Inoperable is Not Impossible

On the Brink of Death, Skilled Cardiac Intervention Saves Bernie Woman’s Life

"We knew it would be a difficult surgery, but we had to try.” - Joyce Causey

When SoutheastHEALTH Board Certified Cardiothoracic surgeon Paul D. Robison, MD, MMM, CPE, FACS, FACC, FACCP, was seven years old, his brother, 12, died of sudden cardiac arrest.  Years later, that unspeakable tragedy turned into hope for thousands of patients with critical cardiac and vascular issues.

"After we lost Mark, I never wanted to be anything other than a cardiothoracic surgeon," Dr. Robison says. And for that Joyce Causey is eternally grateful. Joyce, one of the legion of patients whose life has been saved by Dr. Robison, had been turned down for heart surgery by two metropolitan medical centers. "Her risk was deemed to be too high," he says. "They were reluctant to take on that risk. Sometimes it’s necessary to move forward without fear."

A History of Cardiac Disease

Joyce, 59, was only 30 when she began feeling like her heart was skipping beats. She was, her doctor told her, "too young to have heart disease." Dr. Robison is quick to debunk that theory. "Anyone, at any age, can have heart disease. I’ve operated on patients as young as a newborn weighing less than a pound and I’ve been on a heart transplant team for a 19-year-old patient."

Over the years, Joyce continued to experience cardiac problems. She continued working as a registered nurse, eventually moving from Nashville, TN, to Bernie, MO, where her husband Rusty and his cousin farm acres of cotton and beans, southeast Missouri staples. Joyce’s medical problems continued to mount. She successfully battled rectal cancer and recovered from a fall that resulted in spinal stenosis that required neck surgery.

She ultimately underwent complete pericardial stripping via median sternotomy in 2015. During the procedure, a portion or all of the pericardium is removed. The pericardium is a double-walled membrane sac that surrounds the heart. When performing properly, there is a small amount of fluid that lubricates the heart during its normal pumping movements within the pericardium. She also underwent placement of a right coronary artery stent. For a while, things were better, Joyce says.

In November 2018, the Causeys' world came crashing down when Joyce suffered life-threatening flash pulmonary edema, a condition caused by excess fluid in the lungs that, in most cases, is related to heart problems.  "I was struggling to breathe, literally wheezing and gasping for breath." Rusty rushed Joyce to nearby Southeast Health Center of Stoddard County in Dexter where, after initial stabilization, she was taken to Southeast Hospital in Cape Girardeau.

'She Was Dying'

After an emergency cardiac catheterization performed by Board Certified SoutheastHEALTH Cardiologist David Law, MD, Joyce was referred to Dr. Robison.

"She was dying. Mrs. Causey had critical coronary disease. Heart failure and a blocked left main coronary artery caused edema in her lungs. She also had restenosis from previous stents, a leaky aortic valve, a leaky mitral valve, a leaky tricuspid valve and pulmonary hypertension. She had to have heart surgery to save her life."- Dr. Paul Robison

"Dr. Robison told us that inoperable is not impossible," Joyce recalls. Her husband adds that "Dr. Robison was forthcoming and explained everything. He tells it to you like it is. We knew it would be a difficult surgery, but we had to try."

Fortunately for the Causeys, Dr. Robison is one of handful of cardiothoracic surgeons in this region of the country trained to perform multi-valve, complex heart reconstruction. His areas of expertise number more than 40 and include some of the most challenging surgical procedures in the Midwest. He also is Assistant Professor of Clinical Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis.

Joyce's surgery resulted in aortic and mitral valve replacements, tricuspid valve repair and three bypasses. She also underwent an emergency fiberoptic bronchoscopy right after surgery to remove fluid from her lungs which, Dr. Robison says, “were not light and fluffy like they should be, but heavy, almost like liver. It took two weeks to completely clear fluid out of her lungs.”

Rusty sat by Joyce's bedside and never left, Dr. Robison notes. "He had a clear understanding of what was going on and was well aware of her struggle. Family support like Mr. Causey’s is crucial to a good and lasting outcome."

Joyce’s heart had been sick for over 20 years, Dr. Robison says. "She is slowly recovering her health. It will take a while, but her prognosis is good. Mrs. Causey's future is largely now in her hands with healthy lifestyle choices, cardiac rehab and exercise."

On the Road to Recovery

Joyce Causey coming from the brink of death back to a life she enjoys living is amazing, Joyce adds. A cardiac echo done at the end of February with Dr. Law showed all three valves working perfectly, normal ventricular size and function, a normal sinus rhythm and a normal EKG. "From my point of view it doesn’t get better than normal," Dr. Robison observes.

Joyce is continuing cardiac rehab at Southeast Health of Stoddard County. "Mrs. Causey is making great improvements," says Jamie Walls-Williams, RN, BSN. "When she started she was only able to exercise a total of four minutes on four different machines. She has now built up endurance and is doing eight minutes on four machines. She is well on her way to regaining her strength and stamina. I have full confidence that Joyce will be walking without a cane and living a better quality of life than before surgery."

"I play it day by day," Joyce says. Life is too short to let anything bring you down." As for Dr. Robison? "He's my angel"