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.


One response to “What matters in surgery

  1. EXCELLENT. Can’t wait to hear more tomorrow!

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