The 74-year-old Lancaster man knew all too well what might be wrong. In 1989, he had had three bouts of angioplasty surgery to clear blockages from two arteries.
So back to the cardiologist he went in May, and sure enough, the tests showed four new arterial blockages. Angioplasty again, Vincent thought.
It's not really major surgery. The doctor puts a balloon- or blade-tipped catheter into the femoral artery near the groin, snakes it up through the vessel into the chest and up to the blockages, then flattens them or scrapes them off the arterial walls. These days, he'll usually also install a stent â€“ a mesh tube â€“ at the point of the blockage to help keep the artery clear longer. Most patients go home the next day.
Vincent asked the cardiologist, "When will we clear the blockages?" The answer unsettled Vincent: "We'll talk about it."
A few days later, he got the word: No angioplasty for you, Mr. Caruso. You won't just dip your toes in the water this time around. You'll do a triple flip off the high dive: open-heart bypass surgery.
On July 10, Dr. Richard Wood operated at Baylor University Medical Center. For Vincent, the surprises had just begun.
Angioplasty is no trifle. Compared with bypass surgery, however, it's a day at the beach.
"We do all sorts of unkind things to the body," says Dr. Wood, a heart surgeon since 1962. The surgeon cracks the patient open like a steamed crab, sawing through the breastbone and spreading the ribs back and away from the heart.
Then he grafts pieces of vein harvested from one of the patient's legs onto the coronary arteries, with a piece attached above and below each blockage. This reroutes the blood flow into new, clear channels. Often, the surgeon also will use part of the internal mammary artery for one of the grafts.
It took about 41/2 hours for Dr. Wood to complete three bypasses. He considered the fourth blockage minor enough to ignore.
All Vincent had had to do so far was lie there unconscious. Now came the hard part.
Alive, but hurting
The bypass patient wakes up from surgery to a surreal world.
Pain medication and the remnants of anesthesia conspire to make everything foggy. "From the moment you get the anesthesia, you start with horrible dreams," Vincent remembers.
There may be a brief moment of elation â€“ "I'm alive" â€“ and then a slew of nasty revelations.
It hurts. Oh my sweet suffering Lord, how it hurts.
Even the morphine can't block all the pain. Your chest was sawn in half, for heaven's sake. Your back muscles didn't appreciate having your ribs spread apart for four or five hours. Things are sticking into you in all kinds of inconvenient places: intravenous needles in your arm and neck, a couple of drainage tubes in your chest, a Foley catheter to drain urine.
It's impossible to breathe comfortably. The drainage tubes make it pretty crowded inside the chest, and the lungs didn't relish their sojourn with the heart-lung machine. And, of course, there's that breathing tube stuck down your throat. Some patients compare the feeling to having the wind knocked halfway out of you. It doesn't go away after a couple of minutes, either.
"The first week or 10 days are pretty bad. People can't sleep or eat real well; they may run a low-grade post-operative fever," Dr. Wood says. He lists other concerns: internal bleeding, irregular heartbeat, the vein grafts not healing properly, the rare but possibly lethal chance of a stroke.
But Vincent didn't run into any of those problems. "He did very well," Dr. Wood says. And â€“ first nice surprise â€“ he was one of the lucky ones whose pain is moderate.
"I have a high pain tolerance," Vincent says. "I remember my biggest thought was thankfulness for making it."
After a few hours, bliss: The breathing tube comes out. The next day, out of bed, then out of intensive care.
Dr. Wood operated on a Monday. Vincent went home on Thursday, another nice surprise. Most patients need a couple of more days in the hospital.
"The attitude means everything when you go through surgery," says Vincent, a short, stocky man with wiry gray hair, warm brown eyes and a congenial, chatty manner.
"I'd never felt low about this thing. I always had a positive feeling about this. ... I did everything they told me to do, and was very careful. I didn't stay flat on my back. I read and watched TV. But I couldn't read a lot at first â€“ I couldn't concentrate. I kept getting up and walking around the house."
"He did good," says Vincent's wife of 53 years, Louise. "He listened to me. There were a few things he got aggravated with, but I said, 'You gotta do it, honey. This is life.' Like when they wanted him to sit up in the bed the first time [at the hospital] â€“ he looked at me and said, 'Honey, I can't do it.' I said, 'Oh, yes you can.' He did it, but I gritted my teeth because I knew he was hurting."
"Vincent has a good family, and that's the important thing â€“ a lot of support from the family," Dr. Wood says. The Carusos' son and daughter-in-law, who live in nearby Red Oak, came to the hospital every day and rallied around afterward, too. Vincent's sister came in from Baton Rouge for eight days and offered to stay longer if needed.
At home, Vincent began to conquer the little daily challenges.
"First time I showered, Louise wanted to help me," he says. "First, she brought in a folding lawn chair [for Vincent to sit on]. But it wouldn't fit in the tub. Then she got a vinyl patio chair, but it was still too wide."
Enough, already. An exasperated Vincent said, "Get this thing outta here," and took a shower standing up. He did fine. Vincent was getting around well. But less than a week after coming home, he had a huge scare. Walking out on his patio, he slipped and felt his legs fly out from under him as he fell backwards.
"It rattled my teeth," Vincent says. But his only injuries were bruises to his backside and dignity.
Every day, he could feel more strength returning. A week and a half after leaving the hospital, it was time to take on the next challenge.
Like other major hospitals, Baylor encourages cardiac patients to undergo up to three months of closely supervised therapy. Patients come in three days a week for exercise, during which therapists closely monitor their vital signs. At some point, patients also attend a "Leap for Life" seminar where they learn more about diet and nutrition, cardiovascular disease, cholesterol and other critical subjects.
Physical benefits aside, cardiac rehabilitation also has an important emotional payoff â€“ reassurance. One Saturday, Vincent woke up to find his ankle badly swollen. "I was scared," he says. "I figured I did something wrong. But I went to rehab on Monday, and they said, 'That's par for the course.'" It was just a little fluid retention, a common symptom.
Cardiac patients need that emotional support; many suffer temporary depression. The heart-lung machine can produce some cerebral swelling. "There can be neurological changes or personality changes," Dr. Wood says. And even if that doesn't happen, the whole experience is tough to absorb.
At first, every new twinge sets off alarm bells. And everyday life suddenly poses new threats.
"The one thing that scared the daylights out of me was driving," Vincent says. (Patients can get behind the wheel again about three weeks after surgery.) What if someone ran into him, Vincent wondered, and the air bag exploded into his chest? Right into his still-healing breastbone?
But he dealt with it. His body was delivering more good surprises, too. "After a few weeks, I all of sudden started doing more than I had been doing normally. I had the energy. Your body tells you 'Go,' and you want to go.
"I remember the doctor in the hospital said, 'In two or three months, you're gonna feel like a new man.' I feel more and more like that each day."
Unfortunately, the new man hadn't lost all his old appetites. Vincent is a native of New Orleans; he and Louise moved to Texas eight years ago. He grew up on crawfish, crabs, shrimp, gumbo, etouffee. He loved steaks, breaded pork chops, hamburgers, red beans and rice with sausage â€“ every bite loaded with his worst enemy, cholesterol. Dr. Wood could bypass Vincent's blockages, but not his cravings. That was up to Vincent to do, with Louise's help.
"At the supermarket, we spend more time reading labels than we do shopping. And all these labels contradict each other!" Vincent grouses.
"But Louise is finding more recipes that are delicious. ... She's very careful about what she serves, watches me like a hawk. But I don't cheat, I really don't. ...
"The problem I had most of my life was after every meal I looked for something sweet. It's coming back again, but I don't go overboard. I may buy something sweet, but I check the label first. I used to be a chocoholic, but I don't do that anymore."
Still, even a cardiac patient has to draw the line somewhere.
"Tofu?" Vincent says with scorn. "We wasted money on that. I tried eating it by itself â€“ I didn't know you were supposed to put it with something. But just buy a square of it and try eating it? Nah."
Vincent has made remarkable progress. "I see that he has more energy," Louise says. In mid-September, he resumed yard chores.
"In another two months, we hope to go back dancing, because I love to dance," Louise says. "He's coming along beautifully."
Soon, he'll be able to return to his part-time job as a cafeteria helper with the Red Oak Independent School District. While the nerves in his leg (where the vein grafts came from) may take a few more months to heal, and he can continue to improve his strength and energy, his basic recovery from surgery is complete after six to eight weeks.
But Vincent will never be completely out of the woods. Surgeons can fix the blocked arteries, but they still have no cure for what causes them.
"Vincent will always have heart disease," Dr. Wood says. "I need him to do the good things â€“ exercise, watch his diet, take cholesterol-lowering drugs." Vincent already took one of the biggest steps 25 years ago: He quit smoking after 35 years.
Vincent still marvels at how well he's bounced back from surgery: "I can't believe how quickly you can recover from it. I really feel great."
"It keeps him going when he sees the grandkids," says Louise. Their son and daughter-in-law have two girls, 8 and 12, and the Carusos visit several times a week. "That's what we're living for. We want to stay here and see them grow up."
She reflects on how far Vincent has come, and marvels at it. "To think back how worried I was, and what the whole family went through. ...
"I'm just thankful that he's here."Go to dallasnews.com to learn about current technology in open-heart bypass surgery.