What it was like to watch open-heart surgery (Part 1)

A lot of people have been asking me what it was like watching open-heart surgery. Many of the questions emanate from all-too-human fears that such an experience could be upsetting. There is, after all, the blood. The open chest. The saw.

I won’t lie; I was more than a little bit worried about how I might react. After all, I almost fainted in the doctor’s office once when my son had to have stitches removed from a deep cut in his arm.

But the last thing I wanted to do while I was in cardiac surgeon Brian deGuzman, M.D.‘s operating room yesterday was become a problem for him or his team. So when one of the operating room nurses wheeled a chair up behind me before the procedure began, I took note. And when she warned me that “most people lose it when the surgeon  starts the saw,” I paid attention.

I was not sitting in a room high above the operating theater, separated from the reality of the surgery by a wall of glass, like you see in “Grey’s Anatomy.”  I was on the floor in the operating room itself, right behind deGuzman, who is associate chief of cardiovascular surgery at the Heart and Lung Institute at St. Joseph’s Hospital & Medical Center. I was wearing dark blue scrubs. I had a surgical mask over my face, protective eyewear (“which you’ll need in case the blood starts shooting out,” I was told) and a shower cap-style hat over my hair.

Oddly, what bothered me most was the surgical mask and eyewear. It was claustrophobic, and my eyewear kept fogging up with each breath I took. I had to do some serious talking to myself about settling down and staying focused on the experience before I finally adjusted to the uncomfortable sensation.

When deGuzman and surgical resident Christina Lovato, M.D., began preparing for that first incision at 11:18am, I trained my eyes on the monitor above my head to my left. Somehow, watching what was taking place two feet in front of me on the overhead monitor gave me the distance I needed to adjust to the experience. I glued my eyes to the screen, taking deep, full breaths as I realized that skin and tissue was being cut, and as some of the tissue was burned away from the sternum to make a clear path for the saw. (The smell of burning flesh takes some getting used to.)

The first whir of the saw was a bit jolting but I quickly became absorbed in what I was seeing. Lovato needed only four seconds to separate the thick bone. “It’s all in the teaching,” deGuzman said, jokingly, clearly proud of his confident, capable student.

I could no longer focus on the screen. I was ready to see the real thing. So I cautiously peeked over deGuzman’s left shoulder,  wide-eyed as I saw the open chest cavity and the beating of the heart.

The surgeons cut away the pericardium (the sac of tissue that contains the heart and major vessels) and there it was: the heart itself. Yellowish, not red as I expected. Pumping away and yet, I knew, not pumping efficiently. There were problems with two valves that open and close between chambers. The valves are supposed to close fully after every attempt the heart makes to push blood forward. But in this heart, two different valves were allowing blood to leak back into the starting chambers because the damaged valves could not fully close. That was forcing the heart to struggle and push even harder. And there were other problems with this heart that caused the patient, a woman, to experience the unsettling symptoms of atrial fibrillation (cardiac arrhythmia).

One by one, with infinite patience and calm, deGuzman tackled each one.

Tomorrow: The view from the anesthesiologist’s chair.

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