November 19, 2004

by Eleni Kretikos

 

It could have been my father. Or my husband or brother.

Or me.

 

Instead, it's a 76-year-old man who looks much like a side of beef as he lays on the operating table before a team of cardiac surgeons, nurses, machine operators and anesthesiologists. His body is painted with an anti-bacterial coating that turns the color of iodine. He's under four brilliant lights at a busy intersection in the room, surrounded by a tangle of tubes and sophisticated machines.

 

His chest is held open by a vicelike clamp. Thick cablelike tubes carry blood into and out of his body. Machines monitor his breathing, heart beat, blood pressure and a bevy of other vital signs.

 

The atmosphere in the room is calm. There isn't much talking, just smooth, calculated moves. The procedure seems routine -- yet another man diagnosed with obstructive coronary artery arterioschlerotic disease. In other words, his arteries are choked with plaque and gunk.

 

A bypass operation like this one, says nurse Trish Seifert, is a bit like taking the Beltway to circumvent downtown D.C. Surgeons work to repair a patient's heart using a vein from his leg to bypass a clogged section of his arteries. One end of the vein is sewn onto the aorta; the other end is attached to the coronary artery so blood can flow through the new channel to his heart.

 

The operation started around dawn on a Thursday. I wasn't allowed to watch them open the body, and part of me was relieved. Cracking open a human chest can't be anything less than gruesome to watch.

 

About 64 million Americans have one or more forms of heart disease -- about 8 million of them will suffer a heart attack this year and more than 930,000 of them will die.

 

Puffs of smoke rise from the patient as primary surgeon Edward Lefrak cauterizes flesh, freeing the internal mammary artery from its connective tissues, making an already nauseating experience worse.

 

Meanwhile, a doctor stationed by the patient's right leg begins digging a vein from a bloody bundle. It looks like a sliver of thick yarn. Harvesting a vein of the proper length is critical. If it's too long, it will kink and the blood won't flow well -- too short and it's overly stretched.

 

The team works through a chest hole that looks to be about 5 inches wide and 7 inches long. A perfusionist keeps a close eye on the heart-lung machine, which keeps the patient's blood circulating while his heart is stopped. It processes the blood, infusing it with cleaners and oxygen before cycling it back into the patient. The lungs are deflated during the operation, which allows for more room in the chest cavity.

 

Medications force the heart to stop beating. A moment of panic sets in, but only for me. The moment is both sacred and profane. Beautiful and brutal.

 

One in six deaths from heart disease is attributable to smoking. In fact, smoking kills 440,000 in the United States each year -- 1,200 a day.

 

While a white-gloved nurse holds the patient's heart in position, Lefrak makes a tiny incision on the underside of it. The work of attaching the vein is painstaking and meticulous. Using what looks like plastic thread, the surgeon sews it beyond where the artery narrows, attaching the other end to the aorta.

 

It takes about 15 stitches to attach the vein. Because the thread can stick to the surgeon's glove, a nurse occasionally squirts saltwater onto Lefrak's glove. Another apparatus suctions excess fluids from the cavernous hole in the chest.

 

Lefrak continually stuffs gauzelike sponges into the patient's chest, soaking up blood and helping him position the heart in exactly the right place. Nurses are careful to count them -- about 35 in all -- as they're removed from the chest cavity to ensure none is left behind.

 

The operating room is cold, and the anesthesiologist in short-sleeve scrubs wraps himself in a woolly white blanket. A cool temperature helps because standing hunched over a patient for hours is physically taxing and the docs get warm. Besides, it's important to keep the patient's body cool during such a procedure.

 

I'm struck, too, by the lack of mess. Though the floor is smeared with blood, for the most part the scene is orderly and controlled, nothing like what you see in TV-show operating rooms.

 

Before Lefrak restarts the heart, he pokes a fine needle into the newly attached vein to remove any air bubbles. Insulated pacing wires also are inserted so the doctor can control the patient's heart rate if necessary. A heart rate of 90 beats per minute is the target.

 

The heart begins to beat again, and all I can think is, "Thank God." If there's ever a breather during heart surgery, that was it.

 

Tubes and catheters get unhooked. The clamp is loosened. The anesthesiologist begins to inflate the lungs. The patient is given drugs to help his heart keep pumping. The whole room watches.

 

About 20 minutes later, doctors remove the vice from the patient's chest. One of them uses what looks like a crowbar to hold things open while Lefrak checks for bleeding. The sponges that go in come out less bloody, a good sign.

 

Stainless steel wires are inserted at five or six points in the sternum. To close the chest, the wires are pulled together with pliers and crimped.

 

It's 1:10 p.m.

 

Only 23 percent of Americans get enough exercise to achieve cardiovascular fitness -- 38 percent of them are not active at all.

 

After surgery, the chest tubes will remain for two or three days to drain fluid. Patients typically spend 24 to 36 hours in intensive care and are released from the hospital within six days. After surgery, the biggest dangers are pneumonia and infection.

 

Emotionally, patients live with the fear that comes with this kind of trauma to the body.

 

"We've got many men and some women in high-level positions; they're used to being captains of their universe," Seifert says. "Post-op they're being told what to do, and they're not [the ones] making decisions. Sometimes the psychological part is very difficult.

 

"People think, 'Am I going crazy?' because they're not able to snap back. For some people, it drives them nuts. Of course it's never quick enough for the Type A personalities all of us are."

 

Fannie Mae Foundation executive Glen Howard has, so far, managed to "keep it in perspective" since he had quadruple bypass surgery in 2002.

 

"What is most important is my family and being here to enjoy them," Howard says. "In the heat of everyday battles, we just need to remember that when something goes wrong, nobody died."

 

That's true. This time.