HENRY A. KISSINGER

March 18, 1982

Dear Bob:

I want to thank you for your thoughtful letter
of February 25. What you said about your experience
after your bypass was very interesting, and I will
take your advice to heart. I had no idea the
fraternity was so extensive - or so distinguished -
and I have particularly appreciated the letters I
have received.

My own recovery has gone very smoothly so far and
I hope to resume a normal schedule in a couple of
weeks.

With appreciation and warm regards,

Henry A. Kissinger

P.S. Being only 58, I am somewhat apprehensive
about recovering the energy I had 60 years ago.

Mr. Robert D. Campbell
Newsweek
505 Sansome Street
San Francisco, CA 94111

MAR 22 1982

Newsweek

505 SANSOME STREET • SAN FRANCISCO, CAL. 94111

Robert D. Campbell
Consultant
Retired Board Chairman
(415) 788-4321

February 25, 1982

Dear Henry:

Welcome to the Club!!

Having undergone a triple by-pass myself the end of October at the Eisenhower Medical Center in Rancho Mirage, I have more than a passing interest in your recuperation. Accordingly I thought I might pass along some of my experiences that may or may not be common to your recovery period.

The doctors had suggested that I might have some disorientation after leaving the hospital which should be considered normal. In my case the problem turned out to be mild amnesia. Of course all of us have memories we would like to forget, but the question was how to remember the knowledge we wanted to recall, including the names of people I had known intimately. As a result, I suspected brain damage. My mistake was in not sharing my concern with the doctors or even my wife. Later I realized the unnecessary torture I had forced upon myself.

Rather than keep you in suspense, I would assure you that by the end of two months the land will be a lot brighter. By the end of three months you will probably find yourself performing at 110%. Although each individual recovers at a different rate, the best advice I can pass along is to be patient. But after you reach a feeling of normalcy you will be back in business with a 60 year trouble free forecast and as much energy as you had 60 years ago.

All the best,

Robert D. Campbell

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HENRY KISSINGER MASSACHUSETTS GENERAL HOSPITAL

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DEAR HENRY: ENGIE AND I HAVE KEPT APPRISED OF YOUR CONDITION FROM THE DAY YOU UNDERWENT SURGERY AND NOW THROUGH YOUR EXTREMELY SATISFACTORY CONVALESCENCE PERIOD.

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RICHARD CARLTON • 25 SUTTON PLACE SOUTH • NEW YORK, N.Y. 10022 • (212) 759-2597

February 11, 1982

Dear Dr. Kissinger:

Although I am reasonably certain you will not remember
the occasion we met some years ago when I was Deputy
Director of The American Film Institute. Little did we
know or could possibly even contemplate that the time
would come when we would have something more in common
than mutual admiration for Liv Ullman. Something like
a multiple arterial bypass.

I had a heart attack in 1977 but it wasn't until two
years later that I faced up to the prospect of a mod-
ified life style, frequent discomfort, medication and
constant concern...or go for the angiogram and all that
that implied. Sure enough, three weeks later I was in
Johns Hopkins and underwent a quadruple bypass. Much of
what happened before and after may interest you and I the
thought I'd take a few minutes to give you some words
of encouragement.

First let me tell you that your comments at the press
briefing really hit home. When I knew what I was facing
I called all my program heads together for a staff meet-
ing and broke the news. I really wasn't in the mood to
joke about it...but I lost control of the meeting when
one member of the staff said "We didn't know you even had
a heart!" When the laughter subsided I tried to resume
the meeting on a little lighter note...and again I blew
it when I said that the doctors assured me that I'd be
better than ever in a couple of months. The groan that
went up could be heard throughout The Kennedy Center!
So you can see why I appreciated your remarks.

If my experience is in any way similar to yours you might
be feeling very unsettled as I write this. Certainly, the
first three or four days are the worst...and by the time
you read this you should be greatly improved. The chances
are your main discomforts will have nothing to do with the
operation itself, i.e. the surgery. You may feel like you
have had a lung operation - not a heart operation because
of the tubes, the aspirating techniques, the coughing by
design and all the other little goodies. In fact, it may
take you several days to realize that you have a sizable
incision down the front of you. You might ask, incidentally,
if they restructured your chest wall with metal rings. They
forgot to mention that to me and the first time I saw a

[LC]

post-op x-ray I looked like a large loose leaf book!
Some weeks later I was boarding a plane and the signal
went off indicating metal someplace. Let me tell you,
all I could think was that if it's those damned rings
I'll never be able to explain it and there goes my plane.
Fortunately, it was some loose keys.

The initial recovery should be quick and easy. Barring
any complications you will feel like getting on with it
in about a week or ten days. You'll be weak but you'll
feel fairly good. My advice - stay in the hospital an-
other few days. I came home on the eighth day, and that
was a bit too soon. I had one minor setback - a feeling
that my heart wasn't beating properly the day after I
arrived home. I panicked, had someone call the surgeon
immediately, spoke to him for a minute, started to relax
and then it was all over. If I had been in the hospital
I might not even have sent for the nurse!

Probably the toughest part is the slow steps to recovery.
I mean that literally. Just the act of walking 100 yards
can be formidable. But if you are like I am, you will be
pleased that you did it...and try for 150 yards the next
day. In a week you can walk a few blocks if the weather
behaves...and two weeks after you began your regimen you'll
think you can walk a mile! That's the time to take it easy.
It's a disarmingly simple recovery - and one which tends
to make you think you can do more than you probably should.
Obviously, your doctors will be establishing your pace.

The one piece of bad news that no one prepared me for was
the leg discomfort. The vein was removed from one leg and
at first I thought it was just a long, long scar about to
happen. Then as the walking began, the pain set in, and for
all of the exercise period, I suffered more than I had at
any time previously. It took weeks for that pain to grad-
ually disappear.

All of that trauma had cleared out of my system by the sixth
week. A week later I returned to my office for some critical
meetings...and then began to go in for a few hours a day
regularly. By the end of the second month I was back to a
full schedule. The operation was in March. At the end of
June I was on the tennis court hitting a few for a half hour
at a time. In July I resumed my singles game.

I've never had a bad moment since that one experience on
my return home. I am on no special diet, I live, look and
act like a man ten years younger. The only thing I gave up
was smoking. I hope you will come through this experience
in the same great shape. You're good for another 100,000 miles!

My very best to you, and to Mrs. Kissinger for suffering
for you while you had no idea what was going on.

Richard Carlitz

BRITISH CONSULATE GENERAL
SUITE 4740, PRUDENTIAL TOWER
PRUDENTIAL CENTER
BOSTON MASSACHUSETTS 02199

12 February 1982

Message to Dr. Henry Kissinger from Lord Carrington,
Secretary of State for Foreign and Commonwealth Affairs

Dear Henry

I am delighted to hear that your operation has been a success. I look forward to seeing you back in action very soon, and in the meantime send you my very best wishes for a speedy and comfortable recovery.

I was very glad to hear that you still hoped to visit London in the spring, and to do the lecture to mark the Foreign and Commonwealth Office bicentenary. My officials are urgently looking into possible dates and will be in touch with your office as soon as they can about this. It was kind of you to keep this in your schedule at a time when you have other burdens on your mind.

Michael Palliser will be in Boston on 19 and 20 February, and may get in touch to see how you are and to pass our good wishes on more directly.

BRITISH
INFORMATION
SERVICES

Reference
Biography
Service

SIR MICHAEL PALLISER, KCMG

Sir Michael Palliser is Permanent Under-Secretary in the Foreign and Commonwealth Office and
Head of the Diplomatic Service.

Arthur Michael Palliser is the son of the late Admiral Sir Arthur Palliser KCB, DSC. He was born in 1922, educated at Wellington College and at Merton College, Oxford, and served with the Coldstream Guards from 1942-47, reaching the rank of Captain. During the war, he was mentioned in despatches and created a Chevalier of the Order of Orange Nassau (Military).

Sir Michael joined the Diplomatic Service in 1947 as a Third Secretary in the South East Asia Department of the Foreign Office. In 1949 he was transferred to Athens and the following year promoted to Second Secretary. From 1951 until 1954 he served in the German Finance Department and later in the Central Department of the Foreign Office. He was then appointed Private Secretary to the Permanent Under-Secretary and subsequently promoted to First Secretary.

In 1956 he was transferred to Paris as First Secretary and in 1960 to Dakar as Head of Chancery. In 1963 he was promoted to Counsellor and attended a course at the Imperial Defence College. The following year he was appointed Head of the Planning Staff in the Foreign Office. From 1966 to 1969 he was a Private Secretary to the Prime Minister and was then posted on promotion as Minister in Paris. In 1971 he became Head of the United Kingdom Delegation to the European Communities and in January 1973 Ambassador and United Kingdom Permanent Representative to the European Communities in Brussels. He took up his current appointment in 1975.

He was made a Companion of St Michael and St George in 1966 and knighted in 1973. He is also a Chevalier of the Légion d'Honneur (1957).

Sir Michael is married to Marie Marguerite Spaak, the daughter of the late Paul-Henri Spaak, former Prime Minister and Foreign Minister of Belgium. They have three sons.

Photograph No R 90936 issued by COI Photographs Division

November 1976

N.B. This document has been prepared for British Information Services by Reference Division, Central Office of Information, London, and is intended to be used for reference purposes. It may be freely used in preparing articles, speeches, broadcasts, etc. No acknowledgment is necessary. Please note the date of preparation.

DIAHANN CARROLL L ADAMO
PO BOX 10235
BEVERLY HILLS CA 90213

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THE CONSUL GENERAL
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535 Boylston Street
Boston, Mass. 02116

February 12, 1982
vD/RS

By Hand

Dr. Henry Kissinger
Massachusetts General Hospital
Boston, Massachusetts 02114

Dear Dr. Kissinger:

The President of the Federal Republic of Germany, Dr. Karl Carstens, has asked me to forward to you the following message:

"Zu meiner grossen Freude erfahre ich, dass Sie den ärztlichen Eingriff gut überstanden haben. Ich wünsche Ihnen von Herzen baldige völlige Genesung.

Karl Carstens
Präsident der Bundesrepublik Deutschland".

With my best personal wishes for further good progress in your recovery, I am

NEW YORK TIMES MAGAZINE of May 14, 1978

HOW TO HAVE
OPEN-HEART SURGERY
(AND ALMOST LOVE IT)

Last fall, Douglass Cater, a longtime Washington writer who is now president of Observer International in London, was told he should have a valve replaced in his heart. The operation took place in mid-March. What follows are excerpts from his journal of the experience, which he now recalls as "rejuvenative and exhilarating."

By Douglass Cater

March 4, Day One: As midnight approaches, I am sitting alone in Room 1501 of the University of Alabama Medical Center in Birmingham. I suffer no chest or other pain. My symptoms are invisible to the naked eye. Until entering the hospital this afternoon, I have been accustomed to 8- to 10-hour work days and frequent dining out in the evenings. I can stroke 10 lengths of the Olympic-sized pool in London's Royal Automobile Club without breathing heavily. Yet, four days from now, my chest will be ripped open, my ribs laid back, and my heart penetrated by the surgeon's scalpel. A mitral value — prosthetic or heterograft (animal tissue) — will be substituted for my present one.

But the key fact to be borne in mind is that I made this decision voluntarily and without anguish. Last September, early in my 54th year, the evidence began to pile up that open-heart surgery was, in the jargon of the medics, "indicated." Mine was not the sudden summons of the coronary victim whose arteries have grown clogged by the fatty buildup of cholesterol. For him, the decision to operate must often be urgent. For me, there had been foreknowledge going back over 40 years that this time would come. An early teen-age bout with rheumatic fever scarred the mitral valve of my heart, causing it to fail to open and close as efficiently as it should.

Back in those more primitive days of medical science, the rheumatic heart victim had little choice. He was consigned to progressive invalidism or he could look forward to death at an early

age. That I was spared these dismal alternatives was due in large part to a benevolent uncle who rescued me from the helpless doctors of my native Alabama (rheumatic fever being a fairly unknown disease in the deep South) and took me to the renowned Mayo Clinic in Minnesota.

There, my malady was promptly diagnosed and I was confined for 12 months of rest cure — flat on my back with an ice bag on my chest and aspirin for medication. By the time I rose from the bed, the systolic murmur persisted but the heart was sturdy. It served me well over the stressful years as journalist and Presidential assistant to Lyndon Johnson. I have neither coddled my heart nor, until quite recently, accommodated my habits of work and play to suit its vulnerability.

I am struck by paradox. In the years since my rheumatic fever, medical science has made the giant strides which reduce open-heart surgery to predictably low risk. And my native Alabama, from which I fled to seek Mayo's expertise, now offers one of the world's outstanding centers for the heart, thanks in part to heart-cancer-stroke legislation on which I worked while in the White House. Dr. John Kirklin, who will be wielding the knife next Wednesday, was chairman of the surgery department at the Mayo Clinic before coming to the University of Alabama Medical Center a dozen years ago.

To start this journal, perhaps I should record as faithfully as memory serves how I reached this lonely room on this

The picture of health: Two months after surgery, Douglass Cater is back at work and hiking daily through St. James's Gardens in London. The medical pendant he wears around his neck indicates, in case of accident, that he takes a heart drug.

[L]

particular Saturday evening. Four years ago, my heart began to reveal a proclivity to march to a different drum-beat from its accustomed one. The doctors describe this as fibrillation, characterized by swift and irregular palpitations. While not dangerous, if attended to promptly, it can be damnably unsettling.

My first fib occurred in 1974 during a frenetic period in Aspen, Colo. (altitude: 7,800 feet). Suddenly one morning, I grew aware that my pulse was pounding and I felt as if I were garmented in lead. Each step grew labored. My doctor, who did not seem particularly perturbed, put me in the hospital for three days, administered an electrical shock to the heart and, shortly, I was back in the familiar rhythms and routines.

This reoccurred twice over the next three years. Then, last summer, after flying across the ocean several times, I found myself feeling like an eight-cylinder engine firing on only six. For the first time, X-rays of my heart indicated enlargement of the left atrium — the upper chamber that collects blood before it gushes into the ventricle and then moves on its life-sustaining way. In my case, the scarred cusps of the mitral valve between the left atrium and left ventricle were failing to close the passage tightly, so that a portion of the blood surged back into the upper chamber and had to be moved on its way a second time, causing the heart to bear at least a third more than its usual burden.

Now came that delicate phase in any diagnosis when the doctors politely differ. My New York cardiologist, who had corrected the last bout of fibrillation, recommended one more effort at shock therapy and medication. But my London consultant concluded that this would be futile and might risk dislodging blood clots. His more conservative advice was to adjust medication to achieve maximum well-being while remaining in an arrhythmic state. It was I, the non-

specialist, who broke the impasse by declaring that I was not content to remain halfway toward invalidism. Another consultant in London was called, who, with commendable forthrightness, recommended surgery to replace the offending valve — if a cardiac catheter test confirmed his external soundings.

For those who live in terror of this first stage in the journey toward open-heart surgery — the cardiac catheter test — please be reassured. There is humiliation, of course. Being shaved around the groin area reminds one vividly of the nakedness the newborn baby must feel. But the penetration of the great femoral artery at that sensitive point has been dulled by local anesthetic and the long journey up the artery into the heart is completely without sensation. Apparently, nature never anticipated the need for nerve endings in such secluded passages.

Once the catheter has entered the heart, one's curiosity takes charge. By video monitor, placed so that I could share the investigation, we watched the catheter's worm-like meandering. On signal, dyes were injected, which caused hot flashes commencing in the chest and moving to the body's extremities. Uncomfortable but not painful. In less than an hour, the job was done, although, for observation's sake, I was obliged to stay the night in the hospital.

The cardiologist felt vindicated in his prognosis: While my case was still marginal, surgery within the convenient future was definitely in order. He also gave me the glad news that, except for the offending valve, my heart appeared to be in good shape — no hardening of the arteries or buildup of cholesterol. That, at least was comforting to know.

This explains why, in March, having set business and family affairs in reasonably good order, my wife and I have made this journey back to our native roots. The worst is yet to come. But there are already lessons which I have learned.

The first is that the act of making the decision is itself remarkably rejuvenative. My most trying moments so far

came when the experts were in conflict. It has been five months since the second London cardiologist recommended cardiac catheterization, three months since the test results proved reasonably conclusive. Rather than enduring tormented days and sleepless nights, I have, with my wife's warm support, developed routines that have actually reduced stress and anxiety.

I have come to regard next Wednesday's surgery as my bizarre equivalent to Olympic competition. My purpose is to reach it at a peak of physical fitness. This has meant, among other things, discarding my desultory approach to weight control. By the simple technique of eating less, I have accomplished what a dozen diet fads never did. The spare tire around my middle has practically vanished. Chin and cheekbones now show a prominence reminiscent of my wedding photographs. Having cast away that extra stone, I already feel better before the surgeon has lifted his scalpel. Twice-daily stretching exercises of a bastardized yoga variety together with thrice-weekly swims have given tone to my muscles.

Perhaps more important has been to acquire the unaccustomed habit ofpose. Having always labored under the delusion that the early bird got the early worm, I have at last discovered not merely rest but efficiency in spend-

ing my first waking hours abed. (After all, Winston Churchill, who lived not far from where I now reside in London, led his nation to victory during the Second World War while often cuddled amid his pillows.) The day takes on new orderliness when approached in a leisurely manner. We have equipped our bedroom with the necessities for preparing light breakfasts. At working day's end, an hour of rest and exercise can bring zest to the evening's entertainments. I no longer doze in theaters.

Day Two, 4 P.M.: Dr. Thomas James, chief cardiologist, has just dropped by to report that all tests are "go" for the operation. He believes that by sheer good fortune we have chosen the optimum time — just before serious deterioration of heart functions might have commenced. He confirms the report of the London cardiologist that my heart's other appurtenances appear in good condition. But specific questions about surgical procedures have to await the arrival of Dr. John Kirklin, who will hold the scalpel.

Day Four: A day waiting for Dr. Kirklin. I feel somewhat awed by the stature which the star surgeons attain among the hospital bureaucracy as well as their patients. Drs. Michael De Bakey, Denton Cooley, Norman Shumway and John Kirklin — each appears to evoke tremendous passions. They are at the top of the hospital pecking order, even when measured against

[L]

doctors whose contributions to the sav-
ing of lives may be greater. They are
the great performers. This represents a
contradiction of sorts. Surgery has be-
come increasingly a team operation
where life or death hinges on the swiftly
coordinated effort of many players. But
the chief surgeon emerges as the su-
preme individual, developing a reputa-
tion as a fierce martinet as well as an
addict of marathon performance.

I had been advised to seek out a sur-
geon who displays his machismo
through such obsessive work habits and
Dr. Kirklin certainly fills the bill. He is
in the operating room by 7:30 A.M. and
rarely leaves the hospital before 8:00 or
9:00 P.M. A slight, wiry man of 60, he
has the look of the aesthete. Still, I can't
help wondering whether such men have
their off days like the rest of us — times
when suddenly they are all thumbs.
Perhaps I shall find out tomorrow
morning, when I am slated to be first in
the Kirklin lineup. Will his hands be
sufficiently supple at that dawn hour?

The waiting hours have not proved to
be a drag. On the contrary, I have come
to treasure the solitude and almost re-
sent the solicitousness interruptions of
friends and loved ones. I cannot, de-
spite some effort, bring myself to brood
on thoughts of mortality. If I am des-
tined to explore fresh territories, it will
have to take place without prolonged
metaphysical planning. During times
past, I have pondered at length on the
varieties of my religious experience.
They have led to what might be de-
scribed as a quizzical approach to the
hereafter. Now, even this appears to
desert me as the hour of testing ap-
proaches. I am more curious about ex-
ploring the mysteries of the here and
now.

By the time Dr. Kirklin finally ar-
rives, attended by his retinue, I have
prepared a long foolscap of written
questions, each cleverly intended to
test his certitude. It is not last-minute
fears I feel so much as a desire to hear
it directly from the guy in charge. He is
patient with me but unwavering. He
harbors no doubts that I am doing the
right thing at the right time. The odds
are highly in my favor.

He explains that among the dozen or
so choices, he has decided on a Björk-
Schiley valve — a model which, I learn
later from a candid intern, is designed
somewhat along the lines of the ordi-
nary toilet seat. So this is the contriv-
ance with which I must share a com-
mon destiny. I question why he has not
opted for the xenograft (or pig valve),
which seems to be in considerable fash-
ion among heart surgeons. Björk-
Schiley means that I must maintain a
lifelong dosage of anticoagulant medi-
cation.

But Björk-Schiley has, he estimates,
the advantage of durability. He pro-
vides a subtle reminder that all of us
open-heart adventurers are still in the

pioneer phases. There are not sufficient
statistics to provide a firm prognosis
about how many years of operating effi-
ciency can be expected from a valve
job. He offers the slightly comforting
reassurance that once the great entry
had been made, a return visit is no
more difficult or risky than the first
one.

Only after he has done his persuasive
best do I admit to Dr. Kirklin that I
have hedged my bets. A psychic healer
in New York, mobilized by a friend, will
be devoting the next day to transmit-
ting restorative waves down the East-
ern seaboard specifically in my direc-
tion. If this whole enterprise succeeds, I
tell Dr. Kirklin, he and his team must
be prepared to share the credit. He con-
cedes, somewhat wryly, that every ef-
fort helps.

One healing charm is already at
work. With a foresight for which I shall
ever be grateful, I have purchased a
small cassette player and a dozen tapes
of my musical favorites, ranging from
Prokofiev to Lena Horne, along with a
smattering of Mozart and Brahms. For
the first time ever, I have the chance to
listen to the same movement over and
over again. It has a hypnotic effect,
especially during those postmidnight
hours when the clock always seems to
get stuck.

Day Four, early evening: Only the
ritual known succinctly as "head to
too" remains before S-Hour. Adminis-
tered by my nurse, Gay Nell, it consists
of a total body shave below the neck in
order to be rid of any pernicious bacilli
which may be lurking amid the folli-
cles. Since, unlike Esau, I am not a
hairy man, the decision is reached to
administer my shave without benefit of
lather. A male nurse, I am reassured,
will conduct the final, more delicate
stage with no sparing of the lather. Gay
Nell sets to work with great alacrity,
regaling me with the tale of a neophyte
nurse who had misinterpreted her as-
signment. Too late, she was discovered
with half her patient's scalp denuded.
Given the choice, this unfortunate man
had decided to leave things where they
stood rather than going ahead with the
scraping of his other half.

Day Four, approaching midnight: I
have reached an impasse of sorts. Psy-
chologically, there is a fierce determi-
nation not to admit that the morrow
holds any danger. At the same time, I
feel a need to leave some written word
to wife and to our offspring, who are
scattered in distant parts of the United
States. I would feel remiss to slip off the
next day without a message of farewell.
Finding the right words is the catch. It
must not sound maudlin nor, on the
other hand, like an interoffice memo-
randum dictated to surviving members
of corporate Cater enterprises. So I oc-
cupy these final moments before the
sleeping pill takes effect composing a
few paragraphs of love and support.

It's an awkward exercise, and by the
time I have finished I find there's a
painful lump in my throat. Somewhat
akin to Tom Sawyer's participation in
his own funeral services.

Day Five, dawn: Wife Libby is in-
structed to operate my small Sony re-
corder in order to capture the period
surrounding surgery. A replay reveals
little except a few forays into what
might be called graveyard humor on
my part. The anesthesiologists have
outfoxed me, so timing the creeping
power of their narcotic that I have only
a fleeting memory of the long trek down
the corridors and the rang of elevator
doors. My Sony recalls — though I do
not — my farewell to wife and sister-in-
law, suggesting that we join in a rous-
ing chorus of "Battle Hymn of the Re-
public." All is darkness before I reach
the operating room.

My surgery, I am told afterward,
takes approximately three hours inside
the heart — and another hour or so of
opening and closing me up. My only
personal recollection of the time spent
on the table may not be precisely reli-
able. There came a moment when I felt
fully conscious of the sounds around me
although my eyes felt as though they
were glued shut. The terrifying thought
flashed through my mind that the anes-
thetic had failed and my next sensation
would be of a great ripping open of the
sternum. In vain, I tried to lift a finger
or even wrinkle my forehead in order

to sound the alarm. No part of my
anatomy would respond to instructions.
It was as if I had been frozen in amber.

Much later, I learned that during the
penultimate stages of the operation, the
Latin American drug curare is admin-
istered, producing complete paralysis
of the muscular system and necessitat-
ing the heart-lung machine to sustain
that spark called life. Before I can con-
jure up Edgar Allen Poe visions of live
burial, I hear the dry voice of Dr. Kirk-
lin, "Well, it's all done." Never did so
few words evoke such vast relief.

Day Five, P.M.: Here in the cardiac
intensive-care unit, patients are
stashed around the walls and plugged
in 14 different ways into the equipment
which monitors one's staged return to
nonartificial life. Doctors circulate, but
one's main memory is of the nurses,
three and four to each patient, who
surely have been selected for loveliness
as well as skill. I recall a tremendous
yearning to lift my head and kiss the
peach-down cheek of one young beauty,
but the curare still has me in its spell. I
cannot talk because there's a breathing
tube down my throat, but I muster
enough energy to write on a pad my
desperate plea for a "sip" of water, na-
tive cunning having warned me that a
full-fledged drink will be refused. No
such luck.

Hours later, when the breathing tube
has been removed, I hear wife Libby's
excited announcement that she has the

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[Lc]

Sony in operation. "Well, what do you think?" she inquires in her best Barbara Walters fashion. My voice, played back later, sounds as if it comes from deep within the mattress. "About the Middle East situation, I have concluded ..." I trail off for want of a punch line. But it proves to her that the same old me has come through to the other side. I remark that the pain is far more endurable than I had anticipated but express apprehension for the next day.

**Day Six:** The intermediate-care ward. Dr. Kirklin evidently has his own version of the Coach Bear Bryant technique which has established the University of Alabama among the football giants. One is hardly out of the recovery room before spring scrimmage commences. By the end of the day after surgery, I am sitting at bedside, undergoing my cough routine — three deep breaths and a hacking effort to expel liquid from the lungs. That really does hurt. It is not my idea of fun.

**Day Seven:** Less than 49 hours out of surgery, I am unplugged from most of my devices and embarked on forced hikes up and down the long corridors. No time for the prolonged bedrest which stultifies the body functions. I had been worried that having my rib cage unsprung would aggravate an ancient back ailment once diagnosed as "kissing spurs" of the lower vertebrae. Instead, to my joy, I discover that the lower back is limber and even the upper rib cage responds to my preliminary stretching exercises. I march up and down the corridor, arms thrust above head, in heady imitation of Richard Milhous Nixon's victory stance.

**Day Eight:** In the dentist chair, I have always been as big a coward as the next person, engaging in vigorous isometric exercise as I wait for the drill to plunge through to the nerve. That is why I am so mystified by the absence of excruciating pain after the insult just committed to my body. With a feeling of bravado, I have instructed the nurses to terminate any further doses of morphine. But the agony fails to come. Around the heart region, I feel no painful sensation whatsoever. They tell me it is an insensitive zone, except when cut off from blood flow, thus putting the lie to poets of all ages. My only soreness — of quite respectable proportion — centers in the upper sternum. I live in dread that a sudden spasm of coughing or sneezing will cleave me right down the middle. But I have known far worse pain, when as a youth I banged my kidney against the steering wheel in an auto accident.

Even the great scar which runs down the middle of my chest, terminating just above the lowest rib, proves less awesome than I have feared. Left unbandaged to facilitate rapid healing, it has already lost its fiery color and seems well on the way to mending.

The nights are dividing themselves into half-hour sectors. While TV has me climbing the walls in jazzed-up frenzy, my cassette player makes those wakeful periods a time of tranquillity. Prokofiev's Violin Concerto No. 2 leads my hit parade, closely followed by Mozart's Piano Concertos Nos. 14, 15, 16 and 17. While I cannot gauge with any precision the psychic healing power emanating from New York, something must be feeding my sense of euphoria.

**Day 11:** A final move to the fourth floor, where one is no longer monitored by electronic device. I must be getting well, for the hospital's regimen is beginning to pall, especially that mess of pottage which passes for a salt-free diet. It strikes me as farce that we should carefully select from a tempting menu each morning such delectable choices as "country-fried steak," only to be served an inedible concoction masquerading under that name. The dietitian comes to call in response to my complaints.

Why not, I suggest, try a truly radical approach? Why not scrap the traditional names and concoct preparations of entirely unknown origin? Invent a whole new vocabulary to lend piquancy to this gourmet odyssey? Instead of country-fried steak, say, there might be Hong Kong flambeau. The young dietitian eyes me uneasily. Nothing in her schooling has prepared her for a great pioneer of culinary art. We finally negotiate an agreement that I may order a sandwich — ham, beef or cheese — whenever the particular meal appears too loathsome.

**Day 13:** One week and a day after the knife, I am on my way out of hospital. Before departing, I press Dr. Kirklin to reveal whether he found anything unexpected once he had got inside. He tells me that the decision to replace the valve was amply confirmed. In fact, considering the valve's stress, he is surprised that I had showed so few surface symptoms.

Otherwise, there are no surprises. Although it has retained an arrhythmic beat, it is strong and competent. The new valve is doing its open-and-shut duty. I must confess to a slight disappointment — that they haven't given me back that old, regular rhythm. He tells me it may come with time.

A nurse drops by to give me a final briefing. I am amazed by how few are the verbotens. Everything should come in its season — to be determined by how I feel. Don't push too hard. With becoming modesty, she informs me that I may resume sexual relations at will, but that for the sake of the healing chest scar I should avoid certain positions.

**Day 20:** In the loving atmosphere of my cousin-in-law's Birmingham home, I feel the withering of the insult which my body has sustained. Agonizing pain has yet to make its appearance. Instead there are early-morning and late evening aches where ribs were pried from their accustomed rigidities. That delicate network of nerve endings between the shoulder blades commences an outcry from time to time, but it is more from the extended bedrest than because of any direct affront to their sensitivities.

**Day 34:** Two weeks of rocking on the front porch of a generous friend's log cabin on Lake Tuscaloosa, watching springtime explode in Alabama. Each day, longer hikes and more vigorous exercise. It is time to add up the pros and cons. Reciting the details of what

- 4 -

[Lc]

proved to be an uneventful venture into open-heart surgery can be misleading. I am fully aware of the risks involved in entering — for any purpose — the hospital; and the even greater risk of penetrating the human anatomy. Close friends sing chapter and verse of the terrifying dangers which lurk within those seemingly antiseptic corridors. One open-heart colleague in Los Angeles had to be ripped open again a few days later because staphylococcus had infected his heart linings. Six more weeks of intravenous treatment before he could be released.

I have deliberately not read deeply about all the risks: the body's rejection of alien substances, embolism or blood clots that may go spinning off toward the brain, sheer malfunction of moving parts which must perform their vital role more than once each second amid pressures that would corrupt the most powerful man-made motor.

I think of this incessant demand during the postmidnight hours when listening to the castanet sounds of my refurbished heart and I realize that this is the condition with which I must live from here on out. Those who have had this adventure before me have warned of peaks and valleys of mood. For me, so far, there have been only the peaks. Each day I think I detect a new vitality as the heart disencumbers itself of an ancient burden. The click of those castanets, when I do hear them, has a crisp, efficient, life-renewing sound.

Why wasn't I really more scared? Now that it is all over, I find it difficult to explain the calm that underlay the whole experience. Certainly there was fear, but never even brief moments of panic. If it means anything, it is that the decision for such an operation should not be anxiety-ridden or postponed until it becomes part of the sickness itself. Waiting for surgery should not be a time for neurosis. Recovering from surgery, I am profoundly convinced, is a case of mind over matter. Maybe joyful is not the apt word to describe the aftermath of this great adventure, but I find myself doing a lot more smiling lately. ☺

DRUG THERAPY/JULY 1978

Diary of open-heart surgery It's an inescapable fact of life that people love to talk about their operations. All too often, the result is a rather tasteless exercise (remember Lyndon Johnson's gallbladder surgery?), so it is refreshing to happen upon an enlightening and interesting account of what it is like to be on the patient end of an operation. This example, by Douglass Cater, is aptly entitled "How to have open-heart surgery (and almost love it)" (The New York Times Magazine, May 14, 1978). Mr. Cater, a long-time Washington writer who is now based in London, kept a diary of his experience with a mitral valve replacement. Many candidates for surgery could gain a number of valuable lessons from reading the account.

Mr. Cater begins his journal on March 4, the day of his admission to the University of Alabama Medical Center in Birmingham. He recounts how he came to be sitting alone, reflecting on the surgery he would undergo in four days. He suffered rheumatic fever as a child, and now, at the age of 54, he has suffered symptoms of increasing mitral valve insufficiency. He has seen several physicians—a New York cardiologist, a London consultant, and a second London doctor who performed cardiac catheterization. Opinions were divided on whether the operation was essential, but he opted for surgical correction. He then selected Birmingham and Dr. John Kirklin, chairman of the department of surgery there, because of the reputation of both as being outstanding in the world of heart surgery.

Mr. Cater's description of Dr. Kirklin seems to sum up the mystique that surrounds many leading surgeons. "I feel somewhat awed by the stature which the star surgeons attain among the hospital

bureaucracy as well as their patients.... They are at the top of the hospital pecking order, even when measured against doctors whose contributions to the saving of lives may be greater. They are the great performers." As for Dr. Kirklin himself, Mr. Cater explains that "I had been advised to seek out a surgeon who displays his machismo through such [marathon performance] obsessive work habits and Dr. Kirklin certainly fills the bill. He is in the operating room by 7:30 A.M. and rarely leaves the hospital before 8:00 or 9:00 P.M."

"Still," Mr. Cater muses, "I can't help wondering whether such men have their off days...times when suddenly they are all thumbs."

Like a model patient, Mr. Cater has well-researched questions for Dr. Kirklin—Why a Björk-Schiley valve?—and then informs him that he also has engaged a psychic healer, just in case. The operation went as expected, with both surgeon and patient displaying almost unnerving calm. His main memory of the intensive care unit "is of the nurses, three and four to each patient, who surely have been selected for loveliness as well as skill." By the end of the second day out of surgery, he is again joking with his wife. He never experienced any excruciating pain, "only soreness—of quite respectable proportion—centers in the upper sternum." Eight days after the operation, he leaves the hospital. Dr. Kirklin "tells me that the decision to replace the valve was amply confirmed," but no other problems were evident during the operation.

The journal ends on Day 34 with Mr. Cater "watching springtime explode in Alabama. Each day, longer hikes and more vigorous exercise."

In adding up the pros and cons, he emphasizes the "risks involved in entering—for any purpose—the hospital; and the even greater risk of penetrating the human anatomy." But he also concedes that he deliberately did not read deeply about all the risks. He explains his calm throughout the experience by saying "the decision for such an operation should not be anxiety-ridden or postponed until it becomes part of the sickness itself.... Recovering from surgery, I am profoundly convinced, is a case of mind over matter. Maybe joyful is not the apt word to describe the aftermath of this great adventure, but I find myself doing a lot more smiling lately."

65 ASHLEY GARDENS
WESTMINSTER
LONDON SWIP IQG
01-834 5485

Dr Henry Kissinger
Suite 520
1800 K Street NW
Washington DC 20006
U. S. A.

March 1, 1982

Dear Henry.

I was most concerned to hear that, so soon after our very pleasant lunch in New York, you had had to undergo heart surgery. However, I am delighted to learn that it has been successful and that you are now well on the way to recovery. Indeed, if the British press is to be believed, you have re-arranged your plan to visit Chatham House in March and will now be doing so in May. If so, this is excellent news and I shall look forward to seeing you when you come here.

I wonder if I could persuade you to meet briefly with the All Party Defence Committee of the House of Lords of which I am Chairman, at some time during your visit. I realise that you will not wish to overtax yourself but I believe that a brief encounter with these people would be a much needed educative process for them. They are all deeply interested and concerned about defence matters, especially those which have a European-American context. They are not, however, always as knowledgeable about these things as they might be. My aim is to try to put this state of affairs right and it would be most appreciated if you felt able to spend half an hour or so with them. I shall, however, entirely understand if you feel that you want to restrict your activities on this occasion.

I am taking this opportunity of sending you a photo copy of a recent article of mine in the *Daily Telegraph* which you may not have seen.

Mona joins me in sending best wishes for a speedy and complete recovery.
With best wishes.

MAR 19 1982

FROM: RT. HON. THE LORD CHALFONT, R.C. O.B.E. M.C.

WU
western union

Telegram

BYA120(1918)(1-029496C040)PD 02/09/82 1919

ICS IPMBYBD BSN

09151 02-09 0716P EST

ICS IPMBY20

4-054857S040 02/09/82

ICS IPMBNGZ CSP

3128280468 TDBN CHICAGO IL 26 02-09 0708P EST

PMS DR HENRY KISSINGER

MASSACHUSETTS GENERAL HOSPITAL, 2-9 PM OR 2-10 AM, DLR

32 FRUIT ST

BOSTON MA 02114

DEAR HENRY GET IT OVER QUICK WE ARE VERY DISAPPOINTED WITH
EHRLICHMAN'S MEMOIRS AND ARE LOOKING FORWARD TO YOUR POSITIVE
CONTRIBUTION. WE LOVE YOU GOOD LUCK
SUSIE AND DWIGHT CHAPIN

W.U. 1201-SF (R5-69)

A-584607

SUSIE AND DWIGHT CHAPIN
CONTRIBUTION. WE LOVE YOU GOOD FUCK

DEAN HENRY. 2 MEMOIRS. AND ARE LOOKING FORWARD TO YOUR POSITIVITY.
DEAN HENRY GET IT OVER QUICK WE ARE VERY DISAPPOINTED WITH

HONOLULU MA 08114

DE FRUIT ST.

MASSACHUSETTS GENERAL HOSPITAL. S-3 PM OK S-10 AM. DLR

RMS DM HENRY KIRRINGER

P15880428 TDBN CHICAGO IL 28-05-09 0108P E21

ICB 1PMBW02 CAP

A-0248212040 05/03/85

ICB 1PMBYSO

CAPT 05-09 0518P E21

ICB 1PMBYED P2M

BYA150(1919) C-05849E0400HD 05/03/85 1919

[L.C.]

Executive Director
The Research Institute of America, Inc.
589 Fifth Avenue, New York, N.Y. 10017

February 17, 1982

Dear Henry:

I won't risk any witticisms in wishing you a comfortable and speedy recovery. You exhausted all possibilities in your press conference before the surgery. I suspect, however, that you have once again misled the press. The general impression you obviously want to leave is that you required the replacement of three arteries serving the heart. My suspicion is that you replaced none, but chose to add three more. Foreign affairs are in such a mess that I can see you getting sufficient energy for a major assault.

Your health and vitality mean a great deal to many of us and Phyllis and I wanted to tell you and Nancy that our thoughts are with both of you.

Knowing you, there is even the possibility that this belated note may reach you after your discharge. I hope, though, that you will not rush whatever recovery time is suggested to you.

With our affectionate wishes.

FEB 22 1982

Leo Cherne

OFFICE OF
HENRY A. KISSINGER

March 18, 1982

Dear Warren:

You were very kind to write while I was recovering from my heart surgery. It was good of you to think of me and to send words of encouragement, which meant a great deal.

I hope we will see each other soon.

The Honorable
Warren Christopher
611 West Sixth Street
Los Angeles, California 90017

MAR 18 1982

HENRY A. KISSINGER

March 18, 1982

Dear Dick and Shirley:

Although I have seen you many times, I
still wanted to write you a note to thank
you for the beautiful flowers that greeted
me when I arrived home from the hospital.
Your thoughtfulness meant a great deal to
Nancy and me and I want you to know how
much we appreciated your good wishes.

My recovery continues to be excellent and
I expect to resume a normal schedule in a
couple of weeks. I am grateful for friends
like you.

Mr. and Mrs. Richard Clurman
40 East 66th Street
New York, New York 10021

MAR 25 1982