The Amazing Story of John Zerbini

The old adage of, “a promise is a promise” does not seem to hold much weight anymore.  Friends, significant others, professionals and politicians all seem to make promises they can never keep.  However, in the case of John Zerbini, 36, a promise was the only hope he had to relieve the unrelenting pain he had been struggling to live with for the past 6 years. 

By all outward appearances John was the American dream.  A husband, a father and the owner of a multi-million dollar home remodeling business, he had put his life into his family and his work.  But in 2005, when a congenital defect in his heart began to surface, everything changed.  Since 2005 John has spent most of his life in and out of hospital beds, a far cry from the roofs and scaffoldings he was used to.  John suffers from Angina, a condition which causes constant radiating pain, as well as a number of coronary defects and vascular deficiencies.  In an attempt to correct these defects John underwent a staggering number of surgeries, including, 22 cardiac catheterizations, 13 stent placements, the insertion of an internal monitor for his heart, the insertion of a pacemaker, 2 separate cardiac bypasses and 3 open heart surgeries.  With each surgery the risks grew of puncturing one of his arteries and surgeons became increasingly reluctant to operate on John when during one of these surgeries John’s heart stopped and he was clinically dead for several minutes.  Even after what were declared successful surgeries, vascular constrictions due to congenital defects and coronary insufficiencies have crushed all of the catheters and stents implanted and rendered them useless. 

Desperate to find relief from his pain he even underwent a Transmyocardial Revascularization, a radical procedure in which lasers are used to sear artificial holes into the heart muscle in an effort to increase the supply of oxygen to the heart and relieve Angina.  However, none of this seemed to relieve the unremitting pain John felt.  “I had seen every doctor you could think of, Dr. Moses at Columbia Presbyterian, the cardiac team at Mt. Sinai, even Dr. Oz and none of them could seem to help me.”  John had also spoken to several doctors about a complete heart transplant but he was told that he would have to wait at least 10 years.  Furthermore, doctors at the Robert Wood Johnson hospital refused to perform a transplant because of the extreme risk of complications and death that his conditions posed.  John, who had spent years as a Paramedic saving the lives of others, now needed his own life saved.

John’s only relief seem to come from the plethora of narcotics he was prescribed.  None of these pills offered a cure, but simply a way to partially numb his constant pain.  However, as has been well documented, these narcotics all have side effects of their own and combined with the mental effects of constant pain, often lead to severe depression.  John was reluctant to be on such high doses of medication and was perpetually concerned about the effects these narcotics and opiates were having on his body.  John recalls, “When I would go to the Emergency Room and tell the doctors about what medication I was on, they could not believe other doctors were prescribing such high doses.” 

John was told that this was as good as his quality of life would get and that his heart would eventually just give out and there was nothing more the doctors could do.  This was a grim and morbid prognosis for a 36 year old man, but one John would not accept.  “I refused to believe that,” says John, “I told myself that I would be around for my son and that I would not leave him.”

In the midst of his plight, his business was deteriorating as well.  Due to his condition he was no longer able to work and monitor the business he had spent his life building.  “While I was in the hospital having open heart surgeries, I was being robbed by my General Manager and the business was wiped out.”  Now, at his most vulnerable, John had lost his health, his livelihood, the business he built and his wealth.

John’s family life also suffered the consequences of his constant pain and hospitalization, “This has killed my family financially and put a huge strain on my marriage”.  John’s son Giovanni, 7, has watched his father’s condition wane. “It has been very tough on them to see me go through all the surgeries and the paramedics rushing to the house in the middle of the night.” John says.

John’s life seemed to be crumbling around him, an odd metaphor for a man who had spent his life rebuilding things that were broken for others.  He now found himself disabled, in constant pain and his insurance would no longer cover his procedures.  “I used to be big into fitness and I was in great shape at 5’11 and 285lbs.  I used to work out everyday and train with some of the big names in fitness.  Now, I can barely make it up a flight of stairs.” John was a shell of the man who he remembered. 

Desperate to regain his life and his pride, he was referred to Dr. Richard A Kaul at New Jersey Spine and Rehabilitation.  The two met in November of 2010.  “The first thing Dr. Kaul said to me was ‘I promise you, I will do whatever it takes to alleviate your pain’.  That meant more to me than anything any other doctor had told me.” 

Dr. Richard A Kaul is a Minimally Invasive Spinal Surgeon and has been  pioneering this field for almost a decade.  A spinal surgeon may have seemed like a peculiar course of treatment for someone who was suffering coronary deficiencies.  However, Dr. Kaul came up with the radical idea of implanting a Spinal Cord Stimulator into John’s spine.  The objective was to suppress the pain signals from John’s spine to his brain using this stimulator. “There is currently no cure for John’s coronary conditions but the least I can do is to relieve his pain while doctors work toward a solution.” says Dr. Kaul.

Nevertheless, there were several factors complicating this procedure.  First and foremost, John already had been implanted with a permanent cardiac pacemaker and the implantation of any secondary electrical device in patients with pre-existing devices is highly debated in the medical world.  The fear is that the electric signals from the spinal device could interfere with the pacemaker and cause an arrhythmia, which can lead to a heart attack or death.  Due to John’s already compromised heart, this concern was especially real. 

Yet, there was still another obstacle to surmount. John’s insurance denied to cover anymore procedures and he had no means to afford any further procedures on his own.  Regardless, Dr. Kaul again promised John that his insurance status would not matter and that he would find a way.  Dr. Kaul then elected John as a candidate for a spinal cord stimulator trial. 

Still, before any implantations were made, multiple tests had to be conducted to ensure that John’s heart and pacemaker would not be adversely affected by the addition of this device.  After painstaking testing and diagnosing, Dr. Kaul surmised he could safely implant the device without interfering with his pacemaker.

John’s trial surgery day finally came.  Through a tiny incision in John’s back Dr. Kaul guided the stimulating wires into the appropriate areas of the spine.  From there the doctor placed electrodes on the receptive areas of the spine.  These electrodes are what would hopefully block the pain signals from reaching John’s brain.  Tense moments in the surgical center passed as the device was attached and John’s vitals were intensely monitored.  Finally, the device was turned on and it was the moment of truth.  Immediately, John felt its effects and felt a sensation he had not felt in years, nothing.  No burning, no tightness, no pain. Nothing. A feeling most take for granted John was ecstatic to feel, a feeling his pain addled body was unaccustomed to after so many years. In the recovery room, John was brimming with confidence and gratitude and was astounded by the immediate results.  Soon though the reality set in that this was only a trial and the implant would be removed in 3 days.

Dr. Kaul found this to be a cruel punishment for a man had endured more pain than most will ever know.  He could not bare the idea of depriving John the opportunity to finally experience permanent relief considering how much he had already lost.   So, the doctor asked Medtronic, the manufacturer of the spinal stimulator, to donate a permanent implant and Medtronic graciously obliged.  In addition, Dr. Kaul would perform the full surgery for free at the NJSR facility in Pompton Lakes, NJ.  “Some of the greatest benefits of operating my own surgical center is that I can make decisions like this without having to go through the bureaucratic hurdles that I would have in a hospital and I can shoulder the financial burden. The positive impact I can have on a patient’s life is ample compensation.” says Dr. Kaul.

With the ever changing landscape of health insurance, it is difficult to determine what procedures, if any, your insurance company will cover.  For many patients, trying to ascertain a firm answer of what their provider will and will not cover is almost impossible.  Many patients elect to have procedures because they simply can no longer wait.  After their procedures in the time they should spend healing they instead spend stress filled hours on the phone with their insurer trying to avoid paying out of pocket for a procedure they believed was covered.  “In John’s case, his insurance status did not matter.  He was a candidate for a trial.  The trial worked for him and relieved his pain.  Why should I then deny him a life changing service that he desperately needs and that could change his life, simply because of a flawed system?” says Dr. Kaul.

So, it was decided that John’s permanent implant surgery would take place on May 23^rd at the NJSR Surgical Center in Pompton Lakes, NJ.  John is optimistic about his future and even states that at 36 he is “still a young man”.  He has no intention of spending the next few years like he has spent the last few years, bed-ridden and in agony.  “I would like to get back in shape and have fun.  I have not left my house aside from hospital visits in over four years and I have not been able to play with my son in four years.” he says.

John also plans to repair the financial damage that these conditions have produced over the past 4 years, “I hope to get off disability and rebuild my business, because if you know how to do it once, you know how to do it again.” 

John’s unrelenting optimism has been a source for inspiration for all of those he has encountered, “Most people would have simply given up by now.  The stresses, the pain and the fruitless surgeries John has endured are nothing short of amazing.  oHowhOHO However, despite all of this, John’s sense of humor and humility has remained intact.  I consider it a privilege to help him regain his life in any way I can and I hope that the course of treatment I provide allows him to regain some semblance of the professional and family life he once had.” says Dr. Kaul.

John already has big plans for his life after the surgery.  Yet he still knows which are the most important ones, “Have fun and enjoy my life, especially my wife and family and to repay Dr. Kaul in some way for giving me my life back”.  However, that may be the beauty of a promise, it has no price tag.