Gratitude in the Midst of Open-Heart Surgery

Issue #44

Hello! I’m Aaron Kardell. In my newsletter, I pick one random topic to go deep on.

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To kick off a new season* of my Sunday newsletter, I want to start with something personal and meaningful.

Today’s note is part personal update and part reflection on gratitude – why this surgery stretched me, grounded me, and made this season’s thankfulness hit differently.

Two Sundays ago, I felt a strange mix of nervous energy and determination. I was preparing to step away from work for five weeks, making sure bills were handled, and tying up any loose ends – just in case the upcoming Wednesday didn’t go the way I hoped.

I’ve known since my late 20s that open-heart surgery was an inevitability for me. I was born with a congenital condition called a bicuspid aortic valve. Over time, that’s led to severe regurgitation. Basically, my heart was becoming more inefficient each day. If left untreated, heart failure would be inevitable.

My first cardiologist said she didn’t know if surgery would be in “2 years or 10”. I was blessed to wait a full 17 years. It certainly wasn’t top of my mind daily, but the overhang was always there - presenting itself in frustrating ways. I learned early after initial diagnosis that it was suddenly a near impossibility to get life insurance for any amount I would feel sufficient to cover my family.

The timing of surgery was always going to be based on symptoms or what my annual echocardiogram showed. This March, my new cardiologist said the echo suggested it was time to start preparing. She wasn’t pushing me into immediate action, but she made it clear that 2025 needed to be the year for valve replacement surgery.

I’ll save a post for another day on how I ultimately chose to get the Ross procedure instead of other options, why I traveled to New York to get it, and why it took me another 7 months before I was on the operating table.

Back to two Sundays ago. Some of my pre-surgery/pre-travel prep. was very focused and surgical in its own right. I handle all our bills and finances, and I was documenting everything I considered relevant in case surgery was unsuccessful. Some of it was anything but surgical. I wrote my kids letters in case I didn’t make it. That was a trip. People in my age cohort who undergo this procedure with this surgeon have a success rate of better than 99%. But that <1% chance was still discomforting. I wasn’t sure how much prep for the worst-case scenario was really too much or too little.

Over the next couple of days, I flew to New York and had my pre-op appointment. A flurry of other random things on Monday and Tuesday entered my mind as “must-dos” before undergoing surgery.

I went to the surgeon who does more Ross procedures than anyone in the world. I was really grateful to be informed that I would be his first procedure of the day and that I didn’t have to check in at the hospital until 7:30am for a 9:30am procedure.

Around 8:30am, I said goodbye to my wife, Kate, and my friend, Brad (who had traveled to join us for surgery). I was wheeled back to a holding area to prep for surgery. An hour later, I met my Doctor in person for the first time. He asked how I was doing, and I said, “I’m at peace”. For all the nervous energy I was feeling in the days leading up, I was telling the truth in that moment. I knew I was well prayed for and in the hands of the surgeon I believed to be the most capable in the world.

We quickly walked through contingency plans that we hadn’t fully walked through in the online consult: Plan A was a valve repair (unlikely but worth trying), Plan B was the Ross procedure (the intended route), and Plan C was a mechanical valve if neither option worked.

Five minutes later, they wheeled me back to the operating room. I looked around enough to get my bearings. Then, thanks to the wonderful anesthesiologists, I remember nothing from the next 10 hours or so.

I’m told that Kate received very little information on how things were going via text during the lengthy procedure. This was understandably quite unnerving for her, in spite of a forewarning that that might happen. Around 4:30pm, she received a call from the surgeon to let her know that Plan B was chosen and the Ross procedure was successful.

Somewhere around 7pm, while still half under the influence of anesthesia, a nurse started talking to me to let me know that: a) I was in the ICU; b) they were planning to take the breathing tube out; and, c) Kate and Brad were in the room. The nurse asked if I knew who they were. Lacking the ability to verbally communicate or even open my eyes, I made a heart symbol with my hands.

It was also around this time that I started pumping my fists and arms in celebration. The nurse had to tell me to stop so I wouldn’t hurt myself with all the various tubes in me. But as far as I was concerned, this was the first moment I was aware that I had made it and I was alive. It was time to celebrate!

I spent just under the next 24 hours in the ICU. I was nauseous the whole time. I had two fantastic nurses, and… a third nurse. Just for fun, the patient next door was an inmate guarded by two policemen.

They transferred me to the step-down unit around 5pm on Thursday. I really wasn’t sure I was ready to be out of the ICU, but I met all the criteria for step-down, and they really didn’t have room for me in the ICU. Somehow, I managed to take an extended nap for the next few hours, and my disposition immediately changed. I was feeling much better.

And then basically ever since Thursday, November 20, at 8pm, things have gotten a little better each day.

As of today… I’m 11 days post-surgery and 6 days out from being released from the hospital. While I still have some restrictions - eg, no lifting anything over 10 pounds, no running, and no being in the front seat of a car for several more weeks - in most other respects I’m really starting to feel “normal”. And, I’m frankly in a better mental state because I don’t have the overhang of an upcoming surgery in front of me.

It’s weird. For my Doctor and for all of the medical staff who supported, this was “just another Wednesday”. But for me, I hoped that Wednesday would be a defining midpoint, not the endpoint, of my life. Like a friend of mine says, “Minor surgery is what everyone else has.”

This whole experience has also given me a deeper empathy for anyone facing medical uncertainty. Even with a 99%+ success rate, the lead-up was emotionally heavy for Kate and me. And it made the outpouring of support this season feel even more meaningful. I’m grateful for so many things.

We were well supported and loved on by countless friends and family. Thanks to my friend Brad for traveling to New York to be with Kate and me the day before and after the surgery. Thanks to my parents for staying with and watching my kids for two weeks. I had an army of people praying for me from diverse backgrounds. Numerous people let Kate know they were supporting her in so many real and felt ways.

I’m grateful that insurance covered the procedure I sought with the surgeon and facility I wanted. I’m thankful we had the resources to cover travel and hotel costs that insurance wouldn’t cover, and that I was well enough to travel for surgery at the time I needed surgery. I’m grateful that every single one of my coworkers and superiors fully supported me in taking a full leave of absence to focus on recovery.

I’ve told a few people that I feel like this experience has unlocked a “new level” of gratitude for me.

This has deepened my sense that every day is a gift, and I’m hopeful that 2025 is much closer to my midpoint than my endpoint. If that’s the case, then there’s more I’m supposed to do. ‘To whom much is given, much is expected’ feels a little heavier now, in a good way.

Tomorrow I’m hoping for the all-clear to fly home. I can’t wait to see my kids.

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As my faith has shifted through moments of deconstruction and reconstruction over the years, I’ve decided to create a private Substack to dive in deeper and explore and discuss the moments that have shaped that journey. It’ll be an opt-in space for honest reflection and conversation - not proselytizing. If you’d like to follow along, please fill out this brief form.

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* I’m going to start thinking of times I write this newsletter as “seasons”. The only analogy I can give is comparing to podcast seasons. I don’t want to commit to weekly writing in perpetuity, but I do like revisiting the regularity of writing periodically.

In the following “episode”, I’ll talk through how I found out about and chose the Ross procedure for aortic valve replacement, and why I decided to travel for surgery.

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