Category Archives: Open heart surgery

Ethiopia – Yet another coincidence

Many times in the two years since I first met Brian and Keri deGuzman, I’ve been astonished by the connections and coincidences that have sprung from their journey to build a family through international adoption.

I wrote about one of those “Oh, my gosh!” moments yesterday, when I described the surprise that awaited the deGuzmans as they exited the courtroom where their new youngest children’s adoptions had just been finalized.

There has been a new development since I posted yesterday’s blog: I got an email from the deputy county attorney who handled the case, Janina Walters.

“I wanted to write to let you know of an additional interesting tidbit of information about yesterday’s adoptions,” she wrote. “When I came back to the office, I saw the [December] magazine and read the whole article. I had not seen it before. Weird, since it is what I usually pick up at the doctor’s office!

“I knew Dr. deGuzman was at St. Joe’s and something was niggling in the back of my mind. I read the article and the connection with Dr. [Lishan] Aklog and all of a sudden it hit me! My stepfather (who is more like a real dad) had valve-replacement surgery about three years ago. Dr. deGuzman stepped in at the last minute to perform the surgery on my dad and his aftercare was with Dr. Aklog, with whom  I discussed my dad’s recovery.

“At the time, my mom and dad were telling me about the deGuzman story and their adoptions as well as another surgeon’s in the same group. They asked me if I had handled their adoptions because they knew the family had gone through our office.

“My parents were tickled when I told them that I had met the family and handled the adoption hearing. I found your blog and my dad sat and read it with a huge smile on his face. He couldn’t tell me enough about how nice, patient and warm Dr. deGuzman was to him.”

Janina closed her email by asking if we had an extra copy of the December magazine story so her parents could see it.

It will be my great pleasure to send her one.

In heartfelt company

I spent Saturday morning in a room full of broken hearts. Some were beating a lot faster than they should have been. Some were being monitored electronically. And some were beating only with the help of a pacemaker.

It was two days before Valentine’s Day, and I had taken my mom to a heart symposium at St. Joseph’s Hospital & Medical Center. The topic was atrial fibrillation, something my mom has experienced for herself. (Her husband and I experienced it too, one Saturday morning when I was visiting them in Green Valley. One second Mom was stirring oatmeal at the stove and the next she had fallen over backwards in a dead faint, whacking her head on the tile floor near my feet.)

Atrial Fibrillation (also called AF or AFib) is a common heart rhythm disorder caused by rapid and uncoordinated conduction of electrical impulses from the upper chambers of the heart, according to materials created for the session, which was conducted by physicians from the Heart & Lung Institute at St. Joe’s. AFib affects more than two million people in the U.S. and is a leading cause of stroke. It can also lead to early heart failure and the need for a pacemaker if not properly treated.

My mom’s first indication that she had heart disease occurred one fall a few years ago, when she and her husband were driving from Arizona to Pennsylvania. She didn’t know that her fatigue, swollen ankles and difficulty breathing were related to her heart. When she got home and reported the symptoms to her doctor, she was immediately hospitalized for congestive heart failure. Some time later, she underwent a catheter ablation procedure to stop the wildly firing electrical signals in the left atrium of her heart. Since then she has been been relatively symptom-free and can take aspirin (not the rat poison Coumadin, which is commonly prescribed) to keep her blood thin enough to prevent formation of a clot that could travel to her brain and cause a stroke.

While my mom’s heart condition is stable, it was sobering to learn during the Saturday session that the catheter ablation procedure is not a definitive cure for AFib. At some point she may have to consider other options.

It was jaw-dropping amazing to listen to cardiac electrophysiologist Wilber W. Su, M.D. describe the cryoballoon procedure he can do to cure some types of AFib. (Su was the primary investigator on a device that was just approved last Christmas. The Heart & Lung Institute is now the only site in Arizona where this minimally invasive procedure can be done.)

Then cardiac surgeon Lishan Aklog, M.D., director of The Cardiovascular Center at the Heart & Lung Institute, described surgical cures for AFib that were unheard of as recently as six years ago.

In January, during research for an independent writing project, I witnessed one of those procedures during a six-hour open-heart surgery. Brian deGuzman, M.D., associate chief of cardiovascular surgery at the Heart & Lung Institute, invited me to observe a complicated surgery that included an open maze procedure, in which calculated burns are made to the upper chambers of the heart to block the scattergun effect of uncontrolled electrical signals and channel them through a “maze” that helps them more efficiently signal the ventricle to contract.

My mom and I left the heart symposium inspired and grateful for the opportunity to have a greater understanding of AFib and the cutting-edge options that are available to her should she need them. We both thought sharing that educational journey was a perfect way to say  “I love you.”

For information about the Atrial Fibrillation Clinic at St. Joe’s, call 602-406-2651 or email info@atrialfibclinic.com.

How to sell a book: Step 1? Be famous.

In late January I signed up to take a Writer’s Digest webinar called “3 Secrets to Selling Your Nonfiction Book.” A few days after I paid for the session, I was invited to observe an open heart surgery scheduled the same day at St. Joseph’s Hospital & Medical Center.

It wasn’t a tough choice. The chance to stand in the operating room watching cardiac surgeon Brian deGuzman, M.D. do a double valve repair and maze procedure on a 60-year-old Valley wife and mom was a once-in-lifetime opportunity and an experience I will never forget. (Find related blog posts here.)

At one point during the six-hour surgery, Brian looked up at me and said, “Bet you thought I was kidding about all this heart surgery stuff!” It was certainly a different look at his life. Six months earlier, I was riding around Ethiopia in a white Toyota Land Cruiser with deGuzman and his wife Keri, who had just adopted their two youngest children. (I wrote about that experience, “An Ethiopian Adoption Story,” for our December magazine.)

I knew the audio transcript of the webinar would be available after the event, but it wasn’t until this past weekend that I found time to listen to it.

Continue reading

What I learned watching open-heart surgery

When I was driving home from St. Joseph’s Hospital & Medical Center last Thursday night, it started to hit me.

As I walked into the kitchen and my husband asked, “How did it go?” I started to tell him. And then I lost it. The significance of what I’d witnessed that day finally sank in. And I couldn’t stop crying.

I’d seen the inside of a woman’s chest: the flesh beneath her skin, her breastbone, her beating heart. I’d seen her life systems overtaken by a machine and tubes of her blood running past me on the floor behind her surgeon. I’d stood inches from her head as I watched two delicate procedures to repair faulty valves in her heart — and as her breastbone was carefully stitched back together with a C-shaped hook and some wire, then fortified by several Titanium plates.

I’d seen two surgeons stand over their patient for six hours straight–no water, no food, no bathroom breaks. Only the rare shrug of shoulders indicated any sign of fatigue.

I’d seen the most intense kind of job-related stress. The pressure on this surgical team, led by Brian deGuzman, M.D., was  crushing. For several hours, their patient was, in effect, dead. There were so many times, so many places where something could have gone wrong. And yet there was never a sense of tension in the operating room, never a sharp word, never an expression of frustration that made anyone else feel uncomfortable.

I’d seen that people who have the highest expectations and standards of care can accomplish miracles. And crack jokes doing it. That a surgeon can hold someone’s life in his hands while humming along to a country western radio station.

I’d seen the purest form of teamwork, when two surgeons, an anesthesiologist, a perfusionist and three nurses were so singularly focused on a good outcome for their patient that the execution of their respective tasks looked like a beautiful and meticulously choreographed dance.

I worry about a lot of things involved in running my business and sometimes even allow myself an indulgent moment of self-pity when times are tough. But at the end of the day, no one dies if I make a mistake or have a bad day.

So I learned something watching open-heart surgery. I saw standards I should strive to emulate, patience I should try to find, focus that surpasses personal comfort, purpose that transcends nerves or fear and confidence that emanates from careful preparation — and a team of people who have your back.

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In the doctors' lounge with Christina Lovato, M.D., the surgical resident who assistant cardiac surgeon Brian deGuzman during the surgery I watched.

I can’t begin to express my gratitude to Brian deGuzman, M.D., his staff, his surgical team (including anesthesiologist George Gellert, M.D., perfusionist Barry Steinbock and surgical resident Chrstina Lovato, M.D.) and all of the other wonderful people at St. Joseph’s Hospital & Medical Center who made this opportunity possible for me, looked after me, explained things to me and gave me an amazing experience I will remember for the rest of my life.

What it was like to watch open-heart surgery (Part 4)

I guess I watch too many medical shows on TV. But I was expecting something a little more dramatic.

When cardiac surgeon Brian deGuzman, M.D. finished repairing two damaged valves during an open heart surgery I watched at St. Joseph’s Hospital & Medical Center last week it was time to give the repaired heart a test drive. The intricate network of cannulae (tubes) that had been set up to detour the patient’s blood away from the heart during surgery were reconfigured and perfusionist Barry Steinbock gradually sent warm, freshly oxygenated blood back into the heart, which had been in a state of suspended animation throughout the delicate repairs. (To give you an idea just how precise his movements must be, deGuzman at one point told me, “One stitch too deep and she’s on a pacemaker.”)

I was expecting paddles, someone calling, “Clear!” and an electrical shock to restart the heart.

Instead, as I was waiting around for that dramatic moment, the 60-year-old woman’s warming heart quietly welcomed the resurgent lifeblood. Almost imperceptibly, anticlimactically, it slowly started beating.

“Hey!” I said to Steinbock in disbelief. “Her heart is beating!”

Though his mouth was hidden by a surgical mask, I could tell from his eyes that he was smiling indulgently. “That’s usually what happens,” he said. “It usually starts beating again on its own.”

Proving once again that the quiet miracles are the most profound.

What it was like to watch open-heart surgery (Part 3)

You can’t repair a leaky heart valve when the blood is constantly pulsing through the chambers. So the heart has to be immobilized. Put in a state of suspended animation. Stopped.

It happens soon after the patient has been safely connected to the heart-lung machine, which will take over the work of these two vital organs by pushing blood through the patient’s circulatory system, oxygenating it upon each return to the body, so the surgeon can work on the no-longer-beating heart.

The perfusionist has the dubious honor of stopping the heart by injecting a potassium solution into the web of tubing that returns blood to the body. The process is eerily similar to that of execution by lethal injection. The anesthesiologist already has put the patient into a deep sleep and administered a paralyzing agent. The perfusionist strikes the final blow by effectively killing the heart as the potassium solution interrupts the electrical signaling essential to its functioning.

“The patient literally is dead [at this point],” anesthesiologist George Gellert, M.D., told me. “That’s the kind of pressure these guys are under.”

It happens very quickly. I watched the patient’s heart beating one moment and deflating like a popped balloon the next. Icy slush was packed around the heart; the colder it stayed for the next few hours, the less oxygen it would require to remain viable. The rest of the body would be kept warm and constantly replenished with freshly oxygenated blood, courtesy of the heart-lung machine.

“Nighty, night, Mr. Heart,” someone said.

Tomorrow: A quiet return to life.

What it was like to watch open-heart surgery (Part 2)

Anesthesiologist George Gellert, M.D. describes the pressures of cardiac surgery like this: “It’s like you’re a pilot flying an airplane into a tunnel — a very dark tunnel. You can’t see a thing but you just keep going, hoping the tunnel is straight.”

He told me this as I stood in his area of the operating room at St. Joseph’s Hospital & Medical Center during a six-hour, open-heart, double valve-repair surgery performed last Thursday by Brian deGuzman, M.D., associate chief of cardiovascular surgery at the hospital’s Heart & Lung Institute.

The patient was stable, the surgery was proceeding as planned and, at least for the time being, Gellert was watching and waiting.

So he invited me to join him in his space, a tiny cave created from walls of technical equipment encircling the patient’s head. He explained the role of the cardiac anesthesiologist, whose job it is to put the patient to sleep, block pain and paralyze the muscles of the body so the patient doesn’t move during highly precise procedures required of the surgical team. He drew pictures on my notebook to help me understand exactly what deGuzman was doing to repair this particular damaged heart. He showed me all the monitoring equipment he must watch during surgery — and what the red, blue, green and turquoise lines told him about how well the patient was tolerating the procedure.

He also showed me the monitor for a new echocardiography system that captures 3D images of the heart. St. Joseph’s was the first Arizona hospital to use the groundbreaking Siemens technology in open heart surgery. It uses ultrasound to measure the height, width, depth and motion of the heart to collect multiple two-dimensional images which, in seconds, can create a three-dimensional image on a computer screen, allowing surgeons to view the heart’s function and flow velocity through a clear, 3D image.

Gellert is an expert at interpreting this imagery; several times during the surgery deGuzman conferred with him to discuss a particular aspect of this heart’s unique anatomical features before taking his next steps.

At one point, Gellert allowed me to stand on a small stepstool by the top of the patient’s head, where I could peek over an angled curtain shield and peer into the open cavity of her chest, watching the intricate repairs deGuzman was making to the first of two faulty valves he would repair that day. I stood transfixed for more than an hour, not even flinching when a forceful spray of blood shot out suddenly, leaving both deGuzman and surgical resident Christina Lovato, M.D., covered with bright red spatters.

It wasn’t until I looked straight down, on my side of the curtain, that I started to feel weak. The soft white curls of the patient’s hair were just inches away. I could see patches attached to her smooth forehead like big white, green-dotted band-aids. (The patches, Gellert explained, held monitors in place to track the patient’s brain activity.) I could see that this woman, not so very much older than I am, had beautiful skin. And a peacefulness about her eyes. It made me think about her family waiting anxiously in a lounge not far away. For a few, concentrated moments, I focused my thoughts on this woman, this wife, this mother. You are in wonderful hands. Your surgeon is extremely skilled. I wish you could see how gently, how reverently, he holds your heart. All of these extraordinary people are watching out for you. You will be okay.

Every once in awhile, deGuzman would say something and Gellert would reach past me to make some sort of adjustment to his equipment. It all seemed very routine; I knew, of course, it was anything but that.

No matter how well prepared the medical team, no matter how many tests are done beforehand, unexpected things can happen in surgery.  So the surgeon relies on the skills of the team of people around him, whose job it is to keep the patient stable and help anticipate any problems.

Because the tunnel isn’t always straight.