The City Hospital Experience Begins.
And you thought New York City was your best option?
Summer-2016 — In the days that followed our new revelation that I would need a heart transplant, things seemed ominous.
There was no longer a place for denial of my condition. And so, I went for my first of many visits at Mt. Sinai Medical Center, to see the renown Dr. Madison at the urgent recommendation of Dr. Fillman. Shelley and I took our first drive from Long Island into Manhattan to Mt. Sinai, and it was a bit overwhelming. We had driven into the city hundreds of times before but this hospital was different than the ones we had been to before. First, we had to find the parking lot that we heard many of the patients use, several blocks from the hospital. Mount Sinai is a huge hospital located in “El Barrio”, East Harlem in the New York City borough of Manhattan. It spans along Fifth Avenue between 98th and 103rd Streets, on the eastern border of Central Park. The area bustles with hospital workers coming and going, patients searching for their appointment destinations, street vendors selling everything from bagels to gyros to ice cream. The wind blows unusually strong through the maze of buildings making it difficult to walk when your breathing is challenged.
As we walk through our best guess of an entrance we are greeted by a large staircase demanding what seems like an endless walk up to the main lobby (I found out at a subsequent visit to the hospital that I could have taken an elevator behind the security area). You are not exactly greeted by a host at this place. The large lobby advertises their most esteemed doctors with twenty-foot high pictures and profiles. To the right through another short hallway is a large cafeteria to provide for all of the hospital staff and patients alike, but we walk straight ahead where a smaller coffee stand selling pastries and sodas is surrounded by small tables. As we walk toward the coffee stand, just to the right we see the large glass doors with the words “Cardiology Department” written across the pane, so we pass through this set of glass doors, finally reaching the registration area. We sign in with the help of a gentleman sitting behind a large high counter with a “Welcome to Mt. Sinai Hospital” sign pasted to the front and we are asked to wait to be called so that another receptionist can take our insurance information. When we hear my name called I jump up to provide my health information and driver’s license to this second person, an attractive, young Hispanic woman. It’s obviously important to be bilingual at a hospital in this area of the city. She asks us to wait on the bench to her right to be called to proceed through yet another set of doors to the physician waiting area, a room the size of a banquet hall. Finally we are called by someone in blue scrubs (could it be that we were actually going to see someone with a medical background?) who walks us down another long corridor into an examination room. “Your nurse will be with you shortly, “ we are told.
Miracle of miracles, a young nurse arrives in a bubbly mood. “Good morning, my name is Jennifer - I am Dr. Madison’s nurse practitioner. And you are Mister Sherman? ” “It’s DOCTOR Sherman,” I respond, correcting her mistake. I always feel a bit uncomfortable correcting people about my name, for I fear that the perception is that I’m being arrogant and haughty. The fact is, “Dr. Sherman” is indeed my name and that‘s’ what most people have been calling me for the past thirty-six years! “Doc”, “Dr. Sherman”, “Dr. Gary” or “Gary”. But NOT “Mr. Sherman”. “Mr. Sherman” is no different to me than calling me “Miss Sherman” or “Mrs. Sherman”- it’s incorrect! My father’s name was Mr. Sherman - not mine. When you fill in those forms asking for a “title” — for me it’s “Dr”. That’s what I’m used to. I will find myself constantly making this correction when meeting new medical care providers forever. But I’m not ready to let it go quite yet. The other thing about this, is that to me, being a doctor is an important part of who I am, but more about this later.
First, Jennifer asks me to take off my shoes and step on that “DETECTO” doctor’s scale with the bars and the weights. I hate scales. These particular ones always seem to register a couple of pounds more than the bathroom scale at home. Also, since my breathing has become more challenging, my ability to exercise has lessened greatly, making it difficult to keep the weight off. Jennifer then asks a technician to come in to hook me up for a quick EKG, a test that for me, is usual and customary. The polite technician, a young, friendly, african-american woman with a great smile (I’m a dentist, remember), apologizes as the sticky electrode pads pull at the hair in my abdomen. She performs the test quickly and even takes a stab at registering my blood pressure.
“Dr. Madison will be right in,” Jennifer tells us and within seconds a very petite, somewhat older-looking woman appears, sharing a half smile and an impassive “Hello”. She was nothing like what I had imagined. The “famous” doctor I had imagined was a strongly postured, immaculately dressed physician with a confident smile and stiff chin. Uh…. this was not that person. Dr. Madison seemed not really self-conscious about her appearance and had poor posture. She looked rushed and a bit ill-at-ease. She turned quickly toward Jennifer asking her if she had performed the EKG and had confirmed my medications. My first impression was that it felt as if Jennifer were her “spokesperson” and the doctor would speak “through” Jennifer. Dr. Madison was not unfriendly but serious from the start.
She held a calculator in hand, and it was obvious to me that my statistical test results would guide her assertions regarding my heart’s condition. She quickly reaffirmed that it appeared from the information she had received from Dr. Fillman, that I was indeed in need of a new heart–showing me on a small computer screen that my ejection fraction was dangerously low. She immediately prescribed a stress echo — I would find out later from Jennifer that the stress echocardiogram was her specialty .
Dr. Madison had penned a number of research papers which confirmed a relationship between performance on the test and the need for cardiac surgical intervention. Dr. Madison explained my condition again despondently, and seemed slightly more compassionate as we went along -a…sort of. She seemed to be extraordinarily certain of her findings, and not one to be talked into anything she didn’t know was certain — no use me trying out my stoicism on her.
Jennifer and Dr. Madison then told Shelley and me that they were introducing us to the man who would more clearly describe my options, and soon after my examination and consultation, we met with John. John was an older man, perhaps in his early seventies, I believe with a nursing degree. After a cordial greeting he said almost immediately, “You have a slim to no chance of attaining a heart here, given the dearth of hearts available to patients waiting at Mt. Sinai and the huge number of people on the waiting list.” Then he told us that unfortunately, we were probably in the worst state in the country for obtaining a heart, because New York has so many people with heart failure and has relatively few donors.
John spoke to us about considering taking a residence in Florida or California, where the automobile accidents were many, and poor motorcycle helmet laws provided for the availability of many young healthier hearts -or perhaps New Jersey — which was getting more hearts in the geographic region than New York. It was confusing and frustrating — not at all hopeful. I was not about to move to Florida or California because I never felt comfortable in those places except for vacationing, I was still practicing full-time in Long Island and because Shelley loves the life that proximity to both New York City and Long Island offers.
John told us that typically, a person with congestive heart disease starts out feeling fairly well — like me — but then generally experiences what he called -exacerbations, of the type that I had already experienced when I had cause to spend a weekend at NYU Medical Center several months prior. The typical exacerbation was an episode where I would wake up in the morning with difficulty breathing, a chronic cough, crackling sounds from my lungs, and perhaps some swelling of the lower legs. — I was informed about the possibility of more future exacerbations due to my congestive heart failure. John described these occurrences as regularly occurring, each event leading to a lower plateau — a worsening of my quality of life — and more and more challenging to rebound from.
The first year of appointments were spent with Dr. Madison juggling my medications, keeping me going. At a visit several months into my treatment at Mt. Sinai, I had asked her if she would continue to treat me medically as long as I was functioning rather well- which I was, and didn’t feel I needed surgical intervention -yet. I mean to say, it was only the occasional steep road, or multiple flights of steps that would cause me to take a rest — not a big deal — and maybe I would be the outlier — the one who could live with congestive heart failure forever — or at least many years.
In the spring of 2018, I experienced my third exacerbation highlighted by suddenly waking from sleep, gasping for air. and I was still in denial. For me, an illness like a flu or pneumonia or a persistent cough and difficulty lying down would draw me into the emergency room in need of some diuretics to help remove the fluid that built up around the lungs. A variety of preventable factors can lead to deterioration, two of these being excessive salt intake and drinking too many liquids. It was recommended that all patients with CHF receive vaccination for influenza and pneumococcus to reduce the likelihood of CHF worsening.
Certainly, with each exacerbation I would come away feeling a bit worse, but I tried not to let these occurrences stop me from working, playing and travelling — still convincing myself that I was going to be the outlier. I believe the real driving force behind not giving in to my disease was that I still had my practice to sell, and I was not open to letting that asset diminish or disappear. Selling our practice would certainly help in retirement. I was fortunate that I had this disease in the times that we lived presently. Famous people with unlimited resources such as Elizabeth Taylor , Jim Morrison , River Phoenix , Isaac Asimov , Boris Yeltsin , Andre the Giant and many others died of congestive heart failure having little recourse. But I felt that I could somehow press on.. and I did…much longer than I should have.
