Tag Archives: Heart

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.

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.

What matters in surgery

A very worried husband and his two adult daughters are breathing a little bit easier tonight.

Their loved one — his wife, their mother — is resting easily in the intensive care unit at St. Joseph’s Hospital & Medical Center following a six-hour surgery to repair two of the valves in her heart.

Their surgeon, Brian deGuzman, M.D., associate chief of cardiovascular surgery at St. Joseph’s Heart and Lung Institute, talked with them at about 6pm in the ICU waiting room. He told them the surgery went pretty much as he’d expected. The patient, who suffered from atrial fibrillation, handled the procedures well. She was breathing on her own — a good sign — though she would remain connected to the ventilator for a few hours as a precaution…”until we’re sure she’s alert enough to protect her own airway.”

The daughters asked questions. What to expect, what risks remained, when they could see their mother. The father just kept saying, “Thank you.” His beloved wife had survived a scary, open-heart surgery. At that moment, nothing else mattered.

I was in the operating room during the entire surgery, so I have a pretty good sense of what else mattered.

It mattered that this family chose a surgeon who is among the top in his field, who practices his gift with the most cutting edge of tools and technologies, who takes as long as it takes to get each step, each suture, absolutely right. (“It needs to be perfect,” he says. “Not good. Perfect.”)  As he did today, he chooses to repair, not replace, damaged valves whenever possible — even though it means the surgery takes much longer — because artificial valves require patients to take blood thinners for the rest of their lives.

It mattered that deGuzman surrounds himself with other professionals who also strive for perfection. Today his team included anesthesiologist George Gellert, M.D. (who is a leading expert in interpreting high-tech 3D echocardiagrams) and perfusionist Barry Steinbock, who orchestrates the functions of dozens of dials, tubes, clamps and medications as the patient’s entire circulatory system is relegated to a heart-lung machine that collects darkened blood, filters it, oxygenates it and returns it to the body, bright red with vitality. (The heart-lung machine is necessary because the entire body is paralyzed during surgery, so the lungs can’t breathe, and the heart also is immobilized in a state of chilled, suspended animation.)

Also on the team: a bright young surgical resident, Christina Lovato, M.D., who assisted deGuzman throughout the surgery. Neither of the doctors left the table even once during the entire six hours.

It mattered, too, that even after the surgical procedures successfully concluded, deGuzman and his team took the extra time and steps to reconnect the patient’s sternum with a series of four titanium plates, screwed firmly into the bone with tiny, Phillips-head screws. Traditionally, cardiac surgeons reconnect the bone by wiring it back together. But wires leave the surgically separated bone a minute margin to shift, which can create discomfort for patients during the recovery period. And besides, titanium is several times stronger.

For patients, that matters.

Tomorrow: More about my experience in the operating room.