One Day in the Life of a Heart Surgeon
By DON A. SCHANCHE
Today is Tuesday. Like many
days in the life of Dr. Michael Ellis DeBakey, 72-year-old dean of the world’s
heart surgeons, it had no proper beginning, because yesterday never ended. But if he had to say when it started, he
would choose the emergency call just before midnight.
Monday, 11:55 p.m.: Dr. DeBakey, who had been working
continuously since 4:30a.m. Should be too tired to move. But he half-shrugs the starched white
hospital coat from his angular shoulders, ready to drive to his nearby colonial
home for a short nights’ sleep.
Suddenly the telephone console behind the cluttered desk in his
then-cramped first-floor office at Methodist Hospital in Houston jangles like a
fire alarm. It is the intensive care
unit on the third floor calling.
Guiseppe Caccione, a charity patient from Genoa, Italy, is dying.
Bolting across the halfway,
DeBakey hits the stairwell door with enough force to hurl it to the limit of
its hydraulic spring and takes the steps two at a time. Before the door swings shut, he is on the
third floor, running for Caccione’s bed.
Above the right-hand rail of
the bed, the screen of an electrocardiograph monitor casts a ghostly pallor on
the faces of an intern and a nurse who stare like children at a horror
show. Te chaotic signals on the screen
mean that Caccione’s heart is fibrillating, quivering with imminent death in
its pericardial sac, like a dying animal in a burrow.
Wordlessly, DeBakey
shoulders the intern aside. He grabs
two spoon-like defrillating paddles; trailing wires to an electric console, and
slaps them against the dying man’s bared chest, “Hit it!” he calls to the nurse.
As she presses a switch on
the console, DeBakey looks up at the screen.
Bushy, gray-black eyebrows rise high above his tragic brown eyes—witness
to more human grief than the saddest among us ream of—and send a ripple of
worry lines, like a moving escalator, from his horn-rimmed glasses up the long
arch of his balding brow. For a
deathly-still moment the quivering green scrawl of light on the
electrocardiograph monitor hesitates, like a hummingbird in flight. Suddenly, struck by the jolt from the
electric paddles, it leaps almost off the screen. The it settles into the patterned dance of life, tracing the
normal peaks and valleys of a healthy, pulsating heart. The escalator of wrinkles collapses, and
DeBakey says softly, for the intern’s benefit, “Any doctor who doesn’t feel a
sense of humility at a time like this should not be practicing medicine. We’ve saved his life.”
Perhaps DeBakey is recalling
another incident in this same hospital, nearly ten years ago, when he cried
unashamedly at the foot of a bed as six of his associates tried vainly to
sustain a dying heart. The patient was
Diana Cooper DeBakey, his wife of 35 years; strong, gracious, compassionate
mother of his four sons, and victim, at 62, of a heart attack to massive that,
despite the efforts of the best doctors in the most modern cardiovascular
center in the world, she died.
Tuesday. 12:01a.m, The
surgeon stands at the bedside of the Italian workingman, who has regained
consciousness, smiled in bewilderment over the activity around him and lapsed
into peaceful sleep. DeBakey sights an
almost inaudible, “Okay,” to the nurse, and moves away with a triumphant spring
in his step. He is not a surgeon who
accepts a saved life as a matter of routine; the face and personality of each
of his patients remain vivid in his memory.
He grieves, often to the point of a crushing migraine headache, when a
heart that his hands have but still…DeBakey stops and turns to the intern. “I’ll sleep in my office tonight,” he drawls
in the sugar-cane accent of his native Louisiana. “Call if you need me.”
The moment after he
stretches out on the couch in his office and closes his eyes, he is asleep.
3:45a.m: Debakey awakes as if responding to an
internal alarm. He fumages about his
breakfast: a cup of heavily sugared coffee and a banana.
Every morning, usually after
only three hours of sleep, Debakey writes. (He has published more than a
thousand articles and essays—more than most professional writers manage in a
lifetime.) Today’s literary effort is
on more testimonials to the human right he believes in above all others: that
every person has a right to the best health care medicine can provide. About half of his patients, like Caccoine,
get free surgery. Those who can pay, or
who are insured, contribute more that a million dollars a year to his
practice. But DeBakey takes only a
small share. He gives the rest to
Methodist Hospital, to the Foundren-Brown Cardiovascular Research and Training
Center there, and to Baylor College of Medicine (where he is both chancellor
and chairman of the department of surgery)
6:15a.m. the lean figure in green surgical clothes
and white coat bends into a rapid stride, like Groucho Marx breasting a stiff
wind. Trotting to keep up behind
DeBakey is Dr. Richardo Labat, an argentine who was on a three-month study
fellowship. Labat was a qualified
thoracic surgeon, but gladly accepted the role of student under the master and
carried the metal-sheathed book containing vital data on the 92 DeBakey
patients in the hospital. Behind Labat
hurries chief nurse Sylvia Farrell, who cheerfully hovers over the 45 doctors,
nurses, medical technicians and helpers on DeBakey’s personal surgical team.
The three are on hospital
rounds, and have already visited 37 patients in 30 minutes. Some are recovering from surgery, others
awaiting it; many are still asleep and require only a glance and a quick look
at Labat’s thick book. Patient 38 is
Mrs. Rosemary Kelley, 74, who sits upright in bed; a tremor of apprehension
upsetting the innate beauty and dignity of her lightly lined face.
“I have you scheduled for
surgery first thing this morning.” DeBakey says. “You’re strong enough, and everything’s going to be fine.”
“Dr. Debakey, I didn’t sleep
very well last night, because I was thinking,” she begins. “Maybe somebody cans use…my kidneys, my
eyes….”
“You’re the one who is going
to need them, Mrs. Kelley,”DeBakey replies reassuringly. He puts a hand on her arm. “Listen, dear, you have 13 grandchildren and
one great-grand-child looking forward to being with you when you get our of
here.” (Lismat’s eyebrows rise in wonder that DeBakey knows these personal
details; they are not on Mrs.> Kelley’s medical chart.) “I want you think about getting well and
being with them, not about a possibility that is very remote. Believe me.”
“I do believe you,” she says
with renewed assurance. “But I think I’d
feel better if I signed some kind of release, so that if anything happens I can
at least leave something behind to help someone else.”
“All right, dear,” DeBakey
ways with a broad grin. “I’ll have the
forms send up here right away. But
you’re going to be fine.”
Patient 39 is a former
baseball pitcher, famous for his fastball in the 1920s. DeBakey has cut into his neck and cleansed
out a disease-choked carotid artery, an essential blood way to the brain. Now, instead of nodding with the dim
bemusement of a stroke victim as he dies ten years ago, the long-retired
big-league player is as alert as a boy.
“You’re strong enough to
throw that fastball again,” DeBakey says, chucking, as his lean, delicate
fingers trace the pattern of scars left by the sutures. “You know, when I was a boy, you were my
hero. I wanted to pitch like you. Instead, they made me a catcher.”
“Well, now you’re my hero,
young fellow. Anytime you want to go on
the mound, just say the word.”
7:12a.m: Rounds finished, DeBakey pauses briefly to
examine his personal surgery schedule in his sanctum sanctorum—which no one
enters without invitation—within the crowded suite of offices that he shares
with two associates, Dr. George Noon and Dr. Malcolm Daniel; his former chief
resident surgeon, and current director of the trauma center, Dr. Kenneth
Mattox; two other residents and four visiting fellows; two interns and four
third-year medical students; two volunteer social workers and seven devoted
medical secretaries. Few hospitals
venture more than one intricate cardiovascular operation a day; DeBakey and his
team routinely perform from four to a dozen—today it’s nine.
He is interrupted by a
call. A woman whose husband is
scheduled for an operation today blurts out her opposition to the impending
surgery. “I saw him this morning,” he
replies calmly. “He wants the operation, and he’s ready for it.” She talks on, and DeBakey replies in a
patient, gentle voice as if he, already late for surgery, has nothing else to
do except restore her confidence.
7:25 a.m.: DeBakey’s gleaming-white rubber surgeon’s
boosts squeak like erasers on the polished vinyl floor of the third-floor
surgical wing of Fondren-Brown. Eight
ultra-modern operating rooms surround a computerized, glass-enclosed monitoring
area that looks like the traffic tower of a busy airport. Drs. Noon and Daniel are busy preparing
patients in Rooms 2 and 3, and Dr. Mattox, in Room 4, is getting Mrs. Kelley
ready to have three new vessels grafted to her failing heart.
Mrs. Kelley, already anesthetized,
lies draped in sterile green sheets.
The leads of an electrocardiograph trial for he chest to a TV-like
monitor, and a plastic tube to an arm provides her with intravenous feeding. A scythe-shaped sterile table covered with
hundreds of special surgical instruments—most of them invented be DeBakey—is
ready at the foot of the operating table.
Dr. Mattox has begun removing a 16-inch length of unneeded saphenous
vein from Mrs. Kelley’s right leg, to use for the heart grafts.
Abruptly, DeBakey backs
through the swinging doors into the room, water glistering on his fleshy
scrubbed, upraised arms. Already
wearing an old-fashioned cotton surgical cap and face mask, he thrusts his arms
into the sleeves of sterile gown which surgical scrub nurse Ellen Morris raises
in front of him, then forcefully rams his hands one after the other into open
rubber gloves that she holds ready for him.
It is all a continuum of motion, like an actor’s advance to center
stage, which ends with DeBakey standing at Mrs. Kelley’s right side, prepared
to open her chest.
A less experienced surgeon
would pause now to survey the field and brace himself for the intrusion of Mrs.
Kelley’s body. DeBakey does not
hesitate. His gleaming scalpel rapidly
traces a line from the base of her neck almost to her navel, then retraces its
lower extremity, laying open an inch of fatty tissue. Picking up an electric cauterizing scalpel, he now seals each
bleeding vessel exposed in the long incision, sending up tiny eddies of smoke.
Nurse Morris hands him an
electric saber saw, which he inserts in the incision at the base of Mrs.
Kelley’s sternum, or breastbone, the forcibly pushes against the bone. It is hard going, like making a length-wise
saw cut through green wood. As the
sternum splits open, he puts aside the saw and cauterizes again where newly
severed vessels have begun to ooze blood.
The he takes a heavy steel retractor and, by turning a small crank which
opens the retractor’s box like steel framework like an auto jack, pries the rib
cage apart. Quickly, he moves into the
eight-inch opening and cuts through the pericardial sac, laying its edge aside
with three heavy black threads that stretch like tent lines against the tug of
restraining forceps.
Mrs. Kelley’s heart,
exposed, is pulsing rhythmically, Golden traces of fat and varicolored
blue-reds of muscle fiber glisten like the warm hues of sunrise. “The most beautiful sight in nature,”
DeBakey murmurs softly.
Wordlessly, Dr. Mattox and
Ellen Morris hand over instruments, hold the loose ends of retraining threads
and suction away the trickle of blood that leaks into the heart cavity. DeBakey inserts two stout plastic tubes into
the main vessels leading from the pulsing heart and another into the femoral
artery of Mrs. Kelley’s right thigh.
The tubes lead behind him to the heart-lung machine, a gleaming
stainless-steel apparatus from which a large, sterile plastic bag hangs. The bag is the oxygenerator through which
the blood will pass when DeBakey temporarily stops the heart. On a console beneath the oxygenerator are
the controls that regulate three DeBakey-designed pumps, the unique mechanical
muscle that will substitute for Mrs. Kelley’ heart when it must be stilled for
the surgeon’s knife.
For the first time, DeBakey
takes his knife to the pulsing organ.
He draws a fine, shallow scalpel line across its right surface and
exposes the first of Mrs. Kelley’s three sick arteries, snaking like a gnarled
root through the heart muscle. Highly
sophisticated X rays, called arteriograms, have shown that all three of the
major heart arteries have been dangerously narrowed by arteriosclerosis and are
admitting only a trickle of blood instead of the strong flow that the heart
muscles needs. As a result, Mrs.
Kelley’s saphenous vein that Dr. Mattox removed and use them to bypass the
disease-choked parts of the three arteries.
Working on a coronary artery
while the heart is still throbs is like dissecting a moving snake on a
vibrating table; by the surgeon’s steady hands make the challenge seem
easy. He clamps off the artery, makes a
tiny longitudinal slit in it with his scalpel and, with a delicate pair of
scissors, lengthens the incision to the size of a small buttonhole. Next, he clasps a curved needle to bigger
than an eyelash in the teeth of a long pair of forceps and threads a
polypropylene luture as this as a split hair through the base end of the small
incision.
Mattox holds the loose end
of the suture as DeBakey accepts the waiting saphenous vein from Ellen
Morris. DeBakey deftly trims the end of
the vein with a pair of scissors so that it will match the buttonhole on Mrs.
Kelley’s coronary artery, then pierces it with the eyelash needle and draws the
two vessels together with the hair-thin thread. Quickly and surely, he circles the vein with continuous series of
30 even stitches, drawn to exactly the same tension—as if placed there by some
extraordinary delicate machine capable of sewing together the hollow stems of
to dandelions.
Now DeBakey snips away the
excess vein and prepares to graft the freshly cut end to the aorta, just as he
grafted the other end to the coronary artery.
He repeats the delicate needlework.
In seven minutes the suturing is done.
The clean new bypass artery is swollen with blood, pumping unobstructed
from the aorta to the right side of Mrs. Kelley’s heart muscle.
When DeBakey confirms that
the heart pumps are in action, he clamps off the aorta to stop the heart. It quivers uncertainly, the goes still in
the first rest it has ever had. Working
more smoothly now on the remaining two coronary arteries.
To bring to an end his
life-saving encroachment on Mrs. Kelley’s heart, DeBakey picks up two
defibrillating paddles, identical to those used on Coccione during the
night. Carefully, he slips one paddle
under the heart and lays the other above it.
“Hit it!” he calls. Like a
sleeping cat awakening in fright Mrs. Kelley’s heart jumps abruptly at the
electric shock, then settles into a steady, rhythmic pulsing action.
The surgeon’s final
professional salute to Mrs. Kelley’s heart is to cradle it gently in his left
hand. The three new bypass arteries are
fat with flowing blood. After years of
almost fatal starvation, Mrs. Kelley’s heart muscle is at last getting a
healthy, continuing meal—one that will probably sustain her for quiet a few
years of active life.
9:53 a.m.: In Room 3, a patient’s abdomen has been
opened and his intestines have been lifted to one side on a damp, sterile towel
by Dr. Noon. An aneurysm has stretched
part of the exposed aorta to the thinness of a rubber balloon, in danger of
bursting. A freshly scrubbed DeBakey
joints Noon at the operating table, finger the offending bulge in the aorta and
clamps it off. He cuts it out quickly,
as if snipping away the worn-out length of hose. The fist-size aneurysm bounces like a ball when he drops it into
a pan.
With practiced teamwork,
DeBakey and Noon alternate at stitching to bridge the missing segment of aorta
with ribbed Dacron tube (another DeBakey’s invention) that branches like a
wishbone at its base to connect to the left and right femoral arteries. The two branches of the graft will restore
the flow of blood to the patient’s lower abdomen and to his legs, which have
been all but useless for months. The
patient will walk again in week.
10:47 a.m.: Debakey joints Dr. Daniel in Room 2 and
cleans a dam of atheroscloerotic fat from a carotid artery. And so it goes: working steadily for the
next four hours, he performs four coronary-artery bypasses. As quickly as Drs. Noon, Daniel or Mattox
can prepare a patient, DeBakey is at work.
Finished, he ducks down to the reception room to reassure anxious
relatives, and then goes on to the next operation.
Only once is the smooth
routine interrupted—when an assistant carelessly relaxes the grip of his forceps
on a patient’s femoral artery while DeBakey is inserting one of the tubes of
the heart-lung machine. The open artery
spurts with the force of a fire hose, splashing blood directly in DeBakey’s
face and momentarily blinding him.
Ellen Morris quickly grabs the spouting artery in her loved hand to stop
the flow. While another nurse cleans
his glasses, a glowering DeBakey tounguelashes the humiliated offender. Without another word spoken across the
table, the operation proceeds to a successful conclusion.
3:25 p.m. After a hamburger and black coffee at his
desk, DeBakey dictates a clutch of letters and memoranda into a recorder and
takes a phone call about his promising research program on an artificial heart. The only remaining barrier to success is the
development of pump materials that will pulse in the human chest for many years
without breaking down or damaging delicate blood cells. DeBakey is confident that before he retires
from active surgery, he will be using such mechanical pumps to replace worn-out
hearts as routinely as he now replaces worn-out arteries.
3:55 p.m.: The surgeon slips behind the wheel of a
white Maserati, gift of a patient whose life he saved, and races like a Grand
Prix driver to a meeting of a Baylor faculty executive committee. Presiding over the 660-student medical
college and its $55 million research programs on the run, as DeBakey does,
draws raised eyebrows from some administrators, but it works. Since DeBakey jointed Baylor in 1948, it has
grown from a minor medical school to one of America’s top five, in both
teaching and research.
4:30 p.m.: DeBakey leaves his office and returns to the
operating table, teaming with Dr. Noon for two intricate aortic valve
replacements. Near the climax of the
first, half-dozen surgeons, anesthesiologists and nurses who have finished
their work in the other rooms gather silently in the background. Overhead, an audience of medical students
clusters around a glass observation dome—to watch what is literally a work of
art as the two surgeons, their fingers twirling and dipping with the perfect
coordination of classic ballet, tie down the plastic and-steel valve with 192
knots in 48 sutures deep within the heart.
During the second operation,
there are few spectators—most of the staff has gone home. It is 9:30 when DeBakey and Noon finally
send the patient to intensive care.
10:15 p.m.: DeBakey picks at the last cold shreds of a
hospital meal. Now, for the first time
since his brief sleep early this morning, he relaxes. Normally a man who utters only the words that are necessary to
his work or to the comfort of his patients, he is uncharacteristically voluble
tonight. All of the day’s nine patients
are doing well, and he feels understandably good.
“People say I let myself get
too involved, that I’m a perfectionist,” he says to a visitor. “I suppose I am. In fact, I know I am. I
have to be. I’m dealing with lives, you
know. If people think I can do that
without becoming personally involved with the patients, they’re wrong. You cannot be more intimately involved with
a person than when you literally enter his heart. That’s why I get furious is a resident or a nurse or anyone makes
a mistake. That’s a person on the
table, a living person. A single
mistake can kill him.”
“But doesn’t your
perfectionism cause you a lot of unnecessary pain and anguish?”
“Pain and anguish? Yes.
Unnecessary? I don’t know. Maybe it’s necessary. I do know this, though. If I ever have to have surgery, I want a
perfectionist to do it.”
11:25 p.m.: Debakey shrugs off his white coat, ready at
long last to go home, when the emergency ring of the telephone slices the
silence of the room like a cleaver. The
day that had no proper beginning will have no discernible den.
