EVERY BEAT OF HER HEART

Next door to the rehabilitation hospital that I managed a few years ago in south Florida was a heart hospital. The heart hospital was built a couple of years after my hospital opened. An indoor bridge separated my office from Dr. Smith's, the chief cardiac surgeon. Dr. Smith was originally from Dallas. I had lived there for many years before moving to south Florida, so we had something in common and instantly became friends. He had a lot of time on his hands, as the heart hospital was rarely at capacity. Seven hospitals within a 15-mile radius also had state-of-the-art cardiac programs, each touting theirs as the best in South Florida. At one time, there was an agreement between hospitals that they would specialize in different areas of medicine. Hospital administrations soon discovered the significant revenue from cardiac procedures and started their own heart hospitals. Subsequently, many cardiac beds stayed empty. Although cardiac surgeons are paid handsomely, they maintain their skills by performing surgeries.  

Dr. Smith received his training under Dr. Denton Cooley at the Texas Heart Institute. Dr. Smith once confessed, "I'll tell you a secret. Heart transplants are very easy to do." I responded, "Oh, that's great news! I know a few people without hearts who could really use one!"

He invited me to observe heart surgery on an older woman who needed a coronary artery bypass graft (CABG). CABGs are performed on nearly 500,000 Americans each year. The operation extends one's life and improves the quality of whatever time is left.

Each step of heart surgery is planned and executed precisely, like watching a ballet with every dancer performing their part in perfect accuracy.

A part of a vein from the patient's leg was removed, although he could use veins from the chest or wrist to replace clogged arteries. Dr. Smith stepped on a stool above her chest with his hands folded and prayed. The scene was reminiscent of a priest or minister preparing for communion. Dr. Smith shared with me later that he felt humbled by his role as a surgeon and believed his hands were instruments of God.

As soon as Dr. Smith finished praying, he looked at me to ensure I was not fainting. On the contrary, I was fascinated by what had already transpired. He cracked her chest open within a few minutes, exposing her heart. The cardiopulmonary bypass machine began with a mere nod of Dr. Smith's head toward the cardiac anesthesiologist. The bypass machine acts as the heart and lungs of a patient to keep blood and oxygen circulating in the body. The organ was temporarily stopped by using chemicals and hypothermia (cold).

One minute her heart was beating, and then it stopped. Dr. Smith literally had the patient's life in his hands. Yet, he was utterly unfazed. His many years of experience enabled him to perform his part with perfection. Within minutes, he replaced the clogged artery with a portion of the vein from the leg. Periodically, he would look at me to make sure I was okay. What he saw were eyes the size of saucers. He didn't see a big grin stretching across my face as the surgical mask covered it. After he made the final stitch, the machine stopped. He lightly massaged her heart until it began beating again.

The patient fully recovered to live a few more years. Dr. Smith eventually became concerned that he would lose his skills because of performing too few surgeries, so he moved to South Carolina, where he enjoyed doing many more heart surgeries.

There is now a minimally invasive CABG procedure with no cardiopulmonary bypass machine needed. In the surgeons experienced with this technique, the long-term outcomes are comparable, and the recovery is quicker. Some surgeons are using robotic-assisted methods for heart surgeries, thus offering more precise techniques and less opportunity for infections. Only some patients qualify for the newer procedures.

One of the side effects in 20 to 40 percent of heart surgery patients is depression. The incidence of depression is less in those who have had minimally invasive CABG. Research has shown a high incidence of sleep disturbance and nightmares following heart surgery. Those with the minimally invasive CABG don't have the pain associated with their chest cracked open and aren't under general anesthesia as long as their sleep patterns aren't impacted. Sleep deprivation has been shown to contribute to depression. Ask any mother of a newborn baby about what lack of sleep does to her mental state!

I've wondered over the years about people who save lives like Dr. Smith; yet remain humbled by the gift God has given them. The rare combination of talent and humbleness makes you feel you are in the presence of greatness when you are around them. I feel honored that our paths crossed at one time.