on my family doctor.

But can I really depend on him? My family doctor really must know more about my health than all other doctors. Due in part to his busy schedule, taking into consideration all aspects of my physical condition in one day, is a task no doctor could handle.

I informed Dr. Beltof that recently I have been feeling much better, and there are no obvious indicators necessitating an operation. The cardiologist’s conclusion however, was to him more important. He convinced me that the absence of clinical issues speaks in favor of doing an operation, which should be done as soon as possible, while I can still go to the operation on my own two feet.

I will not complicate things for you the reader, with details of subsequent visits to either doctor. However, one of the last visits to the cardiologist, which took place in 2011, I must describe to you, as it was a decisive one. Dr. Veshinski asked me a question:

-          At what hospital would you like to have your operation done?

A good question. Until now I haven’t thought about it, and didn’t know which hospital in Toronto would be best for such an operation. Luckily, this question was handled my youngest son Misha, who sent me two pages of information about and a photo of Dr. David Glenn – a cardio-surgeon from one of the central hospitals. I showed the information to Dr. Veshinski. In my own shortened summary, the information contained the following:

“Dr. David Glenn – surgeon in the department of cardiovascular surgery, has been a member of a large group of surgeons (Care Team) since 2002. Was born in Toronto and received his education at the Faculty of Medicine at the University of Toronto. Holds a doctorate in molecular biology. He is a recipient of many prestigious awards from some of the most distinguished Canadian medical organizations. During his practice in America, he received a high honor as an outstanding surgeon. “

Dr. Veshinski agreed with my choice. He was curious where I got such information. I told him about Misha, and how before moving to Victoria, British Columbia, he worked as a psychologist at the same hospital for a few years. Misha knew how to find the right information about a good surgeon.

Dr. Veshinski promised to call the director of the department of cardiology, Dr. Britt Estrin, regarding the operation and the surgeon. He will also look into doing an angiograph, which is usually done at the hospital before the operation. He promised to let me know, as soon as he would establish a date for an examination. This conversation took place on October 5^th, 2011, I was scheduled for an angiograph for October 27^th, 6 a.m. I was told that I should not drive myself.

So as to not bother anyone for a ride to the hospital at such an early hour, me and Tanya took a taxi to the examination. The taxi driver was a pleasant man named Nathan. Interesting coincidence, having the same name as the Cardiologist, but unlike the latter, he spoke Russian, which eased our communication. Calm and attentive, unlike most taxi drivers, he also turned out to be a man of few words.

Early morning always draws me in with images of awakening nature. I was so distracted by the atmosphere of anxiety about the upcoming operation that surrounding me, that I was pleasantly surprised and excited by the beauty of nature suddenly unfolding before me. I obtained a much needed calm. Usually, when facing obstacles, I try to calm myself and focus on the task ahead. But here, feeling calm came out of the shifting of focus to the beauty of nature, which was impossible not to notice and feel.

The taxi driver did not hurry, and we were able to watch the wonderful sunrise of a warm autumn morning. A massive sun slowly rising above the Earth, and depending on the position of our taxi, disappeared, and reappeared again, in between towering buildings. A sight all too rare for us. We have never watched a sunrise so early. Around our house, the sun always hides behind a forest or behind tall buildings. Such a wonderful sunrise must be a good omen.

We arrived ahead of schedule. The lobby was empty, after us entered just one more person. We didn’t hurry. I walked over to a stand with medical booklets and journals. I picked up a thin magazine of just a few pages, published by the hospital. Another coincidence: the main article is about the very same cardiologists who I am seeing. An article about the surgeons Estrin and Glenn, as pioneers in the field of the minimal invasion heart surgery. I’m reassured with the hope that my decision was the right one. Maybe with these surgeons I could avoid an open heart surgery. I took the magazine with me.

The registry of the cardiology department I’m issued a burgundy card of a hospital visitor. Later at home I discovered that I already had the same one. Maybe I should have taken it with me, but forgot. I’m hoping that I won’t need either too often.

The nurse offered Tanya to sit in the waiting room near the registry, while escorting me to the facility especially equipped for an angiograph. The surroundings looked like an operation, with a high bed underneath bright lights, whereupon I was told to lie down, reminiscent of a surgical table. I notice a screen to the left of me, I’m hoping to see on it, what is being done to me.

Two doctors approached. One tall, with regular clothes and a backpack, the other of average height in a white coat, seems he’ll be the one doing the angiogram. While looking at my right arm, they’re speaking to each other in Hebrew, perhaps they are residents from Israel, or perhaps former Israelites. Too bad I can’t understand what they are saying. Finally, the shorter of the two doctors said to me in English:

-          We’ll be watching through the arm. We’ll try, maybe it’ll work. It’s better this way for you as well.

I know that a catheter is inserted through a vein in the groin, which is much less pleasant.

The taller doctor nodded satisfyingly and headed for the exit, his soft backpack an indicator of an over-night shift. 

After that everything happened quickly and precisely. The nurse inserted a thick needle into my arm so skillfully, that I barely felt any pain. Through the needle they started inserting a catheter via a vessel towards the heart. It didn’t hurt, but I felt the movement of the catheter. The screen turned on, and I tried to focus on it. I can see the pulsation of my heart, and how a as a dark string, moves from one blood vessel to another the catheter controlled by the doctor. This control through the needle is felt in my wrist.

Dr. Estrin “flew” in with an energetic walk, approached me, greeted me, asked me how I was feeling. I answered that its tolerable. He praised me and disappeared behind a screen, from where just a few seconds later where heard his instructions about where to maneuver the catheter.

Later I learned that the result of the examination depends most of all, on the skill of whoever is performing the examination, not just on the computer (this concerns other examinations, namely echograms). Here the human factor remains of utmost importance. I am certain that in the future it will play a much smaller role.

The examination did not last very long. It was soon finished, and the catheter was extracted from the vessel.  From my point of view as a patient, the whole procedure was performed very professionally, without pain or significant to me discomforts.

I ask about the result. Dr. Estrin tells me that there is for me, at least one good piece of news: the examination showed that my blood vessels for now aren’t too bad. Therefore, it’s not necessary to do a bypass. Already good news. Regarding the valves, they found that the mitral valve is not as bad as was shown on Dr. Vishenski’s echogram (see above regarding the human factor), however the aortal valve, without a doubt requires replacement. This means that an open heart surgery for the replacement of two valves is necessary.

I show Dr. Estrin an article in the journal about closed-heart surgery.

-          They’re quite the journalists, - he laughed.

-          To tell the truth, we don’t have much experience yet. We use this method only then, when we are certain that the patient cannot endure an open heart surgery. But it is always an experiment; therefore the result is not always a success. There is still a lot of work to be done; we are only at the beginning.

-          Don’t worry, before cutting, we will thing about another 10 times; everything will be done very carefully. Here is my business card. Please call me if you have anymore questions.

-          Now please do an echogram one more time in our laboratory.

Even though I was tired after the angiograph, I was under a lot of stress after all; I had to do the echogram as well. A meeting with Dr. Glenn was scheduled for November 2^nd, 2011.

My granddaughter Yana, the daughter of my oldest son Victor (Vica) drove me and Tanya home. At home I got many phone calls from children; from Vica, from Misha in Victoria, from close friends and relatives, all wanted to know the result of my examination, and will I be going through an operation. I answered as it was that I do not play the main role in this story, and the decision is made by the surgeon.

Remained just the hope that at the meeting with Dr. Glenn, I could convince him to do a catheter operation. I really don’t want to go under the knife. However I do understand that being a guinea pig is also not the best option.

Making the decision

On November second I and Tania visit the surgeon Glenn. I will simply provide the main points of our meeting.

To Dr. Nathan Vishenski,

Dear Nathan,

Today I had the pleasure of meeting in the surgical clinic with your patient Mr. Vitali Guitberg. As you know, he is a very pleasant gentleman of 77 years, who immigrated to Canada in 1992. His story began in his youth, when he was told he has noises in his heart. It is unclear whether this was documented as evidence of rheumatic illness in his youth.

(Included is the analysis of the results of the observation, and the latest anagram).

Today I had a long conversation with Mr. Guitberg and his wife, who also participated in our meeting. We discussed the the history of the rheumatic illness of the valve and the possibility of therapy. I am certain the that present condition of Mr. Guitberg confirms the requirement for an immediate surgical intervention, especially considering his main lung hypertension, and the size of his left atrium. We discussed the procedure, the process and the potential risks and benefits. Mr. Guitberg has agreed to the operation. I will take all the necessary measures to perform the operation myself, in  a timely manner.

I am grateful for the opportunity you have afforded me to take part in the treatment of Mr. Guitberg.

Sincerely,

David Glenn

Copy: Dr. B. Estrinand Dr. M. Beltof.

The surgeon inquired as to when I would like to undergo the operation. I answered that sometime in late January (as per the advice of Dr. Beltof). Dr. Glenn smiled:

“By this time, we must already finish everything. I think it should be done much sooner, but you must coordinate this with Ms. Larissa Flora, she is my administrative assistant. She is in charge of the scheduling.”

There is a saying: “Man proposes, God disposes”.

Miss Flora turned out to be a very pleasant and active woman, an immigrant from the Philippines. She gave  me a  prescription for the surgery, and said that she will try to book it for November 17^th, in other words in 2 weeks. I decided that I still had time to consult with my other doctors, and perhaps even cancel or postpone the operation. I didn't feel sick enough to rush going “under the knife”.

Miss Flora phoned a few days later and said that November 17^th would be impossible, but will try to plan the surgery for the beginning of December.

The second to last meeting with Dr. Vishenski, which was also very important for me, took place on November 23^rd. I needed to bring his attention to the various assessments of the condition of my mitral valve that were concluded from the results of the echo-gram tests at his center and hospital. It was evident in the results of the observation sent to him by the hospital (he provided me with copies). Someone made a mistake.  Therefore there could have been a mistake with the aortal valve. I requested one more echo-gram test, in order to reveal the deterioration of the aortal valve. He agreed and scheduled the next visit with him for January 9^th, 2012, with the echo-gram being done on the same day. During this he reasserted his opinion in the necessity of the operation. The assistant Galya, when learning the operation would be performed by Dr. Glenn, was genuinely happy for me. She worked with him a few years back:

-       “He is an amazing person, and an excellent surgeon. I can't even think of words to describe him, perhaps golden, or brilliant.”

She suggested that during the next echo-gram I should bring the attention of the technician to the condition of the aortal valve. She too believes that the result of the test depends on the mastery of the person conducting it.

Despite receiving the opinions of three doctors, I decided to ask yet two more doctors I was acquainted with, who are taking part in our mutual project, which I will describe later.

I phone Dr. Gita Khavronskaya. We agreed that I will visit her on November 24^th, at 8:30, before she sees her patients. I showed her all the copies of the tests that I received from the cardiologist. After viewing them, Rita suggested proceeding with the operation, the sooner the better, in fact, confirming what was said by Dr. Beltof and Dr. Vishenski.

I consult with Dr. Vlad Terlov. He explains to me in detail the physiological functions of the heart, and what happens when the valves are worn out. After familiarizing himself with the same data I showed to Rita, he explained in detail why the operation must be done on an open heart, and why everything should proceed just fine.

Everyone who knew about the upcoming operation phoned me and tried to cheer me up, some even told me of known to them cases of successful procedures. We all want to act this way, when we want to calm someone who is expected to undergo such risky undertakings.

After additional consultations and daily discussions with friends, I decided to call Miss Flora, and asked her to schedule the day of the operation as soon as possible, for example, Tuesday, December 6^th. Psychologically I was exhausted from talking about the operation, and all the possible outcomes. The daily discussions did not allow for any distractions, and a normal way of life.

Miss Flora said she will try her best, but explained that it all depends on the availability of the surgical room. It was difficult for her, because Dr. Glenn had forewarned that the operation would take at least 6 hours, and that day he will be performing only my operation (usually he has 2, sometimes even 3 operations per day).

The last meeting with Dr. Vishenski before the operation was conducted, as planned on January 9^th. The echo-gram was done by a very attentive Russian-speaking technician Tania. As per usual during my visits to the cardiologist, the cardiogram was done by Gala. She understood that the operation was inevitable, and she very warmly wished for a successful procedure. She was completely sure of this, as the operation would be done by Dr. Cohen.

Receiving the result of the echo-gram Dr. Vishenski said:

-“Everything will be fine; we'll meet again in a month, after the operation.”

He went with me to the reception, and scheduled our post-operation screening for April 11^th, 2012.

Its possible that I exhausted you the reader, with an overly detailed description of the period of decision making, but I wanted to demonstrate the complexity and psychological pressure of this process. There was no doubt left, and I was entirely convinced the operation is necessary, and a better treatment option does not exist today, and there is no point in waiting for it to get worse.

Therefore, the question is decided. With doctors I discussed only the main aspect, should I or shouldn't I undergo the operation. With none of them, except Dr. Terlov, did I discuss the psychological aspect, but I was risking my life. During our consultations Dr. Vishenski explained that the operation is a dangerous thing, but to not do it, is also dangerous.

I envisioned that there are several risks associated with the operation: the risk that the heart could turn out to be in a worse condition that previously thought (later I found out that during the opening of the heart it was discovered that the third valve to was leaking), a vital apparatus for maintaining the function of the heart or other organs could fail, the surgeon himself, or a member of his team could suddenly feel bad, and finally, my body might not be able to handle it.

Without a doubt, I was taking a big risk, but as Dr. Beltof assured me, at my age, and at such a deteriorated condition of my valves, complications could arise at any moment, at that point it will be too late to do a surgery; I will not be able to handle it. I wasn't afraid of death. Either due to the confidence in the professionalism of the surgeons chosen by me, or the nature of the consultations, I was calm. Being a fatalist to a certain degree, I believe that in life, not everything is in our hands, and that which isn't, is in the hands of a higher power, whether you call it god or nature is irrelevant.

I can not make important decisions in life, if I don't entirely understand the purpose of the preceding actions, the situation in which they might occur, and the expected outcomes of these actions. If it is possible to understand all of the above, the doubts disappear, and I focus on the attainment of the task at hand. This approach allows me to deal with life's obstacles. Unfortunately, every person undergoing surgery becomes a fatalist, because no one has the complete confidence in the fact that one has understood everything and is 100% certain of a positive outcome. It can't be otherwise, because doctors themselves, those who propose surgery, and those who perform it, express utmost carefulness in their forecasts. I'm doing the right thing; after all, they are not Gods.

At times, when thinking about the decision, I experience anxiety and uneasiness for my dear wife, with whom we have been conquering life's challenges since we where students. Of course it is our own meritthat we have been able to live such a long life together, but not only ours, this is also fate. My parents could have livedno less together, if death had not separated them.

Since Tania retired, she fully dedicated herself to family and the household, and for the most part was sheltered by me from the outside world.

In Canada she bravely embraced the first days of immigration, taking on difficult work that she was not used to. And now that I made the decision to do the operation, she comforted me thatcope with all the difficulties.Of course we were sure that our sons and friends will help, but I understood that in a bad outcome, it would be very hard for her to adapt to a new way of life. Our entire life together, including the 20 years in Canada, w were inseparable. I had nothing left, but to keep living.

Miss Flora unsuccessfully tried to schedule the operation for the 6^th, then the 17^th of December, 2011, until finally she was able to get the operation room for Dr. Glenn for Tuesday, February 21^st, 2012. A pre-operation meeting was scheduled for February 17^th, 2012.

Although everyone anticipated this event, it was not until the operation became a definite reality that members of our small family and our friends became worried. Me and Tania where very touched by your concerns, which were expressed to us by those close to us, and foremost by our sons. It was especially pleasant that they did everything as if it was self evident, while otherwise they would not have even considered their participation in our fate. They way in which our sons and grandchildren carried themselves before the operation, and during the especially difficult time after the operation, they way the supported me, and helped their mother/grandmother in supporting me, brings out in us both feelings of gratitude and pride towards them. I believe the memory of this difficult step will remain in their memory, and the memory of our grandchildren, for we are a strong family, and will always be ready to help each other, no matter what.

When the question of doing an operation first arose, my sons began a very active psychological and practical preparation. My younger son Misha sent me e-books from Victoria (the capital of British Columbia), in which the authors, having experienced a similar operation, shared their advice on how to prepare for such an operation, and how to deal with the post-operation period. He sent me advice of doctors and psychologists. He suggested creating a “support group”, made up of relatives and friends, who would be able to help Tania during my time in the hospital and after my release. One of Misha's ideas, which he especially wanted to realize, was to record special music, which would be played while I was undergoing the operation. It was meant to help me better deal with the pain. He even bought and sent me an MP3 player, in the shape of a small disc, which he filled with music for relaxation and meditation, and suggested I add my own favorite music. I wasn't sure that I would be allowed to use such an apparatus during the surgery, but was prepared to use it post-surgery.

My oldest son Victor lives close to us, just north of Toronto, and we often discussed with him the consultations with doctors. At first he was against me doing the operation, but when in became evident that all the doctors recommend it, he sent me an internet article, outlining that age is not an obstacle for this type of operation. He found many examples of cases where people much older than me successfully endured this procedure.

The “support group” formed all by itself, as all our friends whom we told about the operation, we very eager to offer their help. Within the “support group”, among our older friends there were two, who already experienced valve replacement surgery. When one has such a dangerous operation that goes successfully,  one wants to share one's experience, in order to offer psychological support to those who are about to undergo it.

I'm very grateful to all my friends. Their attention was very touching, and inspired hope for success. They perceived that I, as any normal person would, should experience fear before the operation, and wanted to support me. Perhaps somewhere in the unconsciousness there was a feeling of danger, but for some reason I did not comprehend it. There was only the desire to learn more about the post-operation period, in order to be better prepared for the operation itself.

The long, continuing discussions further tired me. I wanted it all to be over, so we wouldn't have to rehash this topic of such worry to everyone. I even got  a stark feeling, that optimistic predictions might not materialize as a result of constantly repeating them.

To the pre-surgical meeting on February 17^th, me and Tania went by our own car, after that we were forced to rely on our friend's help. It was incredible that at this time the weather remained warm, although it was still winter. The morning was the same as on October 27^th. A large red sun blinked between tall buildings, spreading a yellowish-red gleam over the sky. The weather in many ways boosted the mood.

The meeting consisted of two parts: the first – at 10:30 am, the second – at 12:30 pm. During the first, my blood was taken and an ECG was done, then I was given detailed instructions how to prepare for the operation. I was prescribed a special liquid, which had to be picked up in the hospital's pharmacy. It was necessary to use it in place of soap during the morning shower, to disinfect the part of my chest where the incision will be.

The second session was conducted by the regional cardiac care coordinator Kaitlin Brown. Several people who were awaiting surgery, as well as the younger members of the surgical department took part. Among them Kelly, a tall, slim, energetic physiotherapist, the surgical nurses, as well as an older volunteer, who himself had recently undergone a similar operation. Kaitlin and Kelly were explaining about how to prepare for the operation, and how to behave afterward. The volunteer shared his experience in detail, suggested what underwear is best to wear, and what food is best to bring from home. Vica came to the second session to be informed as well. We were given brochures, containing lots of advice, including that which we've just heard.

The same day, after arriving home I received an e-mail from Miss Flora:

Hello Mr. Guitberg, your operation will be in the morning. You must be here at 6:00 am. Thank you. F.

Misha flew in on the 19^th at 7 pm, Vica met him at Pearson airport, and took him to our house. At this time Yana brought Yulia. We were happy that almost our entire small family had assembled in our home. It was sad that, Misha's wife Dora and son Ezra, who remained in Victoria, and our oldest grandson Elijah, could not be there. However Dora phoned and Ezra also said something into the telephone. Elijah, having gone to Japan for work a month ago sent an e-mail:

“Dear Grandfather, hope your operation goes smoothly, and wish you a speedy recovery. Will keep you updated on my progress here. Kisses and hugs, Elijah”

Everything was very touching, worrying, but at the same time calming. The evening passed in very optimistic surroundings. The food prepared by us was not overly abundant, we weren't sure if it would appeal to our vegetarian son Misha, but it turned out that everything was to everyone's taste. We didn't stay up too late.

Misha stayed in a room on the first floor, with a direct exit to our garden, small but comfortable. We spent the day with Misha, familiarizing him with my car the “Intrepid”, and the nearby grocery stores. He was last with us around the beginning of August 2009, and lots has changed here since then. We went to sleep early, tomorrow is the operation, and in the morning I still have to get ready for it.

Later I learned that at 10:56 pm, Misha sent everyone an e-mail:

“Hello to all friends and relatives of Vitali and Tatiana, this is just a short e-mail reminding you that tomorrow Vitali will have heart surgery, which will begin at around 8 am, and last 4-5 hours. Please send your thoughts and wishes for success during this interval. We will keep you updated on the course of events. Thank you for your care and participation, Misha.”

to be continued

Translated from Russian by Elijah Guitberg