In the final weeks of cardiothoracic surgeon Mark Malias’ tenure at the Welsh Heart Center, he performed cardiac surgery on one of the oldest patients the center had ever treated.
Today, just three weeks after an artificial valve was non-invasively inserted into her heart, Eleanor Carson, 98, rhapsodizes about the experience as if it had been one of life’s celebrations.
“I have to tell you, I never had such a good time in my life. I had a wonderful time in that hospital,” she said.
Carson had her own guest list in mind for that celebration – and it had to include Malias.
She told her cardiologist, Dr. Brian DeoNarine, she would pass up the procedure if Malias wasn’t the surgeon.
And when the heart center scheduler assigned her surgery with a different doctor saying Malias would be out of town, Carson wouldn’t hear of it. “I said, no, no, no, no, I have got to have Dr. Malias,” said Carson. “I would never badmouth somebody else, but that’s who I wanted.”
DeoNarine was another very intentional pick of Carson’s. Years ago, when she went to the ER needing a pacemaker, she insisted the hospital call him to come treat her. She can still summon up the bellow she used to let the nurses know she meant business. “He doesn’t know me but he treated my husband. I don’t want anyone but Dr. DeoNarine!”
DeoNarine, who is independent and not a part of Cleveland Clinic’s cardiology group, has treated her ever since. He is a supporter of Cleveland Clinic, and very glad to be able to refer patients to their specialists, including Malias. “I’m glad they’re here. I didn’t want to send her to Orlando,” he said.
The surgery Carson’s doctors chose for her, a procedure known as TAVR, started becoming popular five or six years ago, Malias said. It does not require opening the chest; that would be far too perilous for a person of such advanced age. Instead, a pliable tissue valve is inserted into the heart through an artery accessed through “two teeny little cuts that have healed completely,” as Carson explains it.
Today, she has so much more strength that she has to remind herself to notice that she isn’t tired, so accustomed is she to having to collapse in a chair and rest. “I just keep walking and walking and walking. I don’t need to sit down.”
TAVR has vastly improved the final stretch of Eleanor Carson’s life. As she points out, she wasn’t interested in extending her life, she only wanted to improve it.
At 98, Carson’s heart valve problem was something she left to the Lord. But over the years, as her spirit still bubbled with life, her heart was increasingly squeezing in vain, trying to force her blood through an increasingly calcified valve.
At last, her doctor, DeoNarine, hit on a name Carson perked up at – Dr. Malias, the highly regarded cardiothoracic surgeon whose work alongside Dr. Cary Stowe, and with the help of Vero’s extremely generous donors, built the small-town hospital’s heart center into a gem of excellence. That gem caught the eye of Cleveland Clinic when the financially struggling taxpayer-owned hospital sought a partner. The merger took place in January 2019.
Carson didn’t care about all that. In her long life, trained as a nurse and married to a Fort Lauderdale urologist who died in 2005, apart from getting the pacemaker a few years ago, she had never needed care of this magnitude.
DeoNarine, her longtime cardiologist, was after her for years to do something about that balky valve. Carson, who became a born-again Christian in late middle age, insisted she didn’t want to extend her life; she was happy to leave the end point in God’s hands.
But eventually, her fatigue began to worsen, eroding her packed schedule. She had given up being a poll worker in the last election, when she realized the 12-hour election days – she was stationed at Indian River Estates – were just too tiring.
Carson moved into a villa at Florida Baptist Retirement Center, but soon seemed too tired to enjoy much of life. DeoNarine saw an opening. He had already told Carson about TAVR, transcatheter aortic valve replacement, a minimally invasive procedure that would be the only option for someone of her age to improve her heart function.
But it was only when he mentioned Malias that Carson softened. She didn’t know him, but she knew who he was, she said. That reputation meant everything.
If the Lord had a backup guy, it was Malias, she reasoned after just one visit with the surgeon.
Malias joined Indian River’s heart center in 2008, having been recruited by Stowe from Melbourne’s Holmes Regional Medical Center.
Together the two learned the new TAVR technique by training with the makers of the artificial valves and by shadowing surgeons familiar with the procedure. TAVR involves passing a tube, or catheter, through a blood vessel in the groin into the heart until it reaches the calcified valve. The replacement valve is then deposited into position and the catheter retracted.
“We were a little skeptical at first,” said Malias of the procedure. “We were disbelievers, then we were skeptics, then we were like wow, this seems to be working well for patients so we should at least explore it and see for ourselves.”
Now, he is sold on the procedure, particularly for Vero’s significantly older cardiac care patient population. “And I’m a true believer in TAVR for near-centenarians,” said Malias.
“I’ll tell you what: The minute he walked into that room, it was a life-changing experience,” Carson said. “Just his presence, the way he spoke – gentle, kind, professional. He had that confidence that you want to see in a doctor. He walked with the confidence you want your doctor to walk with. It was just amazing to be taken care of by him.”
“It was a tough decision, her being 98 years old, We all prayed about it – me, my wife, Malias,” said DeoNarine. “She’s not just a patient, I consider her my friend. She’s a fantastic person. She sends my kids birthday cards.”
In the moments before the surgery began, the seriousness of the procedure moved even hospital staff to tears, made all the more stirring by the courage and effervescence of Eleanor Carson herself, as she drew the nurses and aides around her to share an eloquent prayer.
“The nurses told me afterwards they were in tears,” Malias said.
“They got me in there, and I just laid myself down on that bed and I put one arm out to the right and one to the left and said, ‘Here I am guys, just go to work,’” she said.
Malias took his place at Carson’s side along with Dr. Mistyann Blue Miller, an interventional cardiologist who has worked frequently with Malias since she joined Cleveland Clinic two years ago.
TAVR requires both an interventional cardiologist like Miller as well as a surgeon like Malias.
After training in Philadelphia and Boston, Miller came to Cleveland Clinic Indian River because two of her mentors were here: Dr. Josh Kieval and Dr. Jay Midwall, both interventional cardiologists who retired from the heart center last year.
Like her patient, Miller too has been moved by Malias’ qualities.
“He really has a presence,” she said. “He’s been a wonderful person to get to know and even more wonderful to work with. He really welcomed me when I came here two years ago, and he’s really helped me grow as a physician here.”
“Being here has really opened my eyes to see how vibrant people can be in their 80s and 90s. And they have a different type of heart disease than someone who’s 60 or 70. You tailor the way you perform your procedures to the community. I think it’s made me a better cardiologist to be exposed to the different population here.”
When Malias and Miller finished up, Carson went back to her room. When she woke up the next morning and showed her doctors she was able to walk with a walker, they let her go home. Friends still help her with her groceries and check on her every afternoon, but she has felt stronger ever since, she says.
“She’s a 100 percent better,” said Dr. DeoNarine, who will continue her care.
While Eleanor Carson wasn’t the oldest person Malias has operated on – he once did surgery on a man who was 100 – her surgery was one of the last for Malias in the Vero hospital. Last Thursday, Malias resigned. He was on call over the weekend and had a follow-up this week. Then after a month of accrued leave, he will be gone. Malias, 58, says he will not be retiring but does not know where he will practice next.
“It’s a heart-breaker,” Carson said of Malias’ departure. She said she worries about who will take over her follow-up care. “I’m concerned about that.”