The Scars Remain And The Story is Yours to Tell
I was putting on my shirt in the Grace Community High School locker room when Bryan, a friend, pointed at my chest and said, “I used to have that, too.”
He was pointing at my sunken sternum and misshapen pectoral muscles – a condition I would soon learn is called pectus excavatum. I was 15 years old when Bryan noticed it, but I’d lived with it all my life. Kids would point it out and sometimes make fun of it. I didn’t worry about it too much, but as I entered my awkward teen years, I was becoming more self-aware. It was weird – where everyone else had a normally formed chest, I had a bowl. I joked about it, but it did bother me.
Pectus excavatum is a congenital condition. My mother also has it, though not to the degree I do, and other members of my family do as well. The Olympic swimmer Cody Miller has it, as does Fleetwood Mac drummer Mick Fleetwood. Columbine High School killer Eric Harris had it, though he had his chest corrected by surgery a few years before. It’s a strange club to be in, but it’s more common than you might think – about 0.1% to 0.6% of people have it.
Bryan went home and told his mother, who called my mother, and within a month or so we were sitting in a Dallas doctor’s office – Dr. Theodore Votteler’s.
I still think about Dr. Votteler quite a bit because he was, by any measure, a fascinating man. He died in 2008, and his obituary and Find a Grave entries are full of people telling stories about him – how he saved their lives or a child’s life, how he performed an incredibly complicated or experimental surgery, how he was patient and kind with family members.
He was born in Portland, Ore., and his family relocated to Dallas not long after. He went to school there, then to the University of Texas at Austin. He joined the U.S. Navy and went to medical school at Tulane University after he got out. He quickly made his way back to Dallas, where he started work at Children’s Medical Center as a surgeon. He would climb the ranks there, all while becoming an expert in the surgical removal of conjoined twins. He was known for his surgical skill, and he often conducted the most complicated and precise surgeries one could imagine – working with children and their families in times of extreme distress.
Dr. Votteler examined me and ordered a series of X-rays and tests to better understand my particular condition. Pectus excavatum is a particular kind of condition. For one person it might be merely a cosmetic issue, but for others it can cause serious problems because it repositions the heart and lungs. The result can be decreased lung function and a reduced lifespan. I was in that latter category based on the depth of my sunken sternum, and Dr. Votteler recommended surgery to me.
These days there are several surgical procedures used to correct pectus, but at the time I had mine – the early 2000s – the most widely used and common was called the Ravitch procedure. It’s an hourslong surgery (I think mine took about seven hours) that involves removing the sternum and placing a small metal strut underneath it to keep it in the right place.
There’s lots of sawing and breaking. You’re basically building a new chest.
The pain was intense, and the recovery was long. I spent about a week in the hospital at Children’s Medical Center.
I remember how sick I felt coming up from the anesthesia. I remember the pain and the tubes that drained blood from two incisions in my chest. I remember the footlong scar from one side of my chest to the other (I still have it). I remember ordering CDs from Columbia House and watching the movie Harvey on VHS, borrowed from the hospital’s media library.
The recovery continued. I remember Dr. Votteler pulling the long tubes out of my chest and bandaging me up for the hourslong car ride back to East Texas. When we got home, my dad was so ill from worrying over me during the recovery that he had to go to the emergency room. I watched Wayne’s World and Private Parts on the USA Network that night. The chest bandages stayed on for three months, plus another three months without heavy physical activity. I played high school soccer, but I missed my sophomore season. I was the “team manager.”
But then it was over. I healed, and I moved on. My chest still looked a little funny, but it was no longer concave. It was another decade before I would think too much about pectus excavatum.
Not long after I turned 30, I started having serious chest pains, right under my left pectoral muscle.
I went to different doctors looking for an answer. My heart sounded OK, but my doctor recommended an X-ray. I got it and went back to work. A day later, he called me to tell me there was a small bar in my chest (the strut from my surgery) and that it was broken.
Anxiety had always been an issue for me, and this sent it into overdrive. When I heard the voicemail he left on my phone, I passed out.
My primary care doctor didn’t have much to offer in the way of help, other than I should probably talk to a thoracic surgeon. I called one, and he said he “could probably take it out.”
This was not a “probably” situation to me.
Eventually, I ended up back at Children’s Medical Center with a doctor named Adam Alder. Alder told me that when I had the surgery, the struts were generally left in, but the current technique removed the bar after about six months. He said he could remove my strut by making two small incisions over my existing scar, cut through the cartilage and pull the bar out.
Alder also told me that the bar was not what was causing my pain and that the risk of it being broken was pretty low. He said, in his opinion, anxiety was causing my chest pains.
I had the surgery, which took maybe an hour. I woke up, went home and recovered in about a month. But, looking back, that second surgery would have a huge role in where I am today, for better or worse.
I remember feeling depressed and blue after the surgery, which was surprising, because I was coming off several wins in my life – I’d gotten married, graduated with an MBA and was having lots of professional success. I was in great shape. But I read several research papers during that time that tuned me in to the fact that depression was pretty common in people who had recently had a thoracic surgery or an open-heart surgery. Who knows what happens when we cut on the human body? What does it trigger or release? I am not a doctor, and I do not know. It’s possible I was just feeling the unfulfilled feeling a lot of successful people feel.
I know that second surgery was the beginning of the rest of my life. Regardless of the cause, it marked it. Everything that happened after could only fit in dozens of columns that I may write many years from now, once I am far enough away from that wreckage.
I started to take my anxiety seriously after the surgery. I went to a therapist. I started taking SSRIs (worked, but introduced more severe side effects). I tried alternative treatments (which didn’t work and made things worse, but that’s another story).
Less than a year after the surgery, I was living in Florida, starting my own business. I was meditating and trying everything I could to outrun my anxiety – to outrun myself, really. Very little of it worked. I ended up getting more and more anxious. I got worse at regulating my moods. I turned to crutches and quick fixes.
The scars remain, and the story is yours to tell.
I don’t know what I expected to get from writing about pectus excavatum. Maybe it was about anxiety. Maybe it was about something I haven’t covered in this article, which is otherness. We all have these things – experiences, deformities, heredity – that make us feel like we’re not part of the mainstream or that separates us from the norm. And a lot of it doesn’t fit into a neat box or demographic that can be represented by a special interest group or pandered to as an advertising demographic. They are just there. Things we went through and ways that we survived it. And the scars. The ways that the correction is almost like normal.
Almost normal.
Pain and medicine.
Recovery and patience.
Returning to where it all started.
I’ve heard a lot about bodies the last five years. I’m interested in what people have to say about them, although it seems lately that conversation has been reduced to a set of buzzwords that fit nicely into book blurbs and think pieces. This is my body, and with it have come certain advantages. I’m tall and I’m white and I’m male, and I’ve seen how that impacts the way people perceive and talk to me – usually good, but sometimes bad, too. My heart is pushed over into the center of my chest and back toward my spine, and it will always be that way. The surgery took the pressure off it, but it didn’t move it, and it will never go back. Will my life be shorter? I don’t know, but it’s very possible.
There’s that pain, too. The one I mentioned in my chest. It doesn’t have anything to do with pectus excavatum, but it has everything to do with pectus excavatum. It’s the pain of being in these bodies, and that’s one that we all feel, regardless of what body we’re in. The pain may be in a different place. It may be stronger at one time or another, but it’s there. No one escapes it.
Maybe I’m trying to make more out of what was ultimately just another surgery – Dr. Votteler did tens of thousands of them, and if there’s any response to that, it’s gratitude, like the folks who left messages on his obituary. I am grateful to him. He was a good doctor. He was a great surgeon. And he really cared about people. He cared about children.
Gratitude and survival Guilt and what you can’t control The body you chose and the body you were given Medicine and blood
When I was in my early 20s, I used to play in Adobe Photoshop and make what I thought were art projects, but … weren’t. I was often pretty interested in Dr. Votteler and an article I read about him where he said that “many surgeons will go their entire lives and never encounter conjoined twins.” I have no idea why the quote stuck with other than the fact that it was just a perfectly odd sentence to read that was, nonetheless, true to Votteler’s life. What you are ready for comes to you. If you survive it you are, hopefully, grateful. Votteler was a diligent man and a surgeon of great skill. He handled the odd and the strange, and he did it with compassion and empathy.
Years ago, I overheard a conversation between two family members where one was yearning for a normal life. The reply, from the other (who I often clashed with), came back, “What is normal?”
I’ve thought about that a lot. I used to think I knew what normal was – it was something you strive for. Normal is normal. But now I wonder the same thing – what is normal?
These are my scars, and I’ve written them, poorly and in a disorganized fashion, for you to poke and prod. Do as you will.
