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.