Be Still My Beating Heart


 

*Below is a web-exclusive essay chronicling the writer’s experience watching open-heart surgery. Following the essay is the original print story.

Heart Feb 1

A writer watches open-heart surgery.

By Lindsey Lowe

 

“What it like?” I asked. “What’s it like the moment after everything is split open and you see the heart beating there?” I asked Dr. Parvez Sultan, a heart surgeon at St. Vincent’s Hospital in Birmingham, this question, and I could see that it wasn’t an easy answer. All of the other questions I’d asked—“Where did you go to school?” and “What’s your daily routine like?”—had been met with rolling answers, ones he knew right away. But he hesitated when I asked this question. I knew that it wasn’t that he didn’t know the answer, for his eyes lit up in the space between my question and his attempt to answer. What I understood, though, was that it was hard to articulate. “It’s amazing,” he said, and then he shrugged a little, and I knew that he felt those words didn’t do it justice. “Every single time, it still amazes me.” I wrote that down (well, I typed it into my iPad), but he leaned forward, obviously unsatisfied. “You know,” he said, “the thing you should do is come watch a heart surgery.” I laughed a little, but then I realized he was serious, and that it was important to him that I understood. “OK,” I said. “I’ll come.”

On account of me being both mostly healthy and a writer, I had never even been in an operating room before. I put on my first-ever (and likely last) pair of scrubs. I pulled a surgical cap over my hair and tied a mask around my face. Several of the people who assembled for this particular surgery—a double coronary bypass—smiled at me knowingly and said, “Do you want to be a heart surgeon?” I couldn’t help but laugh under my surgical mask. “No,” I said, “I’m a writer.” Everyone’s eyebrows rose. “Well,” they said, “Just don’t lock your knees, and let us know if you feel sick.” I already felt a little sick, but I hadn’t thrown up in years and had never truly passed out in my life, so I felt I had a good chance of being able to keep it under control.

I followed the physician’s assistant into the OR a few minutes before the patient was put to sleep. He sat me on a stool and talked me through the hour and a half of prep work that followed; the room buzzed with activity as every person completed his or her tasks and told jokes, which I found admirable, since I imagined they’d all gotten up earlier than I had. And then, Sultan came in, everyone got into place, I left my stool and found another corner, and just like McDreamy always said, it was a beautiful day to save a life. He began to cut, and since I was fairly far away, I watched on the screen (he wore a head camera so that everyone in the room could see what he saw.) I was nervous; after all, I’d never fainted, but I’d also never seen a sternum cut open with a saw.

I watched from my corner as Sultan cut through layers of fat and then the sternum. I watched quietly, swaying back and forth, careful not to lock my knees. Then he called my name, and a nurse got me a stool, and I stood right behind the patient’s head. He told me he had reached the pericardial sac. Pericardial sac, pericardial sac…I remembered what he’d told me: “It’s always amazing how when you cut open the pericardial sac, the heart pops out. And it’s beating.” At that point, I’d been in the OR for three hours. My legs were already tired, and I’d missed my morning snack. But then he opened the pericardial sac.

I’ve seen hearts. I’ve seen hearts on Valentine’s Day cards, hearts on Grey’s Anatomy, hearts drawn on teenage girls’ notebooks. I have signed notes with “I <3 you.” I’ve laid my hand on tiny babies’ chests and felt their little hearts reverberating; I’ve laid my head on chests and felt other hearts beating. I have felt my own heart so full that I thought it would burst and so broken that I thought it was actually physically fractured. But when he opened the pericardial sac, I realized why we draw hearts and write hearts and talk about hearts: The heart, beating, was the epitome of life.

It wasn’t as red as I expected, or, frankly, as heart-shaped (it didn’t even look like the ones on Grey’s Anatomy.) It wasn’t going as fast as I know my own has thumped. It was a gentle rhythm, up and down, up and down. It didn’t matter to that heart that it was a little sicker than we would have liked and later, it wouldn’t matter to that heart that Sultan and his team had manipulated it to sleep so they could fix it. There was a job to do—keeping our patient alive—and that heart never gave up. As soon as they woke it up again, it carried on with its beating.

In a rush of understanding, I got it. I understood why Sultan told me I had to see it for myself. I understood why there are so many poems about heartbeats. I understood why I feel my own heart drop, why we name the heart as the holding place for our emotions, why it’s our hearts that skip a beat (as opposed to our femurs). I understood why there are so many clichés and metaphors that have been inspired by that lump of muscle, that muscle that does not care what we humans are doing or saying about it, that muscle that continues to pump life through us.

Now, I’m a writer. It’s my job to find the remarkable things and share them, to go out on limbs like assigning muscles emotions and trying to make you feel it with me. But Sultan and his team looked at me, and I saw it on their faces, too. “What do you think?” he asked. And I knew that later I’d write about it, so the words would have to come. But I shook my head, watching that heart beat, up and down, up and down, and I hesitated, for I couldn’t find the words right then. “It’s amazing,” I finally said, shrugging a little, for I also understood now that those words didn’t do it justice.

I stood there for another three hours, watching them remove and reattach veins and arteries. I was walked through every step, and I was so close I could have reached down and held the heart in my hand (I refrained.) I stood there until the chest had been sewn up again, the heart fixed and drumming life again. When I finally walked out, I threw my mask and cap away and found my way back to my car, where my legs were relieved to find a seat.

I sat in the parking lot for ten minutes, until my heart stopped pounding and I could drive away.

 

 

 

A Conversation with a Heart Surgeon

Written by Lindsey Lowe

Photo by Chuck St. John

 

So many of us begin our mornings early, for we have jobs to do. We pour tumblers of coffee and ease onto the interstates. We arrive at our desks, five minutes late, and turn on our computers. We sit down, we make our to-do lists, and we begin to work.

Dr. Parvez Sultan, a cardiovascular surgeon at St. Vincent’s Hospital, may begin his mornings with coffee, too. But instead of sitting down at his computer, many of his days start with a conversation with his surgical team as they prepare for the day’s work. His office is sterile and his agenda filled with encounters with something most of us will never see: the human heart. And while I believe that I have the best job in the world, I must admit that Dr. Sultan’s gig is pretty neat. It’s a sentiment he agrees with; opening a patient’s chest cavity, reaching in and handling the heart, and fixing it, he says, is still, after more than eight years of practice, exhilarating.

“When you open the chest, it’s pretty amazing,” he says. “We use a mechanical saw. We open the chest, and then the heart is in the pericardial sac, and we open that, and every day, every time I open it, it still amazes me. Everybody’s size is different. The blood vessels can be different. It still amazes me, the way the heart is beating. And any time students or anyone who hasn’t seen heart surgery comes to the OR, it amazes them how when you open the pericardial sac, the heart pops out. And it’s beating.”

Sultan says he was initially drawn to heart surgery because the heart, much like an algebra equation, often gives you the answer you want when you use the right formula. “The physiology [of the heart] is beautiful, and everything makes sense,” he says. “If there’s volume loss, you give volume. If there’s blood loss, you give blood.” Sultan says that despite its intimidating nature, cardiovascular surgery offers him something that a lot of doctors don’t receive: the chance to see it work immediately. “I wanted to do something in my career where I can see the major effects of it,” he explains. “If I fix something, it gets better. It’s like a car-mechanic kind of thing. If you fix it, it starts functioning. Say there’s a bad valve or an aorta that’s being torn apart. I go and fix it.” One of his favorite parts, he says, is the process of stopping the beating heart, putting it on the bypass machine (which keeps the blood oxygenated while Sultan and his team work on the heart itself), and then the moment after: “Once we’re done, we bring the blood back from the bypass machine into the patient’s own heart, and we start making it beat slowly, letting it slowly wake up,” he says. “You put the rhythm back into the heart.”

He points out that the field is constantly evolving as technology improves, and he is learning every day how to better care for the hearts of his patients. “How I did heart surgery during my training and how I do it now is quite different,” he says. “You’re constantly learning. Some of the surgeries that we are doing today at St. Vincent’s are much more innovative, and they were not taught to us during our fellowship, so we learned them on the job. And you have to have a love for learning; every day, there is something new, and that’s what I like. And of course, every patient is different. That is the beauty of cardiac surgery, I think: No two patients are alike. Even in the most routine cases, someone can throw you a curveball. You have to think very fast on your feet…time is ticking when you’re on bypass.”

I asked Sultan is he remembers his very first heart surgery, and he smiled. “Of course I do,” he says. Sultan says it’s a long road—years of medical school, residency, and a fellowship—and that he counts his first time as the day he first did cardiac surgery completely unsupervised. He’d been in the operating room for years by that point, but the whole thing still made his own heart race. “I had a coronary bypass, a bread-and-butter procedure,” he says with a smile. “I made a checklist of all of the things I had to do. Even though I had done it hundreds of times, I wanted to be sure I did not miss anything. I was up early; I was excited. And everything went well, but it was quite dramatic. I still remember the case, of course. I had to make sure there was no bleeding, which is the bane of our existence. Bleeding means there’s something wrong.

“In the first year, I always made my checklists. But it becomes second nature,” he says. “I know all the steps now. You second-guess yourself, though. Even now, when it’s a complex case, I review the details very, very carefully. After all, it’s the heart.”

Sultan says that many of the cases—he does two to three surgeries a day—he sees are the direct result of heart disease, the number-one killer in this country. In fact, one of the reasons he became a heart surgeon is because heart disease is prevalent in his own family, in India. “I thought jumping into solving this problem might be helpful,” he says. And so he does—he fixes hearts. But he says that there are ways to reduce your risk of developing heart complications, things that we should take seriously, for without a healthy heart, a person cannot truly be healthy. The main things, of course, are a healthy diet and exercise. But he also urges people to educate themselves about the risks and symptoms and to go to the doctor sooner, rather than later, if they experience anything that could indicate heart disease. “We see young people dying of this,” he says. “So if I was talking to a group of people, I would tell them that we have to make sure we’re aware that heart disease is a problem. It can creep up without you knowing it; it can be silent.

“Keep yourself in tune to your body. We see a lot of people, men especially, who come in and say, ‘Oh, I’ve had this gas pain for six months,’ and it turns out he has 90 percent blockage. He’s lucky he didn’t die. And women, they are so busy being mothers and wives and being busy at work. They sometimes have less-defined symptoms, [because of estrogen] so a lot of times they ignore it. Instead of the classic chest pain and pain in the left arm, they may present with high blood pressure and sweating or jaw pain. So that’s one thing: We have to be aware, especially if you have a family history. Because we can prevent this now. We can prevent heart disease.”

And while he certainly hopes people do take measures to keep their hearts healthy and prevent disease, he still loves that when they come to him with sick hearts, he can make them better. “It is a great experience. One of the best experiences, to see how [the heart] works completely,” he says. “The heart is stopped, and then the heart starts beating again.”

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