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.
What it's like to step inside the OR with Dr. Oz
"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
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"
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.
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