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How a Near-Fatal Heart Murmur Changed a Physician’s Outlook

Family medicine physician Dr. Neil Skolnik dismissed symptoms months before he discovered his own heart murmur using his stethoscope in his office. His surgery journey will forever change his perspective on life.

Dr. Neil Skolnik remembers the “soft rumble” he felt in his chest one afternoon in March 2021 while lifting dumbbells, the first murmuring that something was wrong. He was in his office at the time and the dumbbells were a recent purchase to use during his lunch breaks or between meetings and patient appointments—part of a new exercise routine after a long hiatus, inspired to get in better physical shape to improve his immune response during the COVID-19 pandemic.

Dr. Skolnik listened to his own chest with his stethoscope and was surprised that what he heard was a heart murmur. In an essay he wrote for Circulation, an American Heart Association scientific journal, he recounts the moment he recognized this murmur was serious and specifically a diastolic murmur.

He underwent a nine-hour surgery to repair the aneurysm and heart valve, and penned “Gratitude” while recovering in his hospital room. Here, we check in with Dr. Skolnik on how he has continued to recover and his reflections on life after facing his own mortality.

Can you tell me more about the events that led to your surgery?

I lecture on exercise nationally—it has many benefits.  It improves glucose control, decreases your cardiac risk, and, not as well appreciated – strengthens your immune system.  As a doctor during the COVID pandemic, you need to do all you can to avoid getting infected.  You have to be meticulous in your use of PPE, and I figured a little extra exercise for improved immune competency would help as well. It’s late October and I’m doing some curls and exercises when I feel the rumble in my chest. I was two feet from my stethoscope so I picked it up and listened. I expected to hear a wheeze but what I heard was a murmur. A murmur is a sound made by the turbulence of blood flow. Most of us, when running or exercising, because blood moving fast over the cardiac valve have a normal outflow murmur.

As I lifted the stethoscope off my chest though, I realized it wasn’t an outflow murmur. I listened again trying to characterize what I was hearing. I’ve been doing this for over 30 years and it became clear—it sounded like a murmur of an aortic insufficiency (leaky valve). In fact, it was the loudest diastolic murmur I’d ever heard. It was a very weird feeling. Clearly, I needed to get checked out.

It was hard to conceptualize myself as having something very wrong with my health. I was in a state of denial. I didn’t do anything for a few days.

A few days later, I listened again and it was there. I told my wife and she told me I needed to see someone. I talked to one of my partners Dr. Amy Clouse. She saw me right away and confirmed the murmur was there. She also found that I had a wide pulse blood pressure, which indicated a high degree of severity in that the blood flowed in the wrong direction –  back through the leaking valve into the heart rather than forward to the body’s circulation. I saw a cardiologist, Dr. Emanuel Kostacos, later that week and got an echocardiogram and a CT angiogram. The angiogram revealed a very large aortic aneurism. Those are very scary because they are often silent and present suddenly as they burst open. You can imagine if that happens in your body, the likelihood of survival is low.

I then called Dr. Konstadinos Plestis, who is the head of the Jefferson Aortic Center. He told me based on all the different parameters, the likelihood of it rupturing over the next year was 12%. His recommendation was for it to be repaired as soon as possible. The next two weeks were really scary for me.

In retrospect, I was so fortunate. I better appreciate that the experience of surgery is two-fold—the actual surgery and then the aftercare – both in the hospital and in follow-up. As a doctor, I have always emphasized competency but now I understand how important niceness is. Nurses helped me take my first steps the evening after my surgery. It is so important to be around people who nicely push you to be your best. I couldn’t take a step without a nurse on either side of me. The steps were thoroughly exciting.

I was in the hospital for five days, wrote that piece two or three days after surgery.

You were still recovering in the hospital when you wrote your essay “Gratitude” and looking forward to going home and resuming your normal life. How have you been feeling since?

For a while, it feels like you are clawing to regain ground to get better. It was really tough. My wife, Alison, supported me every step of my recovery.

At this point, I’m back to working full-time with a fairly hectic schedule. I’m waking up in the morning at 5:30 am to have my cup of coffee before heading down to the basement to do the elliptical for an hour, four to five days a week. Afterward, I work out with some light weights for 10-15 minutes before I head back up to shower and get ready to go to work.

Your connection to Keats and his poetry you describe in your essay is particularly tender. In your essay, you reflect on Keats and how he self-diagnosed the tuberculosis that wound up killing him in 1821.

I’ve always loved poetry. I just love the taste of words and the feelings that words inspire. Words affect us. Words are very important. I studied poetry for many years—both in college, where I was the editor of the literary arts magazine and then afterward at various writing conferences I’ve attended.

I thought of Keat’s while I was recovering, particularly the line, “When I have thoughts that I may cease to be….”.  I also thought of other poems, some by Robert Frost, and a poem by William Henry Ernst. I wasn’t familiar with Ernst’s poetry until a medical student two years ago shared his poem “Invictus” with our team at the end of rounds. There’s a verse at the end of the poem that goes, “I am the master of my fate, I am the captain of my soul.” I started whispering that poem to myself as I pushed to walk further and further outside in the weeks and months after surgery. The poem was a source of strength. At the same time as I was walking and repeating that poem to myself, I also thought a lot about how much of life is out of our hands — that we aren’t actually the masters of our fate. And yet, if we put our mind to it, within boundaries imposed by life and circumstance, we can have a large effect on what happens to us as well as how we feel about it.

The COVID-19 pandemic has been an extraordinarily stressful and traumatic period. You were able to find immense gratitude though for living in the age in which you are living and discuss that some days, you just need to look at what’s right in the world. How is your outlook on life these days?

There is a new wonder in everything—almost childlike. There was a day recently when I was driving into work, for what was shaping up to be a busy day on hospital service, and I was really looking forward to working with our family medicine residents and seeing patients. Then it struck me. Prior to my surgery, I might not have had this same sense of joy going into a busy day in the hospital. Now, I am regularly overcome with gratitude for the opportunity to show up and work with my residents and help people.

I walk outside and I’m happy to see the sky. I feel particularly lucky because it’s the second time in a decade that I’ve come near death and escaped it.

Dr. Neil Skolnik setting up to fish on the ice surrounded by snow

At the end of February, ten years ago, my son and I were ice fishing about three miles out on a deserted lake near the Canadian border. I heard a loud crack and the ice dropped out from under us.  We were both now in a large hole that had opened up in the middle of the lake in over twenty-five foot of water. We were weighed down by heavy boots and bulky winter gear. It was hard to process what happened. I was floating, surrounded by gray ice and the water. There was a light snow.

I went to push myself up out of the cold water onto the ice when the ledge of ice I was pushing on broke off and I was again bobbing up and down in the water.  I knew I only had about four minutes to get out before hypothermia would set in and my muscles would stop responding. My son had the wisdom, a few weeks before, to make sure we watched some videos of how to get out of ice if you fall through. He got out right away because he remembered that you needed to slide out of the water onto the ice, almost like a seal, instead of pushing yourself up, which only breaks the ice on the thin edge where you just pushed with all your weight.  I then remembered as well, gave two quick breast strokes to gather momentum, and slide up onto the ice.

We then crawled far enough away from the hole to where we could stand safely and walk.  The outer layer of our coats began to freeze and the water on my beard turned to ice as we made our way to the nearest road on the side of the lake and hitched a ride back to our truck.

You grow a lot through these types of experiences. You realize how precious life is, how tenuous. I’ve never really been bothered by small things, but they bother me even less now.  I have been left with a sustained sense of gratitude. I wake every day. I take a deep breath.  Then I move forward with the conviction that each day is a gift to be cherished.

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