Tag Archives: St. Joseph’s Hospital & Medical Center

An Ethiopian adoption story – a chance to hear it told

July 2010: Keri and Solomon.

I’ve heard her tell it dozens of times but I never tire of the story. When Keri deGuzman tells people about the remarkable journey she and her husband, cardiothoracic surgeon Brian deGuzman, M.D., took to adopt their four Ethiopia-born children, she is transformed.

Any pre-event jitters evaporate as soon as she begins to talk. There is no place for discomfort she may feel about public speaking. This isn’t about her. It’s not even about the four beautiful children that she and Brian are raising, though the children are the underpinning for her amazing and still-evolving story.

When Keri speaks, it’s about the millions of other children. The ones who don’t have clean homes and nutritious foods and the chance for meaningful education or productive lives. The orphans of Ethiopia.

Keri will share her Ethiopia adoption story at 10:30am tomorrow (Saturday, April 23) at Scottsdale’s Mustang Library. I’ll be with her, adding what I can about my experience traveling with her and Brian to Ethiopia last summer, when they welcomed their two youngest children, Solomon and Tesfanesh, into their family.

Keri’s four Ethiopia-born children are happy, healthy, thriving — and cherished. The story about how they came into her life is beautiful, uplifting and inspiring. Hearing it will be a perfect kickoff to the Easter weekend.

After flying all night from Addis Ababa, Keri and Brian unite their family at Washington's Dulles International Airport. The two older children, Jesmina and Musse, stayed with Brian's parents, who live in the Washington, D.C. area., while we were in Ethiopia.

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.

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 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.