As many of us reflect on the recent death of Robin Williams, the gifted comedian, actor, husband and father of three, much of the focus in the media this week has been on the issues of depression, substance abuse, addiction and suicide.  It was refreshing to hear some of the commentators talk about depression as a “brain disease” and not use the term “mental illness” as much as might be expected.

One of the aspects mentioned in reviewing Williams’ history was the issue of his heart surgery (a bovine aortic valve replacement) in 2009 and whether depression after this procedure was part of the reason why he may have taken his own life.  In the early part of my career, I helped develop inpatient cardiac rehabilitation programs, where patients were transferred from the cardiac surgery floor to the inpatient rehabilitation unit or hospital, often within four days of the cardiac event, whether it was coronary artery bypass surgery, valve replacements, peripheral bypass procedures or myocardial infarction.  Many of the patients had temporary cognitive deficits (“pumphead”) due to low cerebral perfusion during the time on the bypass machine.  Mood adjustment issues including anxiety and depression were common.

More recent studies have shown that the risk for developing depression and/or anxiety after cardiac surgery may be as high as 40%, and the effects can last for many years.  While this likely is not the major reason for the events leading up to the tragic death of Mr. Williams, it does warrant discussion with patients and their families to understand this long-term morbidity issue for cardiac surgery.

As only Mork from Ork could do, he found humor in getting his chest opened up and living with a piece of cow in him.  His friendly advice to those undergoing heart surgery?  “First thing to come back online, your heart ... Great.  And then your brain.  Last thing ... Rectum.  The drugs make you so constipated, I thought they were gonna have to bring in a priest to do a rectal exorcism.  The power of fiber compels you!”

We lost a legend this week.  But, hopefully, his death brings much needed awareness to millions more, so they may avoid the same fate.


Stuart J. Glassman, MD

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Liked your essay this week.