Metamorphosis by Dr. Vladimir Zelenko: Chapters 19 and 20

In 2018, Dr. Vladimir Zelenko published an autobiographical book Metamorphosis, in which he talks about how he, being a completely non-religious young man, came to faith, and how he overcame a serious illness. The book has multiple positive reviews online and was well received by the readers all around the world.

Today, we are publishing the nineteenth and the twentieth chapters of the book.

§19

CANCER

When I arrived in the Emergency Room, the doctor ordered another CAT scan. The results showed worsening of the blood clot. The clot had now extended further into the right lung, causing areas of infarction (tissue death). The blood-thinning medication had failed. There was also concern that I was developing right heart strain from pulmonary hypertension^[1] My condition was life-threatening, and urgent intervention was needed. Dr. Mina transferred me to the intensive care unit. He consulted a cardiac surgeon, Dr. Derek Brewster. We discussed two treatment options: using clot-busting medication (TPA) or surgery to remove the blood clot. I spoke to Dr. Mina, Dr. Berkowitz, and Moshe Aron Steinberg for advice. After reaching consensus, I decided on an open chest procedure called a pulmonary artery thrombectomy. Simply put, the surgeon opens my chest with a saw, cuts into the pulmonary artery and removes the blood clot. I was not looking forward to major chest / heart surgery, but this was my best option. The fact that I did not choose the clot-busting option was fortunate and probably saved my life. I will explain shortly.

The surgery was planned for the next day. That evening, I had Rinat, Shira, my parents, and Yitzy in my hospital room with me. I was scared and anxious. I had sent hundreds of patients for major surgery during my career, but now I was the patient. I prayed to G-d that He should work through the surgeon’s hands and asked for forgiveness for my past wrongs. I called Wolf Perl, my life insurance agent, and asked him to come to the hospital. I wanted to make sure that my life insurance policies were intact and that my wishes were accurately expressed.

Moshe Aron Steinberg stayed with me overnight. I was very relieved that my best friend was with me on the eve of surgery. I was anxious, perhaps more than the average person was. Since I am a doctor, I knew exactly what was going to be done to me. As a student and resident, I had participated in several similar surgeries. It put my mind at ease to have my friend with me. During the night, Moshe Aron noticed that my oxygen level had dropped, and I was having trouble breathing. He alerted the nurse and I was put on oxygen, which helped me breathe better. It is so important for a patient to have an advocate with him in the hospital. I have seen it prevent major medical errors and save lives.

The next day, I was transferred to the surgery wing. I said goodbye and expressed my deep love for Rinat, baby Shira, my parents, and Yitzy. They were asked to go to the surgery waiting area. I also called and spoke to my other children and told them how much I love them.

The nurse prepared me for surgery and the anesthesiologist came and examined me. Dr. Brewster also came and reassured me. He explained that this is a “simple” procedure and that everything will be fine. I was wheeled into the operating room. It was a huge room with powerful lights, many surgical instruments lying ready on organized trays, and around ten medical personnel waiting for me. I was transferred from the stretcher to the operating table.

The table was heated, and it felt somewhat nice, in a surreal way. The anesthesiologist came and placed an IV into my arm. I was lying and looking at the ceiling. My thoughts were surprisingly calm, and I quietly spoke to G-d. Then the anesthesiologist put some drugs into my IV and I fell asleep. Obviously, I do not recall what happened next since I was under anesthesia.

However, I was able to piece together the sequence of events from speaking to my doctors, family, and friends. Dr. Brewster, my cardiac surgeon,sawed through my sternum (breast-bone), pulled apart my ribs, gained access to my heart, and located my pulmonary artery. I was put on a heart-lung bypass machine and my heart was stopped. Dr. Brewster then cut into the pulmonary artery to locate and remove the suspected saddle embolus (blot clot).

Unfortunately, he did not find a blood clot. That explains why the blood-thinning medication did not work.

Dr. Brewster did find a large tumor, originating in the pulmonary artery and extending into the arteries of the right lung. The lung also showed evidence of infarction (tissue death). A small biopsy was made of the tumor and sent to the pathology lab for a frozen section (immediate intraoperative biopsy result). At this point, Dr. Brewster came out of the operating room and went to the waiting room to speak to my family. Dr. Bushra Mina and Dr. Israel Berkowitz (my physicians, colleagues, and friends) were present during the surgery and came to speak to my family. They explained that instead of a blood clot, a tumor was found. Dr. Brewster also aid that he requested a thoracic surgeon to join him to assist in the surgery.

Dr. Richard Lazzaro, a renowned cardiothoracic surgeon who specialized in lung removal, was consulted. Dr. Lazzaro had just finished another surgery and was still in the hospital. He joined Dr. Brewster in the operating room and assessed my medical and surgical situation. It was discovered that my right lung was filled with the tumor and mostly dead from lack of blood supply. The results of the intraoperative biopsy confirmed a cancerous tumor called a sarcoma.

Both surgeons decided on a complex course of action. Dr. Brewster would cut out the tumor from my pulmonary artery and then reconstruct the artery using bovine pericardium (heart sac tissue from a cow). I could not live without a functioning pulmonary artery that took blood to my remaining left lung. Dr. Lazzaro would perform a pneumonectomy (complete lung removal) of my right lung. The lung was dead and filled with the tumor. It needed to be removed.

Rinat was holding our ten-day-old daughter in her arms when the news was broken to her. She felt like a truck hit her. My parents and oldest son were also present and were in shock. My mother was in disbelief and started searching online about sarcoma. She knew that it was an extremely deadly form of cancer. My son, Yitzy, asked the surgeon about my quality of life with one lung. My father started saying Tehillim.^[1]Dr. Lazzaro explained that my best chance for survival was to surgically remove the right lung and the tumor in the pulmonary artery.

The surgery lasted eight hours and I was transferred to the recovery unit. The surgeons told my family that the operation went extremely well and that they were able to remove the entire tumor with clean margins. Dr. Lazzaro said, “If it was known before that the lesion was a tumor and not a blood clot, nobody would have operated on me.” Dr. Mina said that if I would have received the clot busting drug (TPA), it would have caused the tumor to break up and seed my remaining left lung. That would have been a death sentence, G-d forbid.

Sarcoma of the pulmonary artery is extremely rare, with less than ten people a year being diagnosed with it in the world. Most people die from it because of its location and late diagnosis. It is usually discovered at autopsy. In my case, I had surgery for a suspected blood clot that led to a fortuitous diagnosis. The doctors were able to perform heroic surgery that is almost never done.

Everyone went to the recovery room area and waited for permission to see me. After an hour or so, my family was allowed into my room. I was sedated, intubated (breathing tube in my airway), and had two IVs, plus multiple surgical blood drains, and a Swan-Ganz catheter^[2] in my neck. It was very difficult,shocking, and painful for my family to see me like this.

Everyone was emotionally and physically exhausted. The day had been filled with terrible surprises and unexpected events. My parents and Yitzy left the hospital and went to pray for me at the Ohel^[1] of the Lubavitcher Rebbe. My wife was less than two weeks postpartum with a nursing infant. She was sleep deprived and still physically recovering from having a baby. She drove home from the hospital with Shira, who was crying all the way home. Fortunately, her mother was coming from Israel the next day to help Rinat handle everything.

Several of my friends came to the hospital during the surgery. They kept my family company and tried to reassure them that everything would be okay. One of my friends, Joel Meisels, stayed with me in the recovery room overnight.

Abraham Steinberg, (Moshe Aron’s son, whom I mentioned earlier, a registered nurse from Lenox Hill Hospital), joined him. Apparently, I started to regain some consciousness and began to pull on the breathing pipe to remove it. The nurses were alarmed and wanted to restrain my arms so that I did not pull the tube out. Abraham witnessed this and intervened. He did not let the nurses restrain me and convinced the doctor to try to have me extubated. Fortunately, the tube was removed successfully, and I was able to breathe on my own. I can only imagine the pain, frustration, and anxiety that I would have experienced if the breathing tube had remained, unnecessarily restraining me. I do not remember any of this.

One of the nurses asked Joel Meisels, “Why does this guy get so much attention?” He answered, “He is a doctor, and this is how he would treat any of his patients.” She then asked Joel,“Are you his son?” He told her, “Since he treats me like a son, I treat him like a father.” The nurse become very emotional and asked, “But why do the doctors treat him like a VIP?” Joel answered, “He is highly respected by his colleagues, and some of the doctors here work in his office.”

Joel also told me that he stayed by my bedside and said Tehillim. He said to G-d, “It will be a real kiddush Hashem if Dr. Zelenko is healed. Last Rosh Hashanah, I thought I needed to be admitted to the hospital. Dr. Zelenko treated me outside of shul and prevented me from going to the hospital.”

I have a very vague recollection of the following day. I remember Rinat coming, and me talking to a doctor, but I do not recall what he said. It was Dr. Lazzaro and apparently, he told me about the diagnosis. I was very heavily medicated with pain medication. It would take another day before I was alert enough to begin to process my new reality. My father and Yitzy stayed with me overnight in the hospital. My father told me that I was in severe pain the whole night. He had to hold me most of the night and help me find a position that was the least painful. He said it was a horrific night for me and he felt very helpless. I do not recall that night.

On the third day, I was much more aware of my surroundings and in severe pain. During the surgery, I’d had a sternotomy. This is a procedure where the surgeon cuts through the sternum and afterward uses metal wire to close the chest and put the breastbone back together. In medicine, this procedure is considered one of the most painful.

Every time I moved, sneezed or coughed the severity of the pain was beyond anything I had ever experienced. It hurt to breathe and talk, and I was given heavy narcotics, which numbed the pain somewhat. I do not recall how but I was moved from the bed to a chair. Then the physical therapist came and told me that I had to try to walk. I tried to get up with the help of the therapist and my father. The next thing I remember was a group of doctors and nurses standing over me and yelling at me. Apparently, I had passed out from the severe pain and become unresponsive for around a minute.

Dr. Lazzaro came to examine me. It was the first time that I recall meeting and talking to him. He was an extremely soft-spoken and refined man. He explained to me that Dr. Brewster had asked him to assist during the surgery. The diagnosis was sarcoma of the pulmonary artery and not a blood clot. The tumor was excised, the artery reconstructed, and the right lung was completely removed. The lung had to be removed because the cancer had spread into the arteries and caused infarction in most of the lung. The lung was essentially dead.

My parents and Rinat were in the room when Dr. Lazzaro was talking to me. Afterward, Dr. Richard Lazzaro spoke privately to my mother. He said to her that when he started to operate he felt “an unusual presence of G-d” with him in the operating room. I had heroic and highly unusual surgery performed on me that in most cases would have never been done. The sequence of events that led up to the surgery appears to have been perfectly orchestrated to save my life, IY”H^[1]
During the next several days, I had someone with me twentyfour hours a day.

Moshe Aron Steinberg took it upon himself to make sure that I was never alone. Yitzy got special permission to take time off from his school and spent most of the days with me. Yitzy encouraged and helped me start walking around on the hospital floor. The pain was unbearable, and I had to take heavy pain medicine to be able to walk.

Rinat’s mother had come from Israel and helped with taking care of the baby. Rinat would come every day and she was obviously exhausted and emotionally strained. I felt terrible that she had to deal with my illness, especially so soon after having a baby. What should have been a joyous time, turned into a time of worry and anxiety.

I had many visitors come and wish me well. The Satmar Rebbe, Rabbi Aron Teitelbaum, came to visit me as well. His Rebbetzin also came to see me. It was very moving and special to know that so many people were praying for my recovery. I was still in shock and disbelief and had not begun to understand what had happened to me. The pain and the pain medicine kept my mind cloudy. Even as I am writing this book, the memories are vague, and I had to interview the people who were there to get an accurate picture.

Five days after the surgery, which was erev Shabbos, Dr. Mina came to tell me that the final biopsy report had been completed. The results confirmed that it was a highly aggressive form of sarcoma of the pulmonary artery and that it had spread to multiple sites in the right lung. It was absolutely the correct decision to remove the lung. The results also confirmed that the surgical margins were clean. This means that the edges where the surgeon cut were free of any obvious disease. He also told me that I needed to see an oncologist and would need chemotherapy six weeks after the surgery.

Reality finally hit me; I had serious cancer that almost no one survives. I went into surgery thinking that I had a blood clot and when I awoke, I had sarcoma and was missing a lung. I began to feel anxiety, fear, and dread. My father and son spent Shabbos with me. That night I had multiple panic attacks and my father had to get the nurse to help me. She called the doctor and I was given Xanax^[1] to relax me.

§20

COMING HOME

Nine days after my surgery, I was discharged from the hospital and allowed to go home. At this point, I was able to walk for around a minute and then needed to stop and catch my breath. I had a persistent cough and had no appetite. I was in constant pain, made worse by the coughing, and I was taking oral narcotics, which helped for a short period. My friend, Joel Rubin, picked me up from the hospital and drove me home to Englewood. When I came home, Rinat, her mother, and Shira were waiting for me. It was nourishing to the soul to be back home with my family. I held my three-week-old baby daughter in my hands, and became very emotional and broke down crying.

For the next week, I focused on pain control and breathing. I was still on pain medication and needed to use oxygen. I had to sleep sitting up in a recliner since lying down was too painful and made breathing difficult. Rinat was a great help and took wonderful care of me. That I week I had several very bad coughing episodes that led me to lose consciousness. Rinat witnessed these episodes and it really frightened her. I cannot fathom how she felt during this time. Rinat had to juggle taking care of a newborn and a husband with cancer. That put incredible emotional strain on her. The way Rinat managed the situation is a testament to her strength of character and commitment to her family.

My younger children came to visit, but it created mixed emotions within me. I was thrilled to see them, but it caused me great pain at the thought of the possibility that they could be orphans soon, G-d forbid. They were scared and filled with many questions. They wanted to understand what had happened to me. The kids had made their own unique get-well cards for me.

There are five known stages of grief and loss: 1. Denial; 2. Anger; 3. Bargaining; 4. Depression; 5. Acceptance. The first week after the surgery, I was in denial about what had happened to me. My mind could not psychologically process and accept that I had bad cancer.

However, after the initial shock had worn off, my new reality hit me: I became very angry. I asked internally, “Why me? I am the doctor: the one who tells OTHERS that they are sick. How could it now be me?”

What bothered me most of all was not my potential death, G-d forbid; rather, the effect that my death would have on the people I love. Who would father and mentor my beloved children when I was gone? What would happen to Rinat and Shira? Why should my parents bury their son? It hardly seemed fair and just.
After the anger wore off, I started to try to understand why I’d gotten sick. Perhaps, if I had been a better Jew I would not have gotten sick? Maybe I should have been more sensitive to my patients? Maybe I should have been nicer to people? (etc.)

Two weeks after the surgery, I was in a depressed state of mind and had trouble sleeping. I was having morbid thoughts about my prognosis and was worried about the effects of my illness on my family. One night, at around 2 a.m., I was doing research on sarcoma online. I would be seeing an oncologist soon and wanted to know my treatment options. Unfortunately, most of what I read was depressing. None of the standard chemotherapy regimens seemed to be effective against sarcoma. My specific subtype of sarcoma was extremely rare and had very little information known about it. Then I came across a very recent study that was done on sarcoma.