Where I have been in the last year, in case you are interested
When I was young, there was a memorable TV commercial for the watch brand Timex. In that commercial, a diver dropped the watch from the edge of a steep cliff onto the rocks below, and then the diver followed the watch into the sea. Clambering onto the rocks, the diver held up the watch to the camera with the famous tag line: “It takes a licking and keeps on ticking.”
The commercial was wildly successful, so of course the company made a series in the same vein: They put the Timex watch into a paint mixer; into a freezer; onto the leg of a race horse; fastened to a boot blade of an Olympic champion speed racer; glued to a motor boat propeller; and my favourite, a Timex attached to an arrow shot through a pane of glass and into a tank of water. And many more versions. After the tag line, the presenter always held up the watch to show the second dial of the watch – still ticking. Yes, they don’t build watches like a tank nowadays, and a bargain for $9.95!
This was the genius of that campaign: durability sells products. Ditto with surgical prostheses companies, like the St. Jude Medical company, that made my artificial aortic valve. Having a mechanical valve has many inherent problems, but their ads in doctor’s medical magazines rightly emphasised the durability of the St. Jude valves.
I had a genetic congenitally malformed aortic valve, undiscovered till I was thirty, when I began presenting signs and symptoms. It’s called aortic valve regurgitation. In other words, my aortic valve did not close properly so the blood pumped into my heart main pumping chamber to leak back into it again.
As a result of the flawed contour of my aortic valve, the flow of the blood across the valve attracted life-threatening bacteria, causing an infection of the lining of the heart (infective endocarditis). This is rare, but that’s what happened to me – twice. The first time I was thirty-eight when I contracted endocarditis, which landed me in the Alfred Hospital in Melbourne for eight weeks. That led to the removal of the damaged valve to be replaced by a St. Jude aortic valve made with Pyrolytic carbon. Luckily for me, this was the first year it was used in Australia.
And so back to the Timex watch commercial (“It takes a licking and keeps on ticking”) – my mechanical heart valve “ticked away” as the valve opened and closed, and that is not an ad, it actually ticked. And not just ticking, but also like the Timex, it just kept on ticking way past its use-by date. I’m available for an ad for the St. Jude company: “My St. Jude aortic valve kept on ticking at eighty beats a minute for twenty-four years and …”. In fact, that St. Jude aortic valve replacement (AVR) worked so well it still remained the gold standard for a mechanical aortic valve.
Less importantly, though more importantly for my lifestyle, every time my mechanical valve opened it made a high-frequency, metallic and clearly audible sound, eighty times every minute.
People used to say to me in a lift, “You are wearing a very loud watch.”
I would reply, “It’s in me, I swallowed a watch.” Usually it was not audible to others, but not for me. I heard it in my head always. Always.
I remember the surgeon who implanted the valve said that I would eventually get used to it. But I didn’t. It was particularly loud because my large ribcage made it a perfect acoustic echo chamber. Every night when I tried to fall asleep, all I heard was tick, tick, tick… People say that after sex men get sleepy – not me. Every time I had an orgasm, it was like having a ticking bomb about to explode, getting faster and louder after a particularly energetic bout of sex.
Nevertheless, despite saving my life, the artificial valve had many drawbacks, including having to take blood thinner medication and weekly blood tests. More hazardous, the artificial valve is susceptible to form a clot. Though it is rarely, that is exactly what happened to me. A clot broke from the St. Jude valve, and travelled straight into my brain to lodge in an artery, where it caused my stroke.
Hence my stroke and this blog.
Part Two – A Cow Died For Me and The Borg
The St. Jude mechanical aortic valve, which was implanted in my chest when I was forty-one, was (and still is) an ingenious collaboration of scientific/medical and engineering design – the mechanical St. Jude valve (named after the St. Jude hospital Minnesota, U.S.A) was devised by an engineer and a cardiologist. At the time it was a seemingly impossible goal to design a workable device that mimicked an aortic heart valve.
This is my original St. Jude mechanical valve:
Because it worked, the St. Jude artificial valve was the apex of valve technology at the time. These St. Jude artificial valves have stood the test of time – for me, it lasted far longer than it was predicted.
If not for the cardiovascular issues associated with my heart disease, the St. Jude valve would still be in my heart, and it certainly would have outlived me. Look into my coffin in the next century, and you will find an all-carbon valve in perfect condition (you will also find my two titanium Radius and Ulna rods and eleven titanium screws in my left arm, but that’s another story). The valve had to be replaced because my aortic root was getting dilating. The aortic root is normally 3cm width in a healthy heart; for me it had reached 5.5cm and needed replaced to dodge a fatal rupture. Late last year, in a single operation, the surgeon replaced both my mechanical St. Jude valve and my organic aortic root in a biomedical tissue transplant procedure, using a biological valve taken from the heart of a pig or a cow as well as a synthetic tube from medical-grade Dacron. It will also outlive me.
And now to the cow. My new valve – a bovine pericardial xenograft – is built by a cutting-edge manufacturing process, in which the pericardial sac (the tissue sac that surrounds the heart of a cow) is collected and then turned into the right shape and size. Here are the cute but doomed cows where the tissue came from, Canning Downs South farm in Queensland, and thereafter sent to Texas to manufacture the valve, and then back again to Australia. My cow is third from the left in the front staring at me, or so it seems, like a juror looking accusingly at a murderer:
Last year, while surrounded by futuristic beeping machines in the Intensive Care Unit after the operation to replace the aorta and the valve, I suddenly thought about the television series: Star Trek New Generation, the sequel of the original Star Trek. There was a two-part episode called The Best of Two Worlds, arguably the most powerful arc in the Star Trek franchise, the source plot of a later movie Star Trek First Contact. The captain of Enterprise Starship (NCC-1701-D) is Jean Luc Picard, who is kidnapped by The Borg, a cyborg advanced civilisation linked through a group-mind “The Collective”. The Borg, a techno-totalitarian spacefaring, roaming the universe to assimilate the technology of a different species into The Collective – commonly considered by Trekkies as a metaphor for the Third Reich Aryan Nazi master-race. Hitler, Stalin, Lenin and Mao would have salivated seeing what The Borg achieved, a nightmarish totalitarian state they could only aspire to.
I clearly remember my reaction when I first saw that second-part episode when I was 34. Because I had already been diagnosed with a failing aortic valve, and I knew I would get an artificial valve, it was a chilling episode. I could see it that episode what is represents, for the rise of totalitarian technology. Thirty years later, I was lying in a bed in an Intensive Care Unit and connected to a morphine drip that allowed my doped-up mind to wander. And where it did my mind wander? Back to The Borg. Like the members of The Collective, I too am a combination of medical technology, artificial intelligence, advanced biomechanical engineering, fluid mechanics (which my son studied), bio-compatible materials, and who-knows-what? And it is much more than I will ever understand – a bio-medical technology field that is currently growing at a rapid pace.
While in that Intensive Care Unit, I reflected, “Maybe I am the prototype of humans in the future.” And I won’t forget that poor doe-eyed cow in Queensland who died for me.
That is where I have been. And now back to the regular series of my stroke journey …