Close Quarters in Surgery

Surgical work is up close and personal.

Surgical work is up close and personal.

When you work in the OR, it gets close and personal.  Head to head, as it were.

Especially when you’re working with tiny children that Dr. Guleserian and her colleagues treat.  Some of them are, literally, less than a day old, needing emergency heart surgery from the very start of their lives.  Those hearts aren’t even the size of a ping pong ball. (Your heart, by the way, is about the size of your fist, in case you were wondering.)

 

Cold Front in the OR

It can actually get downright chilly in the operating room.  One of the things that’s often done during open heart surgery is to cool the patient’s body down quite a bit, to buy the surgical team more time to repair things.  The colder the brain is, apparently, the more time you have before damage from loss of oxygen sets in.  So in addition to drugs which can lower body temp, they also actually turn the thermostat down in the room.  Sometimes to 65 or so.  And when you’re wearing those thin, cotton scrubs, a chill sets in pretty fast.  There’s a blanket warmer just outside the OR, and if you’re part of the team, and not doing anything for a few minutes, a warm blanket is a pretty hot idea.

A nurse sits in the OR while the patient's body is cooled.

A nurse sits in the OR while the patient’s body is cooled.

Advice To Patient Families

Often times, Dr. Guleserian finds herself on the other side of the doctor-patient equation.  In 2013, her father suffered a serious heart issue, and Dr. G went home to Boston to be at his side and, as a doctor, to ask questions she felt should be asked.  Even if you have no medical training, she says, you still need to be an advocate for your family member.

My father had a long history of heart disease. When he was in the hospital one time, they told me they were going to do a ventricular tachycardia ablation procedure on him. I asked, “Are you going to do a cardiac catheterization first and take a look at his coronary grafts,” and the doctor said, “Oh, no – no, no, we’re not going to do that.” And I told him I was a bit surprised by that. And then, within the hour he came back and said, “Yes, we are going to do that,” and it was at that point that I knew that he probably had gone back to discuss everything with the attending cardiologist and that would be part of the plan.

So, yes, you need to be an advocate for your family member. I don’t care if you’re a physician or not. In this day and age of medicine, there are so many people involved in patient care that sometimes, things get lost in translation. Sometimes people get lost in the mix because there’s not a single point person who’s kind of running the show. So, if you’re a family member, you need to be on it and be sure that everything’s OK.

Dr. G talks with Rylynn's parents following the transplant surgery.

Dr. G talks with Rylynn’s parents following the transplant surgery.

 

Call it “Children’s Health”

Children’s Medical Center Dallas, the scene of most of the action in SURGEON’S STORY, has long been recognized as one of the leading pediatric medical facilities in the country.  And as Children’s has grown to serve areas beyond Dallas, it became time for a rebranding.

So, Children’s Health has debuted.  For more about what’s more than just a name change, click to get the info direct from the source.

A Surgeon’s Motto

A lot of us have a personal creed we live by.  Kristine Guleserian, heart surgeon with a sense of humor, is no different.  But we’ll let her tell the story.

“Dr. Hardy Hendren is a pediatric dental surgeon at Children’s Hospital of Boston.  OR 7 at Children’s Boston was his OR, and he had a sign on the wall in the operating room that said ‘If an operation seems difficult, you’re not doing it right.’

“A couple of years later, I was in St. Louis and I was doing a double lung transplant with Dr. Alec Patterson and for some reason I left my clogs at home. I ended up doing the transplant wearing four-inch Prada heels. So, at the end of this very long night, someone said, “you operated in those heels?” And I said, ‘Well, if you can’t operate in heels, you can’t operate.’  That’s where my motto came from.”

If you can't operate in heels, you can't operate.

Dr. G, after a surgery, in heels.

Photography in the OR

Since my only entree into the OR is as a photographer, that’s the vantage point from which I view it.  And since a photographer is always looking at light, and how it plays off things, and how it mixes with shadow, etc., the OR turns out to be a really interesting place to photograph.  The most intense light is, obviously, on the patient.  As the surgeons are the closest to this light, they are often illuminated by it.

Surgeons and Techs around the patient in the OR.

Surgeons and Techs around the patient in the OR.

What makes it a bit more of a challenge is that everybody has a mask on, so you can’t see facial expressions.  And the surgeons have on their loupes to magnify the field in front of them.  Often, however, you still get facial and body poses in such a way that the action in the room is easy to understand.

This black-and-white shot of Dr. Guleserian at work has always been my favorite shot from the OR.  The Italians called the mix of light and dark “chiaroscuro,” and I don’t think I’ve ever had another shot that so fits that term.  This shot was one of those where I really didn’t know what I had until I saw it on the computer.  There’s no mistaking the drama going on in here.

We’ll be pairing the pictures with words in SURGEON’S STORY to help you understand just how dramatic it really gets.

In the OR

The Pump

Surgeons call it “the Pump.”

The heart-lung bypass machine which oxygenates blood during heart surgery.

The heart-lung bypass machine which oxygenates blood during heart surgery.

The complex collection of tubes, dials, computers, pumps, IV ports and more which keeps a patient alive during open heart surgery by providing oxygen to the blood while the heart is stopped.

The real name for it is the Heart-Lung Bypass Machine and the story of its invention is quite fascinating.  The original machine used tubing from beer kegs.  It wasn’t quite put together with chewing gum and bailing wire, but it did take some time to get right.

Now, upwards of half a million people in the US go “on pump” every year.  And none of the parts come from a keg anymore, either.

OR Symmetry

A tray full of clamps, needles and more sits ready near the Surgeons at Children's Medical Center Dallas

A tray full of clamps, needles and more sits ready near the Surgeons at Children’s Medical Center Dallas

As one whose desk looks like the perpetual victim of a tornado, I’m always impressed by the almost obsessive-compulsive order of the OR.  The Techs have everything laid out in perfect form, ready to grab whatever the surgeons need and have it in their gloved hand in an instant, or less.  The only other place I ever really saw this amount of intense prep was during my days in the NFL, broadcasting for the Dallas Cowboys and Houston Oilers. Seeing how much work went into the three hours on Sunday afternoon is very much akin to what goes on in the pediatric cardiothoracic surgical suite.

What Spurs You to Become a Heart Surgeon?

In Dr. Guleserian’s case, it was several things.  Her younger brother, Mike, having open heart surgery at a very young age had a huge impact on her.  But there was also a young boy in their Boston neighborhood who had an even more serious problem.

“There was a little boy who used to ride the school bus with us every day named Tommy Kaplan.  He was born the same year as my brother. Tommy had two older brothers, David and Peter, and they would always try to help him on the school bus. And he just looked extremely blue. And we wondered, ‘Can’t anyone do anything? Why is this kid so different than everybody else?’

“It would take forever for Tommy to get onto the bus. And, you know little kids — they don’t know what’s going on, so they’re yelling ‘Come on! Get on the bus! We’re going to be late,’ you know.  Very few people knew that he had end-stage heart disease.

“But anyway, this was in the ’70s, – transplantation wasn’t an option. So, Tommy was managed medically. There were no surgical options for him, because he had pulmonary hypertension, which is abnormally high blood pressure in the lungs.

“And all he wanted to do on his birthday that year was eat a lobster and hit a home run. So, he put on his Red Sox uniform on, ate a lobster, went in the backyard, hit a home run, told his Mom and Dad he felt tired, took a nap and never woke up.”

Surgeon's Story, available in 2015.

Surgeon’s Story, available in 2015.