Part 1: Death
The red line on the monitor, bouncing just moments before, flattens. The green one below it rolls out flat moments later. The man on the table has no pulse. I can see his heart exposed in his open chest, a still lump of raw meat. His lungs no longer inflate.
"Everything is flatlined," says Mehmet Oz, M.D., from behind his mask, gazing over his surgeon's magnifiers to see for himself. His gloves are smeared with blood. "That's the clinical definition of death. Which isn't normally what you want to see." And yet, there it is.
The man on the table has to die today.
He has to die in order to live. Men and death. Quite a pair. When a man indulges a deep need to please many lovers, some blame it on his fear of death. Others chide a man of a certain age in a red convertible, letting him know he can't outrun death, not even in a turbo.
And there is an ample and popular supply of film, music, and literature--from Johnny Cash to Cormac McCarthy to all the Shawshank Redemption you can handle on cable--designed to make a man think on death from a safe distance.
Get busy livin' or get busy dyin'. Right? Right.
Dr. Oz has considered death. As a heart surgeon and, yes, as the host of a television show about health, it's his job. He's been known to bring up literary references when he talks about life and death.
"Do you remember the poem by T.S. Eliot, 'The Love Song of J. Alfred Prufrock?' " he asks me. I do, although my memory of it is vague. "There's a line in there where he says that most of us live our lives a coffee spoon at a time. That's the biggest lesson I've learned watching people die. You watch them die emotionally as well as physically. You see them melt into the bed because no one came to visit. You see them look back and realize they blew it."
Dr. Oz, 56, savors this perspective; you could call it insider information. He sees literal death but also living death--the defeat that illness brings, along with the bonus burden of regret. It forces one to ask: Have I been living? Or dying? Have my choices over many years sucked the life out of my life?
That's why the man on the table, covered in sterile wrappings, head under blue shrouds and clear plastic sheets, eyes taped shut, skin like wax, is nameless for our purposes. He represents you and me and maybe even Dr. Oz one day. We all know it. But knowing isn't enough. "People don't change behavior based on what they know," he says. "They change based on how they feel. When you start to feel differently about your responsibility, then the knowledge comes into play."
The anonymous figure on the table has a name and a family. But is seeing his condition laid bare enough to make others change their deadly behaviors?
"That's why I went into medicine," says Dr. Oz. "It's not just so you live longer. You realize what true vitality is about."
Today's procedure is an aortic valve replacement with a double bypass. Even though he's taping The Dr. Oz Show three days a week, he still performs open-heart surgery every Thursday. He does this for the same reason some doctors play golf on Wednesdays--it clears his head and focuses him. And as a cardiothoracic surgeon, he never wants to abandon his roots as a doctor and healer.
The 56-year-old patient has had a defective aortic valve since birth. "It should have three flaps that come together like a Mercedes-Benz logo," explains Dr. Oz, "but he has only two. They're fused. Over time, with the turbulence, the valve develops calcification. Over the last six months he's had a lot more shortness of breath." The angiogram also showed blockages in two arteries around his heart, so the double bypass is a bonus. Two vessels that run to the chest wall will be redirected and sewn into the heart to provide the blood it needs.
You learn a lot watching open-heart surgery. This particular aortic valve is 25 millimeters (nearly an inch) across. A small tray of plastic templates helps surgeons measure the hole. When the old valve is sliced out, Dr. Oz hands it to me. The tissue is pale and delicate. The point where the flaps have fused feels as hard as a pebble. Replacement valves can be mechanical but can also be made from bovine or pig tissue.
The valve replacement takes roughly 45 minutes, and the bypass grafts about 20 minutes each. Facts fly fast: The left anterior descending artery--one of the diseased vessels--is nicknamed the widowmaker. And surgeons are trained to use their thumb, index, and middle fingers only. Anything more can bruise or puncture an organ as they reach in.
Before all this, the patient had to be prepped, his chest cracked, and the chest wall painstakingly peeled away from the sternum to expose the heart. This took a couple of hours, but it's pregame. Stopping the heart is the starting gun. A cross clamp on the aorta halts blood to the heart. The "engineers" running the heart-lung machine send a 4°C cardioplegic solution directly to the heart to shut it down and cool it off, which protects the tissue during the procedure. The patient then flatlines and, according to the monitors, is dead. Thinned, oxygenated blood circulates through the patient via the heart-lung machine, a unit about the size of a mailroom cart with dials, lights, tubes, and several churning turbines.
Once the heart stops, the surgeon has two hours. "Any time beyond that puts the heart and patient at greater risk," says Dr. Oz. "So expeditiously, you sew the valve, you do one graft, you do the other, and you get the hell out."
You can also learn some nonmedical things while you're staring at a still heart. Like how we're great at fixing the blowback from bad living, as Dr. Oz is demonstrating, but pretty lousy at fixing the bad living itself. It's not just our questionable habits; it's our disconnection from our lives. Dr. Oz knows how deep this self-soothing runs. Everyday life decisions are generally based on addictive tendencies--masking a feeling you don't want with something else.
"A lot of medications are like that," he says. "So when I give you a blood pressure medication, I'm helping you block the high blood pressure. But am I dealing with why you have high blood pressure? When I give you an antianxiety medication, I'm blocking a bad thing, but why do you have that bad thing?"
"Men know," Dr. Oz continues, "but they won't listen. The problem with being smart is you're better at lying to yourself. Lying to ourselves is one of the biggest mistakes we make."
James Gandolfini's sudden death from a heart attack in June, at age 51, struck a chord with the doctor. "He was a guy's guy. And The Sopranos was all about family. I operated on one of the Sopranos, and my partner operated on another one while the show was on. They both had exactly what Gandolfini died from. It was interesting to watch how they dealt with it. My partner and I realized how crazy common it was for men to spend too much time trying to take care of family--that's what a stud does--without taking care of themselves."
Men, he says, are the worst patients. "Atrocious. First, we inherently lack insight about the specialness of life because most of us never face death. We also don't have menstruation and childbirth. Women have these rites of passage. They're bleeding. They're bearing. It's different for us. We spend our lives, especially our 40s and 50s, building monuments to ourselves like Ozymandias, the self-proclaimed 'king of kings' in Percy Bysshe Shelley's famous poem. We spend the first half of life building the field we're going to play on. Eventually, when it comes crumbling down, we realize who we really are."
It becomes a legitimate question, then: While building our careers, our families, our homes. . .are we truly like Ozymandias, spending our present (and precious) lives trying to ensure our immortality while simultaneously burning through our bodies with that which masks reality: the booze, the meds, the work?
"Ask yourself this question," says Dr. Oz. "What percentile of your life are you living? Are you 90th percentile of who you could be? Are you 50th percentile?" He smiles. "I bet most men would put themselves in the bottom half. If they're honest."
Part 2: Living
"Two gentle breaths, please."
The nurse ventilates the patient. Inside his open chest, in the dark shadows beyond the still heart, I see his lungs inflate. . .deflate. . .inflate. . .deflate. . ."Clamp is off. Gentle breaths, please." Inflate. . .deflate. . . His coronary arteries are filling with blood, washing out the cardioplegic solution that stilled it. Within a minute, the lump or raw meat stirs. And beats.
Out of the OR, Dr. Oz shows me a photo. Several weeks earlier, he and his family visited a farm that kept raptors. One of the staffers stood behind Dr. Oz holding a chicken embryo just above the doctor's head. Fifty yards away, a falcon handler removed the bird's hood. It lasered in on the chicken and took off. All Dr. Oz saw was a powerful bird coming at him, talons extended for his face. But it was neither stupid nor reckless. It skimmed his hair and snatched the meat without leaving a scratch. The photo shows the instant it happened, and something else: Dr. Oz's expression of terror and exhilaration--the face of a man living.
Later he tells me a story: "There was a 16-year-old kid who was killed at the St. Paddy's Day Parade in New York more than 10 years ago. The father needed heart surgery, and he came into my office. He was clearly despondent. He didn't care if he lived or died. I said, 'It's terrible that you lost your boy, but I can't operate while you're in this mindset.' You never want to operate on a person who doesn't care if they don't make it. You operate on people who are demanding it. So he left.
"A couple of days later another father came in needing heart surgery. I went through the details, and he said, 'Fine, when do you want to do it?' I asked if he had any trepidation. He said he had a lot, but he also told me he had a 16-year-old son who was profoundly--he used the word 'retarded,' but he meant developmentally delayed--and he did everything for him. The boy would die without him.
"That first father had 16 years of bliss with his son, planning for his future, playing catch, all these things we take pride in. The second father will never have any of that. But he valued what he could do. At the end, that's what it's all about."
Dr. Oz's patients--he's had thousands in his 30-year career--have taught him the difference between living and dying. So many are dead even though they have a heartbeat because they don't care, disconnecting from loved ones, numbing their feelings with all the versions of novocaine that society provides. When you spend time with Dr. Oz, you see a mind engaged. You see a man alive in his skin, moving with purpose, executing whatever task is in front of him. If there's one word for what sets him apart, it's curiosity. "We all get that it's not the destination, it's the path," he says. "But we get it on a cerebral level. We have to get it on a visceral level. Deep in our hearts we have to understand that wisdom. When you feel stressed, it shouldn't panic you. It should exhilarate you. 'Hey, I'm stressed-out; that's really cool. What's going on here?' Most of these events are external; only you can affect how things bother you internally. So it's not stress--it's your response to stress."
A man who is truly alive keeps his brain engaged and his body moving, and he's locked into the moment in a fundamental way. "Our prefrontal cortex grew to the size it is not because we have to hunt--reptiles do fine hunting without it--but so I can read you, so I can play poker with you, so I can see where you're going and predict what other sentient animals will do. When we're focused on figuring out who we are and living our best life, that prefrontal cortex is fired up. But when we ignore life, are depressed, we stop processing there."
High-stakes medicine and media are two ways Dr. Oz remains engaged on a moment-to-moment level. Other ways: a longtime marriage and four children, and side trips to raptor farms. But there's one more important lesson about staying alive in your life that no one thinks about. It has to do with a guy Dr. Oz once knew named Ned Carpenter.
"Ned served in the OSS, the precursor to the CIA," he explains. "Flew bomber missions over Berlin. He became a leading lawyer, one of the best jurists in the nation, and died recently. For his eulogy, his family read a poem he'd written around 1940 when he was 18 and the war was starting. He wrote down all the things he desired, and one of them was that the people closest to him have, at some point, deep but manageable pain in their lives. Go out and fail, have pain, because once you've felt it, you'll be able to embrace the monster."
Dr. Oz nods and smiles. "That's Mike Tyson's line, right? Everyone has a plan until they get punched in the mouth." Then, pausing for effect, he adds, "Being comfortable when you're uncomfortable, that's important. You have to engage the journey that's going to be uncomfortable. And treasure it. . .It's only when you get to play on the field you've built that you enjoy what really matters."
