When it comes to affairs of the heart, our columnist needed a few answers. Thanks to a visit to the OR, she got a whole lot more than she bargained for.
Her coat seemed sort of floaty, like it was made of parachute material. I remember that.
And it was the color of ginger ale, kind of creamy with a hint of metallic gold sheen. She
must have noticed me noticing it because she smiled slightly as she swept by. If memory
serves—and it may not—I think I wanted to tell her how great it looked,
but she was moving at a fairly brisk pace (was she late for a meeting? Was
she anxious to get indoors before the soft drizzle turned into a hard
rain?), and I got shy and chickened out.
A few blocks later, I saw her again, only now she was crumpled on the sidewalk.
A guy was putting his backpack beneath her head. A woman was going through her bag
for identification. Somebody else was calling an ambulance. A perfume sample from Henri
Bendel rolled out of her pocket and a shoe had fallen off her foot. I don't know why that matters
to me but it does. She wasn't young, but she wasn't old, either—mid-50s would be my guess.
The paramedics said it was a massive heart attack.
This entire event probably lasted seven or eight minutes, but it has stayed with me for more than
20 years. I just keep seeing her shimmering coat fanned across the sidewalk with backpack guy
kneeling on it as he holds her hand. I try to make it make some sense, I try to fix it, I try to forget it—but I can't.
Why is a 50-something woman walking down the street one minute and lying in it the next? And,
at the risk of sounding like I'm auditioning for the Bee Gees, my real question:
How do you mend a broken heart?
I know exactly where to get the answer. With one call to Dr. Mehmet Oz, I'm invited to
see for myself on the fourth floor of New York–Presbyterian Hospital/ Columbia University
Medical Center.
Two weeks later, I'm wrapping paper slippers over my shoes as one of the nurses says,
"I take it you've never witnessed an open heart surgery?" Her look tells me that watching
all 11 seasons of
M*A*S*H
doesn't count. Suddenly I regret that the patient consented to having a guest reporter
around and my palms are sending flash flood warnings to my wrists.
"You might not want to be here when the band saw comes out." I've received plenty of
good advice in my day, from "pack a sweater" to "stay in school," but I am particularly
grateful when Dr. Ryan Davies, the chief resident who will be assisting in today's procedure,
directs that little nugget my way before I can wander smack into Quentin Tarantino territory.
The bottom line is this: Try as one might, it is impossible to unwatch something. And so it
comes to pass that I am standing outside operating room 23
not
watching while an 80-year-old woman has her chest cracked open as part of an aortic
valve replacement that, if all goes according to plan, will take approximately six hours
and give the woman an extra ten to 15 years of life. It is her first (and God willing last)
major cardiothoracic surgery. Here's hoping I can say the same.
Tentatively I step into the OR. It's a shockingly ordinary room—no glistening tile,
no shiny viewing gallery that might allow me to observe the proceedings from a
semi-bloodless distance—just plain manila walls with "Evacuation Plans" taped
unobtrusively off to the side ("Step 1. Remove patient from site of fire. If hair is
burning, extinguish the flames") and a dull blue linoleum floor. "Can you see
everything from all the way over there?" cardiac surgeon Mathew Williams calls to
me, knowing full well that I can see nothing from the spot I have staked out directly in
front of the exit. "Yep, pretty much everything," I answer as casually as I can. But
nobody's buying it, and a small step stool is positioned at the head of the stainless
steel gurney. I am then invited to take a closer look, "so in case you ever feel like
replacing somebody's aortic valve, you'll be ready."
Gingerly, I tiptoe around video screens and over cables, skirt the heart-lung
machine and the two perfusionists in charge of it, duck under the beeping
monitors and beyond the busy nurses, the visiting med students, the tubes
coursing with blood, the bag filling with urine, and, with all the enthusiasm a
girl who passed out cold when she got her ears pierced can muster—I step onto
the stool, peer down into an open chest, and stand utterly transfixed by a stranger's
beating heart.
I am amazed, I am mesmerized, I am nauseated. It's remarkable how much can be
read on my face despite the fact that half of it is concealed by a mask; the anesthesiologist
to my left would prefer that his patient be the only woman in the room to lose consciousness
today, but he is a realist. "Hey listen," he says, "if you're going to fall, do not fall forward."
What it's like to be 18 inches from a stranger's beating heart
Conversation among the doctors and nurses is mundane: "I had no idea they're into
country music. Clamp, please." Yet they remain hypervigilant. "Yeah, they—venous
return is down. Are you guys pushing?" I am a mere 18 inches away from the problem,
but I'd be hard-pressed to explain what the problem is. "Something's not tight," someone
calls out. "It's sucking air in," says Williams. The team recites vital signs, as Williams
issues directives. "Okay, pressure's coming up...whatever you did." And then we're back:
"They even went to the CMA Awards in Nashville."
So, let's review: The patient has been intubated, an incision has been made, a
Swan-Ganz catheter has been threaded through her neck to her heart. We are
two and a half hours in, and now she is put on cardiopulmonary bypass. Her body
temperature is cooled to 32 degrees Celsius to lower her metabolic rate and protect
her brain and other organs. Her heart is officially stopped. It is now up to the heart-lung
machine and the perfusionists who run it to keep her blood flowing until she is ready to
come off bypass. "Is it time to call Oz?" one of the nurses asks Dr. Williams, who answers,
"Give me ten more minutes, then let's get him down here." Right on cue, in comes Mehmet
Oz, a man who clearly commands the deep respect of all his colleagues. "Whoa," someone
deadpans, "aren't you Dr. Phil?"
The energy level instantly rises. Dr. Oz is happy to see everyone, and they're happy
to see him. As he examines Dr. Davies' handiwork, he wants to be sure I've been
properly introduced to the family. "Luz is our charge nurse. She makes her own jewelry,"
he says proudly. "Luz, show Lisa your bracelet." Luz holds up a hand, as I try to
make out the shape of the bracelet hidden under her bloody glove. "And we've got the
A team over here," he points to Jimmy and Linda—"I mean these are the people
who worked on Bill Clinton!" Before I can even ask the question, Jimmy volunteers
the answer, "I'm a Republican, she's a Democrat."
Oz brags about the surgical technique Mathew Williams is pioneering: "It's a far less
invasive procedure—he runs a catheter through the groin muscle to the heart." He
and Williams have performed today's procedure hundreds of times together, and it
shows—they know precisely when to get out of each other's way.
It's a complicated tango, choreographed with finesse and subtlety. There's a
good chance they could pull off the whole thing without ever saying a word to
each other; the talk seems more for the chief resident's benefit, who is currently—you
should pardon the technical-medical speak—tweezing at a little blob just south of an angry
looking artery. "Don't grab at it, just give it a nudge," Oz deftly demonstrates.
Davies gently follows his lead. "There you go, that's it. Now, you've gotta be
careful right in here—you can kill someone with that valve," says Oz.
Later he will tell me that "there is always a moment in every operation when
someone can die." For now, as the surgeons delicately lower the new valve into
position, everything goes according to plan.
What it means to be "gloved up"
I've actually forgotten that I am staring at a human heart. It's more like a really
intricate craft project, complete with filament-thin hooks and long, white sutures.
But faster than you can say "
Grey's Anatomy,
" I am jolted back to reality. "Get some gloves on," says the good doctor. I stare blankly.
"Let's go," Oz repeats, "glove up." I look behind me to see who he's talking to. No one
is behind me. Three thoughts flash through my head:
"Oh my God! Oh my God!"
And,
"Oh my God!"
"That's okay," I say quickly. "I mean you guys are doing fine. Really.
Maybe I can make a little Starbucks run—who's up for a Frappuccino?
Anybody? Anybody? Anybo—" "Can someone help Lisa get gloves on,
please?" Oz says, as he examines the new valve. Six seconds later, my hands are
encased in latex and Dr. Oz is placing pieces of calcium plucked directly from the
aorta into my trembling palm. "See the spongy part?" he asks, "and over here it's
cracking a bit, you see that? Give it a squeeze. This stuff here can break off and
cause a clot." As Oz pokes, prods, and continues to teach, I silently tick off the list
of foods I will not be eating again. Bye-bye bacon, farewell fettucine...it's like a very
special episode of
Scared Straight.
The ability to remain upright when hit with a handful of yuck has
earned me a five-minute break. Oz and I take a seat in the lounge.
Somebody stops by to thank him for seeing her cousin; somebody else
wants a picture. Finally we are alone and I can ask the question I've been
thinking about all morning. "Mehmet, what's it like to hold someone's life
in your hands?" Oz is quiet for a minute. "You know, the heart always used
to remind me of a python. I'd see it beating away and think it was about to
spring at me," he says. "But gradually, you realize that it's not the enemy,
and you begin to embrace it." I get the python thing; what I don't get is
how you handle the responsibility for keeping it beating. Oz tells me a
story. One New Year's Eve, a man thanked him for saving his wife's life.
But the man made it extremely clear that he felt the one who actually
deserved credit was a far higher power than any surgeon. Oz doesn't tell
me if he believes that matters of life and death are ultimately up to God,
but he does say that "if you start believing your own bullshit—thinking you're
infallible—you're going to start making mistakes.
Everyone's got an ego, but the operating room has to be a place of
controlled arrogance." We adjust our masks and walk back to the OR.
"Will she be okay?" I ask, probably looking as anxious as the people
pacing the waiting room. "She'll be sitting in a chair by tomorrow," Oz
assures me.
Still, I stick around until they warm her blood, wean her from the
heart-lung machine, get her heart once again beating on its own,
and repeatedly promise they don't need me there to help them close.
I head out of the hospital, into the drizzly afternoon. I look at the
people racing for cabs, buying the paper, checking their BlackBerrys,
and I can't help wondering what's in their hearts. What are their most
ardent desires, their secret shames...their cholesterol levels?
If we're smart, we shop for whole grains and pray for good genes
and go to the gym and hope for the best. But as I learned years ago
on a damp day a lot like this, the body is breakable. This morning I saw
living proof that if we're lucky, it can also be fixed.
