I try to calm my racing heart as I push through the breaking waves of the San Francisco Bay. The ocean is more rough than the forecast predicted and each breath I take is full of fishy saltwater. I begin to choke and flail my arms, feeling the increasing weight of my tired limbs as the shore of San Francisco shrinks away.
As a cold fear began to grip my arms, I heard, “Lilli! How fun is this, these waves are gnarly!” Dave Yacubian is calling out to me while calmly backstroking through the water, as if he is floating in a bathtub. Yacubian is a father, National Outdoor Leadership School (NOLS) instructor, open-water swimmer and no stranger to navigating chaos. Yacubian’s newest challenge is scheduling an open-heart surgery to replace his aortic valve.
Throughout his entire life, Yacubian has always been active. Kayak guiding and working as a NOLS instructor were just a few of the things that gave him both joy and purpose. After seriously injuring his back in his mid-20s, Yacubian could no longer be a kayak guide, go backpacking or teach people what he found important in the outdoors.
“I think it impacted my identity because I was trying to rediscover if there are things that I find that bring me a lot of joy then how can I pivot and that was really a struggle,” Yacubian said.
He pivoted to open-water swimming, a low-impact sport that allowed him to be active. Soon after he started, he was diagnosed with a bicuspid aortic valve (BAV). BAV is the most common congenital heart defect according to cardiologists at the University of Athens. This change leads to increased shear stress of the heart and stenosis, or narrowing of the valve that restricts blood flow to the heart — leading to risks of fainting, shortness of breath and even heart failure.
One day, in 2017, Yacubian was competing in the Alcatraz Triathlon. Suddenly, he almost passed out mid-competition. After taking a stress test later in the year, Yacubian’s doctor decided that surgery in the next six months to a year was necessary and in the meantime he would have to slow down even further. He had the procedure done in January 2019.
“I was still doing the things I like to do,” Yacubian said. “The [doctor] told me that he wouldn’t be my doctor anymore if I didn’t slow down.” This led Yacubian to decide what procedure would be best for him.
Trying to find the right doctor and procedure proved to be incredibly difficult. Yacubian went to UCSF, USC and Stanford, meeting with top cardiologists and surgeons and hearing different opinions every time. “It was kind of confusing to have three different people saying three different things,” Yacubian emphasized.
Yacubian eventually chose the surgical option that would best suit his love for outdoor sports. He settled on a doctor at Stanford, who inserted a bioprosthetic aortic valve, a synthetic heart valve, according to doctors at the University of Colorado, which — at the time — seemed like the best option. Unlike other valve options, such as a mechanical valve, bioprosthetic aortic valves do not require constant use of anti-coagulant blood thinners, which appealed to Yacubian as he often found himself in the remote backcountry on NOLS trips or in the San Francisco Bay on a swim where a cut could be deadly. Now, nearly seven years later, Yacubian faces this process again.
Soon after a stress test — a noninvasive, exercise-based procedure to diagnose patients with suspected heart disease, according to the Department of Cardiac, Thoracic, and Vascular Sciences of the University of Padua — Yacubian began to start feeling weak during exercise again. Yacubian was told that his heart rate could not exceed 125 beats per minute, meaning that his heart could not withstand the pressure of high-intensity exercise.
“The challenge for me is, if I want to swim longer, like go around Alcatraz or something like that, I'm trying to swim harder,” Yacubian said. The bioprosthetic valve from 2019 wore down faster than the doctors predicted and was too narrow for Yacubian’s body. In the next couple months Yacubian must decide on where to go for his second open-heart surgery. The only thing Yacubian can control is the decision and how he prepares for the procedure.
After the stress test and warning about his degraded valve, Yacubian began to start hyperanalyzing his heart rate, wearing a watch to check during long swims and whenever he was active. For now, Yacubian has been avoiding longer swims and conditions where the waves are too big, and the current is stronger than usual in order to keep his heart rate in the recommended range. “I don’t want to do that for the rest of my life,” Yacubian emphasized.
Yacubian attempts to control the little that he can, whether it is his heart rate even if it is just choosing the doctor.
Yacubian’s child is starting college in the fall on the East Coast and Yacubian wants to be a support for them without still being in the recovery stage of the surgery or still worried about stressing his heart. Finding a time for this while still allowing time to make a decision has been weighing on him.
Hearing different opinions from professionals, and being expected to both digest and then make a decision was an incredibly isolating and overwhelming experience for Yacubian, and is not uncommon for patients. Trying to weigh the different options, Yacubian also talks with friends and does his own research, but notes how he feels entrenched: “I get too much in my head if I’m reading stuff,” he said.
While Yacubian balances the chaos of finding the right doctor and time for his surgery, he has come to realize that there will always be unknowns. When I asked about how he mentally prepares for a surgery like this, he answered with “it starts with [the] sort of acceptance of there’s degrees of challenges in life and it’s not a small deal.”
“It starts with [the] sort of acceptance of there’s degrees of challenges in life and it’s not a small deal.”
As Yacubian has risen to the challenge of long open-water swims, leading remote trips for NOLS, being a single father to two, where disorder is inevitable, there is an understanding that even the most thought-out plan will have holes. While in the face of uncertainty it is easy to want to grab for the few things that make us feel more confident in our path ahead, Yacubian encourages people to be brave.
“It’s being comfortable with the unknowns,” said Yacubian.