The Worthy Physician Podcast
Reigniting your humanity and passion for medicine.
The Worthy Physician Podcast
From Doctor to Patient: Dr. Kadar's Journey of Overcoming Heart Disease and Embracing New Beginnings
Imagine feeling invincible, only to find yourself grappling with a life-threatening diagnosis and experiencing vulnerability like never before. Join us as we dive into Dr. Kadar's emotional and psychological journey from being a top-notch physician to becoming a heart disease patient. Through his candid account, you'll gain deep insights into the struggle of acknowledging symptoms, overcoming denial, and embracing the role reversal from caregiver to patient.
Discover the meticulous steps of recovery from a coronary bypass surgery, where Dr. Kadar emphasizes the critical role of proper medication management and cognitive function preservation. Reflecting on his experience, he shares the profound impact it had on his colleagues and family, sparking a newfound awareness about heart health. Dr. Kadar's book, "Getting Better," serves as a guiding light for those navigating their own recovery, highlighting the transformative power of gratitude and positivity.
The journey doesn’t end with recovery; it’s about finding hope and resilience in the face of adversity. Dr. Kadar opens up about managing post-surgery challenges like low blood pressure and atrial fibrillation, and how a positive mindset and clear communication were key to his healing. His inspiring story of hiking to see mountain gorillas underscores the possibilities that life holds even after significant health setbacks. Tune in for valuable lessons on managing chronic illness and applying these insights to foster strength and support in any life situation.
Check out "Getting Better"
https://www.gettingbetterdoc.com/
https://www.linkedin.com/in/andrew-kadar-5b1b1113/
Though I am a physician, this is not medical advice. This is only a tool that physicians can use to get ideas on how to deal with burnout and/or know they are not alone. If you are in need of medical assistance talk to your physician.
Learn more about female physicians' journey through burnout to thriving!
https://www.theworthyphysician.com/books
Let's connect for speaking opportunities!
https://www.theworthyphysician.com/dr-shahhaque-md-as-a-speaker
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https://www.theworthyphysician.com/freebie-downloads
Battle of the Boxes
21 Day Self Focus Journal
Have you ever found yourself facing a medical crisis, only to be trapped in denial, overwhelmed by the fear of what's next? You're not alone. Today I have Dr Kedar, who is going to dive into his journey, reversing the roles from being a physician to a patient and that emotional roller coaster and for the listener, no matter what age you may be, you can always find yourself in the seat of being a patient but also to learn from his words of wisdom he's going to share with us today. Welcome to another episode of the Worthy Physician. I'm your host, dr Sapna Shah-Hawk, reigniting your humanity and passion for medicine. So, andrew, thank you very much for joining us today and I really appreciate our conversation before the recording, because your experience and your book that you have written surrounding that and I will let you tell the listeners about that it really does bring back the fact that we, as physicians, are human and I think that a lot of times, we forget that. We forget that.
Speaker 2:Yeah, I think I hadn't been in superb health my entire life. I was a uh college athlete. I was on the ucla gymnastics team. Afterwards I ran cross uh cross country I. I ran lots of 10ks around los angeles and had always been considered in very good health, never had a major illness.
Speaker 2:So one day I was working out in the gym and about nine minutes into a pretty intense workout on the elliptical, I started feeling a little bit of burning under my chest. Now I knew I didn't have heart disease, but I wasn't feeling well so I figured I'd knock it off that day. Three days later I'm back in the gym and the same thing happened again. Now I still knew I didn't have heart disease, so I waited a little bit. I started. Pain went away right away. I started up and this time pain happened again. Way I started up and this time pain happened again. So now I sat down. I said, okay, I know that I don't have heart disease, but what would I tell anybody else who had the same symptom history? And then the answer became immediately obvious and it was difficult for me to face that, because part of my self-image was that I was this superbly healthy individual. I did not have the usual risk factors no high blood pressure, never been overweight, wasn't a smoker, had a great family history. My father lived to be 94, went on a hike in the Canadian Rockies when he was 86. So I had no expectation of having any major illness for a long time.
Speaker 2:But when I got the workup, so at that point I called my doctor and got set up for a stress test and that was the ugliest looking EKG that I'd ever seen. About a couple of minutes into that stress test and the following day I had angiograms, thinking it may be angioplasty, and in fact it turned out to be a triple vessel disease with a pretty large blockage in the takeoff of BLAD, the pathology that's known as the widowmaker because it causes sudden death so often. So the next day I was having triple vessel bypass. And now at that point I still thought, okay, I'm going to have the fastest recovery of anybody ever with open heart surgery.
Speaker 2:Because before I went to medical school I thought that doctors routinely exaggerated the amount of time it took to get well Because the guys I knew on the gymnastics team they'd be told oh, it's going to take you six weeks to get back to the gym after this injury and three weeks later they were doing flips and getting up on the rings and doing stuff, and I had realized that my sample wasn't typical, that the young athletes who are in very good shape and who are highly motivated get back and kick faster than average. So I figured that in my mind I was still that 20-year-old gymnast, but in reality it didn't turn out so well. I had numerous stepbacks, so I learned to expect the unexpected and deal with that and I think along the way one of the things I realized that I was learning a lot from this experience and that if I shared that with others, it might be helpful for other people who are facing a major illness and, of course, their loved ones as well.
Speaker 1:Let's unpack that. You were in the gym, gym had pretty typical symptoms, and I don't have heart disease because I don't have these risk factors and it's that's that's. I could see myself thinking that along those lines as well, especially if, no, I don't have heart disease. So how would so? How would you label that?
Speaker 2:Obviously I knew about denial. A lot of people say the slump is not so big, it's not so hard, it's going to go away, and then the tumor grows. So I was well aware of people ignoring heart disease. You have stories of people like Kim Fixby, the running guru, who dropped it in the middle of his run, and you have people like Steve Jobs who ignored the advice to have his cancer removed and waited till it was too late for a cure and operation. I was well aware of denial and obviously I knew that the classic triad of the most common presentation of coronary artery disease was exactly what I had Pain under the sternum, comes on with exercise, goes away probably with rest, and I basically had that three times before I sat down and said, okay, maybe I should think about this. And some people are not so fortunate, some people don't have that three chances, and others can be way more fortunate and can be fine for months.
Speaker 1:It depends on how fortunate you are in terms of how you're these progressive, but clearly I was in a situation where waiting was not a wise thing to do I'm glad that you're still here with us and it's very different being being the patients and being in the, not really having the control that physicians have of leading the team. And I don't mean that in any bad way. I'm still a practicing physician, but there is a partnership between physicians and patients and that's very different to where that patient had. I've been in that situation before and it's humbling. It's very humbling.
Speaker 2:And I think that there's a feeling among physicians at times that we need to be superhuman. I had a colleague who was working in the ninth month of her pregnancy, stopped about a week before she delivered and was back in the operating room three days later.
Speaker 1:Wait, how many days later? How many days later.
Speaker 2:Three or four days later, within the week.
Speaker 2:Of giving birth, yeah, Because I think again, she felt that she owed it to her colleagues and everybody had a call schedule and so on, and we all told her you can stay home. And we all told her you can stay home. But I think there's sometimes a pressure that we put on ourselves and perhaps it's expected too. I know that in residency, when somebody's out sick, it was a burden on everybody else and so you didn't want to put a burden on your colleagues and you felt it was your obligation to come through and do your job. I think most physicians have felt that.
Speaker 1:Yes.
Speaker 2:It was a little different from that, or a little more than that, in that I just felt that I was fortunate to be from a family that has a history of good health and longevity. My grandfather was born in the 19th century, lived until he was 87. It wasn't. I did not expect to have problems along these lines and of course, once I did get sick I expected to have a real smooth recovery, but that didn't turn out to be the case. I had a number of unexpected complications. The first one that hit me was inability to swallow. Now there's the old Rumsfeld thing about the known unknowns and the unknown unknowns.
Speaker 2:This was an unknown to me. I knew about a number of potential complications that you can have after heart surgery. I wasn't aware that people can't have swallowing problems afterwards and it's not the most common complication. But when a BNT guy that came and talked to me about it, he said he'd seen it a bunch of times and it goes away on its own in less than a month, and in my case it went away in about two weeks. But when it was happening I couldn't swallow hardly anything without it. Every meal was a tortuous exercise. I was coughing, gagging. It was rather discouraging and I had no idea how long it would last until I got the ENT consultant. So once I knew that it was a problem that would be of limited duration, I felt much relieved and much, much better about it. So there are surprises along the way and there's some surprises in terms of another complication that I had was intractable hiccup.
Speaker 2:Now I knew that upper abdominal surgery and chest surgery can irritate the diaphragm and cause hiccups, hiccups. But when my drains were being taken out after the last one was taken out I had hiccups like I'd never experienced Now. In medical school I learned that some people have hiccups that go on for weeks and months and some have even died from respiratory failure when their diaphragm became too exhausted. But I had never when in medical school, when I first heard about that killer hiccup sounded like the attack of the killer tomatoes to me, nothing that I would ever see. But when it was hiccups on top of hiccups, just staccato hiccups for hours on end, I was beginning to wonder what the heck was. And the first and the things that you could usually do, since I was having trouble swallowing I couldn't swallow grainy sugar to try and make it go away and reaching up and swallowing was out of the question, because I couldn't I wasn't allowed to raise my hand, arms above my arms, above my shoulders.
Speaker 2:So pharmacological medications were the only source, and the first couple didn't do anything, and it was about a day and a half before I got some. It was Baclofen, and then I got so much of it that I fell asleep for a day and a half after that. So there were a number of complications that I wasn't expecting at all, and ones that I wasn't expecting to the severity that I got in. But then I had thrombofibitis, things, that one thing after another. I ended up staying in the ICU a little longer than usual, and I ended up staying in the ICU a little longer than usual, and I ended up staying in the hospital a little longer than usual, but I was able to get back to work in time. That was expected and I probably could have really no reason for me to rush back.
Speaker 2:I worked at Cedars-Sinai. We had 100 anesthesiologists. Somebody is always off, so it wasn't really an issue.
Speaker 1:So, when you had that time to reflect after a major health crisis and then after a major surgery, complicated by not an ideal recovery, with the complications you've mentioned, what was your reflection on? What was your thought process? I mean, this is a major life event.
Speaker 2:your what was your thought process? I mean, this is a major life event, right? So I think that it's natural in these circumstances to reflect on your life, and I had more time to do it. So one of my concerns, of course, was is this going to change my ability to practice?
Speaker 2:And I remember being up in the middle of the night in the hospital and going through a whole bunch of medications for anesthesia, induction medications, muscle relaxants, reversal medications, all kinds of things to make sure I knew the proper doses. And I was very relieved when everything seemed to come back and no problem, because there are reports of people having mental issues or brain damage after coronary bypass. And then I did multiplication in my head, two numbers by two numbers, to make sure that I could do that as well. And obviously it's not a mental status test in any formal sense, but it reassured me that hey, I'm OK. And then it's a question of of what have you done with your life and what do you want to do going forward, because obviously we all know that our life is not forever, but we don't live that way when we're young and I didn't live that way I figured it never really reflected on what I want the totality of my life to be, and I think this event forced me to do that. And one of the things that I realized is that I actually did like my life. I had a work situation and a home situation that was satisfying to me, so I very much.
Speaker 2:My goal was to get back to work and get back, and I did go back full time and continue my practice. But I also thought, okay, can I take something away from this and do something positive about it? One of the things that I decided to do is to try to be a more positive influence on my environment, thank people more often and compliment them more often. When we're in the operating room, we're not by ourselves. We need help from the circulating nurse and from other people throughout and, I think, showing them appreciation. It's not that I wasn't doing that before, but I figured that maybe I should ratchet up my efforts on that, and so I have tried to do that since then.
Speaker 2:And then, in terms of, I also thought about could something positive come out of this? And that's why I wrote the book on getting better, because I felt that the lessons I learned from this experience other people could benefit from as well, and not only the patients but their family members, because I think the person who was most affected by this was my wife, but other family members and friends as well. I think I caused a minor run on cardiac workups in West LA because, seeing me as they had before, nobody was really expecting that I would be the one having a serious heart problem. I worked with some physicians who were much exercised, much less and were in much worse shape than I was, and so if somebody was to say who among the OR crew in the places that I was working at was going to have heart disease, I think I would have been about the last one chosen.
Speaker 1:So it was a wake-up call not just for me but, I think, people who knew me. We're going to circle back to the title of your book Getting Better. That's a great title. What inspired that? What inspired you choosing that title?
Speaker 2:I have to give some credit to my publisher on that, because we went back and forth on a couple of things. The first title I was working on was Cardiac Bushwack, but nobody seemed to like that. But I think the theme is getting better, how to get better after you have a major illness, and so that seemed to fit and I think everybody agreed that the story was about how to get better once you have a major illness, and I think that's the goal of the book is to help people get better if they have a major illness.
Speaker 1:Yeah, there's a lot to unpack there, going from daily life and then having a significant health event or a significant life event and going to the denial but then really circling back and saying, no, I think this is I better pay attention to this, I better pay attention to this. Having that insight is a lot of times we in the health care field make the worst patients just because it's never going to happen to us, or going circling back. Yeah, we have to be super, super human because we have to be there for work. I need to put everybody else's needs before mine, or we forget that what happens to us does affect those around us family, friends, etc.
Speaker 2:What happens to us does affect those around us family, friends, et cetera. Yeah, I think one of the things is I don't like the notion of physicians being bad patients. I was determined to be a model patient but it was difficult to be allowed. I think all the complications I had led up and reinforced the doctors make problem patients with EDA, and I tried not to be that. I tried to be as good a patient as possible, but the stresses of an illness sometimes do make you behave in ways that perhaps aren't so ideal.
Speaker 2:In my case, I was a gymnast, so I've always had really good balance and one day I woke up and I saw this band around my wrist and there are various bands that are put on people's wrists as a warning, and this one was a balance, bad balance warning. And I thought what the heck? I don't have bad balance. So the nurses came. I said who put this on me? Why is this on me? And they said they don't know, but they can't take it off without a doctor's order. And I said look, I don't have bad balance, I can stand on my toes, I can stand on one leg. And they were saying no, don't do that. And I was trying to show them all these things that I could do without that. I didn't have bad balance and I blamed it on the night nurse that they must have put it on me while I was asleep and couldn't protest it. And why would they do that? And later on I found out that it was actually a routine thing that they put on everybody before they go into surgery, and it had just been done recently, so I wasn't aware of it. Only once I got back in the OR and I saw that all my patients had that.
Speaker 2:Now, of course it could have been taken off, because at that point I was like a week out of surgery and there was no reason to have it on.
Speaker 2:But I overreacted to it in retrospect.
Speaker 2:But I think part of it is that when you're a patient, a lot of your self-identity gets taken away, A lot of your autonomy gets taken away, and to me, being told that I had a balance issue was like telling a musician that they're tone deaf, and so there are a lot of things that are done in a hospital that are denying the patients their autonomy, that are unnecessary.
Speaker 2:So having this band on me and not taking it off was one of those things that hit me more harder than it might have some other people and in retrospect I was blaming the wrong people because it wasn't the night nurse. It had just been done routinely in the pre-op area. So I think there's sometimes a tendency not to be entirely your normal self, and it's rational when you're the frustrations of being ill and there are a lot of frustrations because when you have a sternotomy it's just sitting up in a painful and a difficult thing and I use my bed to get me to an elevated position and a lot of strategies to figure out on how to make life a little more pleasant when pretty much everything you do is a pain, literally and figuratively.
Speaker 1:No, you're absolutely right, you're absolutely right Everything that you have shared about the autonomy taken away. Absolutely. If you have a history of being a great gymnast, always being in great shape, and then you're slapped with a bracelet saying you're a fall risk or a bad balance, it really hits you to your core. Yeah, because no?
Speaker 2:that's not who I am.
Speaker 1:Yeah, yeah, I'm at a full risk right, but it's thank you for pointing that out and I'd like to clarify that I don't think physicians, by all of us, are bad patients. I'm just with the knowledge that we have. It's always. No, that's a issue that somebody else has, not me, or I'll address it later, because I have a laundry list of things to do, whether it be work or family or something on another personal level. But it seems and I've been guilty of this of addressing our own health later. It's a work in progress. I'm always putting our needs on the back burners, whatever you meant by saying sometimes we don't make the best patients.
Speaker 2:Yeah, yeah, I think that, yeah, I think that's a good point. But the other thing that I don't want to neglect here is being good to your caretakers. Now, in that case, I probably wasn't the ideal patient regarding the fall risk situation, but for most things I did my level best to be as good a patient as possible and also to be as considerate of the caretakers as possible. For example, the first night I was out of the ICU at Cedars, where I was a family member, could stay with the patient overnight, but it's in a narrow, uncomfortable cot. And my wife wanted to stay that first night but in between blood pressure checks and noise in the hospital and in the narrow, uncomfortable bed, she hardly got any sleep at all. So we decided after that she should go back to our home and get a good night's sleep, because it would be better for her and it would be better for me as well, because she'd be better able to help me as well if she wasn't exhausted.
Speaker 2:And I think there is that caretaker exhaustion syndrome where people just burn out from having to help a loved one. And I wasn't really in that bad of shape Once I got home. I was okay most of the time I did get a fair amount of help, but my wife was able to do some of her work and still help me out in things that I needed help with. But I was always very aware that she had her life as well and it wasn't entirely centered on taking care of me, because it would be unfair to her and it was unnecessary. So I think being cognizant of that and being kind to your caretakers is not only a smart thing to do, but it pays back in dividends to the patient, because then you don't have to resent men. I think an illness like this can be bad or good for a relationship, and I think for our relationship it actually brought us closer together in some way, because I appreciated everything that she was doing for me. When I was having trouble swallowing, she went out of her way to make really delicious soups and things that I would have an easier time getting down. And she said that she expressed some admiration for the way that I faced the various crises that came along, because I did try to go with the approach of clearly telling my doctors and nurses this is the problem I'm having, what can we do about it, and do that in as rational a manner as possible. I was trying to give a good history along the way and I think that a patient should in order to get better care if you can communicate clearly about what's bothering you, and so I tried to prioritize.
Speaker 2:Okay, this is my chief complaint today, and the chief complaint changed from day to day. First it was the swallowing, but then it was the hiccups and then it went. The thrombophlebitis became the big issue and then after that I had an elevated white count, probably from the thrombophlebitis, but the infectious disease guy didn't want to let me go home because he wasn't sure. I think I had like a 19,000 white count and he didn't feel comfortable sending me home until it went down a little bit from that. So along the way, I think there's always a chief complaint, something that sort of takes center stage.
Speaker 2:I mean, I may have had more than one symptom, but there was one that needed to be addressed most urgently, and the reason I stayed in the ICU an extra day was because I had a little bit of low blood pressure.
Speaker 2:I had one bout of atrial fimb which came down with medication within hours and never returned, but I had a coterie of problems that you can have after a periorhyteric bypass. That was probably more than average and I'm not sure why that was the case, but it was and everything had to be dealt with and once it was, I was basically back to normal. I had no coronary artery symptoms for over 13 years. Really, in November it'll be 14 years that I will have had no coronary artery symptoms of any kind. Last year I was hiking at 7,000 feet to get to see mountain gorillas in Rwanda. So I was able to get back to my normal life and I think that's a hopeful message in my book that having a major illness is not the end of life. You can continue with your life as you want it, despite having had a major medical crisis that could be life-threatening or life-ending if not properly treated. So I want it to be an encouraging story in the long run.
Speaker 1:Yes, it is especially. This happened almost 14 years ago and you're still living a fulfilling life. You're still going on adventures and I'll tell you this when my son hears about the UN to go see gorillas, he's going to be thrilled because he's infatuated with primates, the methods of communication, of really digging in and saying, okay, I'm going to do my best possible to recover and having that mindset, having that in the forefront and then being reflective upon it Very encouraging that you can come out the other side, even 14 years later and still have a very fulfilling life. Going through everything that you have with your a major operation, an unexpected disease process, with what I would classify as. A lot of times we physicians are type a personalities. How did you overcome a lot of maybe the hurdles of this is something that was unexpected. The road to recovery is going to be long. How will this impact my future? How did you address those thoughts, if they were present?
Speaker 2:Of course, yes, they were present, obviously one. It was a shock Because my self-image was somebody who was superbly healthy and clearly that was shattered On the word. As soon as I had the diagnosis, I could no longer think of myself as being, unfortunately, healthy and guaranteed higher longevity than most. I still consider myself healthy right now, but not to the same degree. I think some doubt has crept in, because obviously this can happen and obviously it can happen to anybody else as well.
Speaker 2:So it was a reason to reflect on my assumptions about life and fortunately I felt that I did have a good life. I enjoyed what I do, I had a family situation that I was happy with, so I started from a good place, but then had this major setback and had to deal with it, and I think that at the end of the day, I continue to have the same sort of life that I wanted to have before. So, even though this is a major setback, I still have the life I want to have, and I guess the positive aspect for others is that you can have the life you want to have despite having an illness, and I think it's encouraging because in reality, all of us are likely to have some illness along the way and hopefully you can recover from it and continue to live a productive life.
Speaker 1:Now beautifully said and if the listeners wanted to reach out to you or to check out your book? How can we do that?
Speaker 2:The book is available in some bookstores and then, of course, through Amazon, which is the way most people seem to get books these days, and I also have a website and it's called Getting Better Doc so it's the title of the book, with the O-C at the end, dot com. So they can check out that website as well. And beyond that, I hope people read my book and get benefit from it, because it's a fair amount of effort to write a book, a lot more effort than going to work at the OR yes, or. It's a different kind of an effort and the reason was to an attempt to have something positive come out of. This is a difficult experience for me, because it was a very difficult experience for several months. It does have some reverberations in terms of. I suppose it made me realize some things. It woke me up to the fact that I should think about my life in its totality and not just go to work from day to day but reflect on the overall impact that I provide for other people in my life.
Speaker 1:That is very beautifully said, and those are some things that we don't always think about. So, regardless of the age of the listener, you can definitely learn from what he has said and what he has written. So the links are in the show notes. Go check it out, get a copy, read it and reflect, because we learn from what we see, what we hear, what we read, what we experience, and you have put your experience into words. Thank you for that and thank you for shining the light on a part of humanity, of our humanity, that we really don't discuss. I've really appreciated this conversation.
Speaker 2:Thank you very much. I appreciate it as well.
Speaker 1:What is one last pearl of wisdom that you would like to leave the listeners?
Speaker 2:I think it's really several pearls that I think are contained in my book, and the first one is I think the best way to overcome denial is to take it away from you, the situation, away from yourself. That's what allowed me to get over my denial. It's not me having these symptoms. What would I tell somebody else who had these symptoms? And then I think, if you have a major illness, to expect the unexpected, because I certainly was surprised by the number of setbacks that I had along the way. And then I think, if you have a problem, communicate it as clearly as you can and with the goal of how do I get over this in order to get well. And I think those are some of the take-home lessons that I learned from this experience and I hope that it will help other people who might be facing a similar situation might be facing a similar situation.
Speaker 1:I love all of those. I love how you reiterated what we have discussed, because those are definitely pearls to apply not just to a chronic illness but to any situation, whether it be a life situation that, hey, if I were in a situation, or if it were somebody else in this situation, this is what I would do. So following your own advice, your own prescription and communication, and stay on riding those waves. Thank you very much To the listeners. If you have found this helpful, subscribe, share with a friend, because we can all use camaraderie.