Dr. Nolen's "Double Cabbage"

Dr. Nolen's "douvle Cabbage"

At 47 he was only slightly overweight and considered himself reasonably fit. He ate and drank moderately, exercised often and did not smoke. But on a warm day last May, after only five minutes of racquetball, he suddenly became extremely short of breath. A burning sensation swept through his chest. Too exhausted to continue, he crouched on the ground trying to recover. Eight weeks later he was wheeled into an operating room for a coronary bypass.

Though thousands of middle-aged victims of heart disease have undergone such operations in the past decade, this was no ordinary patient. He was William A. Nolen, M.D., author of the 1970 bestseller The Making of a Surgeon, a startlingly candid behind-the-scenes account of his surgical apprenticeship at New York's Bellevue Hospital, and other popular books. Not one to miss an opportunity to publish, the articulate Litchfield, Minn., surgeon has now made the most of his unfamiliar position at the other end of the scalpel. In a new book titled Surgeon Under the Knife (Coward, McCann & Geoghegan; $8.95), Nolen tells an exciting life-and-death story--his own--and also provides useful insights that should help less informed surgery patients.

As always, Nolen is refreshingly candid. He admits that he foolishly refused to take his first chest pains "seriously--though he had a history of high blood pressure, and his father died at 58 of heart disease. After an electrocardiogram finally confirmed that the pain was angina--a condition caused by an inadequate flow of blood to the heart muscles--an immediate concern, he allows, was whether he would be able to keep up an active sex life.

"Let me confess that. . . I like sex--one might say I love it." While he is graciously appreciative of his doctors' skills, he is also willing to point out their occasional fluffs.

He recalls, for example, that his original cardiologist in Minneapolis carelessly neglected to look at his EKG for six days. Then, when he finally did, he abruptly announced that if delicate heart X rays he was about to take confirmed his suspicions, Nolen might have to undergo surgery the very next day. Refusing to be stampeded, Nolen left Minneapolis and headed for Boston's famed Massachusetts General Hospital to get another medical opinion.

Electric Shock. It was a defiantly wise decision--one, Nolen concedes, a layman might have been too timid to make. At Massachusetts General, he learned that his problem was arteriosclerosis; a buildup of fatty deposits was obstructing two of the three coronary arteries. The suggested remedy: an operation that heart surgeons humorously call "a double cabbage"--from the acronym CAB (for coronary artery bypass). Though more than 90% of the patients who undergo such operations survive at least five years, Nolen knew that any heart surgery posed grave risks. While the surgeons do their work, the heartbeat must be stopped and the blood pumped by machine. Later, the stilled heart must be jolted back to life.

Nolen's operation went without a hitch. Awakening in the recovery room four hours later, he found himself in a tangle of tubes and wires. Almost every bodily function was being monitored or controlled. To ensure adequate oxygen for his heart, he was hooked to a respirator. If he tried to move, he felt a sharp chest pain (from the break that was made in his breastbone to get at his heart). Later, as he listened to the beep-beeps of heart monitors echoing through the corridor, he nervously wondered whether any change in their steady rhythm was coming from his machine.

Nolen acknowledges that his fellow doctors gave him unusually cordial treatment--possibly, one young resident slyly suggested, because he might write another book. But his special status and posh private room ($154 a day) did not protect him from "screwups." Several times wrong pills were delivered; a blood test meant for him was taken from the patient next door. Once a nurse even forgot to hook up the crucial heart monitor. Nolen's advice to patients: keep aware of the number and variety of prescribed pills, ask why X rays are being ordered and demand explanations of everything.

Though Nolen has no assurances that his heart disease is over, he has passed one major hurdle. Three months after his double cabbage, he returned to the racquetball court--and won. He has been breathing easy ever since.

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