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Halfway through my cardiac nursing school rotation, I met him: an elderly gentleman, Mr. Moran, assigned to be my patient. He was quiet and reticent, subdued by preop anxiety. Tomorrow would be his cardiac bypass surgery. He was undergoing it out of sheer necessity. Two months before, Mr. Moran had a minor surgical procedure and during it, his heart stopped. He was revived, and tests showed previously unknown cardiac disease.

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He'd had warning signs: high blood pressure, shortness of breath that cut short all but minimal activities, high cholesterol. But life went on, until life itself was threatened. Now Mr. Moran had to face it squarely, no matter how he might wish to deny it.


We had little in common. I played a minor role in this climactic life event of his. I was there to help care for him, to learn. I would spend many hours collecting data about Mr. Moran, hours writing a paper focusing on him. I would observe and learn about him and his surgery. But before long, he would become a symbol to me of myself.


I have been a Christian for twenty-four years. Like Mr. Moran, my heart was deteriorating, and I didn't or wouldn't notice. But my struggle was a spiritual one. Telltale signs showed that all was not well. I had grown to take the struggles that seemed to have no answer and bury them deep below the surface. Pain was the hardest to suppress. It was increasing, and I was growing weary of it. It invaded too many areas and relationships of my life.


I was despondent over my struggles. I began to question how true my faith was, how faithful God was to let me come to such a state. I quit struggling against the pain and allowed myself to lie in it. I became introspective and saw the cause of my troubles: circumstances beyond my control. I reckoned myself as Job, without the character to deal with my trials. I vented my feelings in my heart and mind. I shared with those I am close to that I was vulnerable, exposed, in need. I was overcome-so overcome that I was afraid of what I might do. I had no concept that the root of my problem was a diseased heart. I thought it was other painful things.


At the start of the surgery, the patient was stripped of his blanket and gown. Naked and lying on the operating table, he was unconscious, completely exposed and vulnerable. Could this man with his sick heart be more helpless, more humbled than at that moment? He was then draped, and initially only his left leg was exposed. Two nurses slowly and methodically began making an incision down his inner thigh. Strange, this surgery of the heart was beginning in a completely different place. The nurses were taking out portions of a vein that the leg can do without to use in the bypass.


The surgeon would use it to bypass the blocked coronary artery and reestablish the delivery of oxygen-rich blood to the heart muscle. In doing so, the clogged area is bypassed, and the heart has the blood it needs to do its vital pumping. The surgery starts in the leg because the vein is needed before they enter the chest to begin work on the heart.


In my life, God began not at my heart, but rather he fashioned seemingly unrelated things in my life into the tools he would use to fix my heart. I didn't understand what was happening and questioned his role. I only saw my pain, my fear and my vulnerability. He slowly forced a surgery that I would never choose, except in desperation. His role was a painful one. It stripped and exposed me, not to him, for he already knew me. He was preparing me to see myself.


Prior to the surgery, informed consent forms had to be signed. How sobering it was to read in the chart all the things Mr. Moran was told could happen as a result of the surgery. Death was a possible outcome that had to be considered. So many variables exist that it is impossible to predict who will have which complication. He might get none, one, several or even death. There was no way of knowing until the time came. How heavy his heart and hand must have been as he weighed the cold, objective, black words on the stark white page. At the bottom he had scrawled his name. To what was he consenting?


In spite of my questions and doubts about God and his care in my debilitated health, I look back and realize that he didn't need to tell me what might occur during my heart surgery. The only possibility was that what he had purposed would occur. There were no variables that he didn't know. He was in absolute control. My lack of trust did not mean he was unworthy of trust.


The operating room staff that day were trained in an aspect of the procedure. The surgeon, the anesthesiologist, first assistant nurses, scrub nurses, circulating nurses, a technician operating the bypass machine-and me. I was a student, an observer, standing on a stool above Mr. Moran's head, in awe of God as creator of this amazing human body and the technology we have achieved.


Who were these people cloaked in the anonymity of surgical garb? Their conversations gave clues of their lives-from trivial to jesting to base. The radio played rock hits. The team was skilled at performing their craft. They appeared to be desensitized, for they played this role daily. It seemed like it was routine to them, as natural as working on a car to a teenage boy. My thoughts seemed so different as I saw the surgery through inexperienced eyes.


I thought of the conversations I'd had with Mr. Moran prior to surgery, and I looked under the drapes at his face and his taped eyes. I remembered that this was a man. His humanity was more than the monitors and machines so closely watched. How many purposes were being fulfilled that day in that room? Restored health, salaries to support families, reputations earned, skills gained and exposure for a wide-eyed nursing student.


How different than in my own situation!! God was interacting with me in a personal way, alone, without any need of a surgical team. He was motivated by his love for me and his desire to make me well. I am awed at this meeting of the Creator and creature. I am humbled by his love for me despite my doubts and fury. It is a love I cannot comprehend, one foreign to my heart.


The veins are still being removed when the surgeon directs his attention to the patient's chest. A scalpel cuts down the length of the sternum. A cautery tool continues cutting in deeper layers. Eventually, the bone is exposed, and a power saw is brought out to split his chest. I think if I dwell on this, I could be sick. It is a mutilation to flesh that seems to threaten his survival. A metal retractor spreads the sternum. The chest becomes an open cavity, with lungs steadily rising and falling above the unceasing beating of his heart. It would seem barbaric if not for the fact that all are united to fix his failing heart.


At times of deepest pain and anguish of soul, I have felt God to be barbaric, allowing a mutilation in my life. In Where Is God When It Hurts? Philip Yancey says we must stop asking why? and ask, rather, to what end? Why? dwells on the past and on the current pain. To what end? looks forward in faith that God has a purpose he will achieve in the trial. In my pain, I begin to ask to what end? But I have no clue what God is trying to accomplish in me.


The surgeon begins to work on the heart. I don't know the procedure, and as I watch it unfold, I occasionally whisper questions to the anesthesiologist. I limit myself. I have so many questions as I watch that I feel certain I will annoy everyone if I ask them all. It is amazing. They have shunted Mr. Moran's blood supply into a machine and dumped sterile iced saline on his heart. The saline and an intra-cardiac injection of potassium stop the beating heart.


This organ that has functioned without rest for seventy-six years now appears to be a mushy blob, but the patient is doing fine. Every vital sign is being monitored and controlled. He is stable. It is a slow process to graft five veins in place and bypass all the sickness of his heart. At one point the surgeon seems flustered, and another surgeon scrubs in to give an extra pair of hands. They are having difficulty finding a spot healthy enough to insert the final graft. It is the most important artery of the heart. The entire length seems hard and diseased.


The atmosphere becomes tense; the confident surgeon is on edge. One can sense that he has limitations, and so does Mr. Moran, so vulnerable and in need. In time, an adequate graft site is found, and the room lightens up again. The surgeon tests his work, looking for bleeding and areas that need additional sutures. Satisfied, the blood supply is brought back to his heart, and internal paddles are applied. One shock is administered. A palpable feeling of happiness spreads in the room as a normal sinus rhythm pops up on the monitor.


Mr. Moran's heart is once again doing its job, much more efficiently than before. Almost five hours into the procedure, the incisions down both legs are closed. It is time to take surgical steel sutures and hook them through his ribs. Wires on each side of the rib cage are twisted tightly and flattened down against the sternum. Barring postoperative complications, the surgery is a success.


During weeks of struggle and pain, I still am unaware of my deepest problem. My thoughts are only outward. Any introspection focuses on my feelings. One comes along and interjects something new into the turmoil-a question about gratitude, asking if there is any in my heart. I squelch my initial negative response and promise to think about it. Perhaps he can see something beyond my focus.


Considering gratitude causes me to hold a mirror up to myself. God has shown me myself in a new light. It is a horrifying picture: twisted, grotesque. I immediately understand that in my focus on outward circumstances, I have neglected to see the twisting of my soul and the disease of my heart. I understand why God has allowed me this pain. He has given me a mirror to see who I truly am.


Now he acts mercifully toward his child. He does surgery on my heart. And the mercy is that he has done such surgery before. He saved me. Many years ago he took my heart of stone and gave me a heart of flesh. Through poor choices in my response to life's circumstances, my heart of flesh has become diseased again. In his grace, he doesn't bypass the disease. We both know this heart is beyond fixing.


He tenderly reaches down and cuts through the doubt, anger, bitterness, unbelief and ugliness of my heart. He places a new heart within me, as he promised: "A new heart I will give you, and a new spirit I will put within you; and I will remove from your body the heart of stone and give you a heart of flesh" (Ezek 36:26). I bear the pain and scars of someone who has had a radical procedure that has given me a new lease on life.


Though the pain and scars in time will fade, I will guard the health of this new heart by remembering what I learned about my Savior and myself.


Although I am a student nurse with much to learn, already I understand that the lasting health of a heart, whether physical or spiritual, lies in how one chooses to live after the surgery. Though the NCLEX likely will not contain it, it is by far my most profound lesson from nursing school.