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.

One Big Advantage for Rylynn

One of the big things in Rylynn’s favor as she faced her heart trial was her family.  They were everything you could want in a family about to face this kind of problem.  Dr. Guleserian explains:

“Rylynn’s family is very well-educated, very on top of things. This is the perfect family for me to work with in a situation like this. Mom and Dad are just terrific.

“Andrea had a prenatal ultrasound that showed the baby had hypoplastic left heart syndrome. Many years ago, the only option for patients with hypoplastic left heart syndrome was transplant. But Dr. William Norwood came along in the ’70s, and realized there was an operation which could be done for these patients.

“Remember, with hypoplastic left heart, the patient has one functioning ventricle, and one very hypoplastic ventricle which is too thick to work properly. Dr. Norwood wanted to find an operation which could be done so that you don’t have to go to transplant because there just aren’t enough donors. We have plenty of recipients, but not enough donors.

“And so the Norwood operation was developed to help these patients. At it’s inception, it was an operation that was done on older kids — if you survived to get it, you got it. But now, it’s a neonatal operation that we do in the first week or so of life.”

 

Andrea and Rylynn Riojas in ICU at Children's Medical Center, Dallas

Andrea and Rylynn Riojas in ICU at Children’s Medical Center, Dallas

Congenital Heart Disease Strikes Everywhere

You’re young, a great athlete, lots of money… the world is your oyster.  Until they discover that your infant son has Hypoplastic Left Heart Syndrome.  That’s what happened to Greg Olsen, of the NFL Carolina Panthers.

Click here to find out more about Greg, and his amazingly tough son, who is fighting the same sort of battle which Rylynn fought at Children’s Medical Center.

Peace, Hope & Butterflies

Lizzie Cochran is a young woman I’ve known since she was about ten.  I took headshots of her several times during her acting career.  Now, however, she’s veered off toward medicine, and is an undergrad at Columbia making her way up.

Here at home in Dallas, though, Lizzie is a person of high social conscience.  We’re coming up on the fourth year of her amazing “Peace, Hope, & Butterflies” event at FlagPole Hill.  It’s an annual fund-raider to help the cancer research department at Children’s Medical Center.  Lizzie raises thousands annually for cancer research.  (Two years ago, I had my head shaved at the event by six-year old pediatric cancer patient Libby Serber!)

Click here for info, in case you’d like to come and join us this Sunday, September 21st.

This Sunday, September 21st, at FlagPole Hill in Dallas.

This Sunday, September 21st, at FlagPole Hill in Dallas.

Ebb & Flow of the Heart

No artwork really does it justice, but we’ve put up so much about the heart here, I thought a diagram might be in order.  Apologies to all you med students who already know this stuff.

The red blood, coming from the lungs, full of oxygen, goes through the heart and into the aorta for delivery throughout the body.  The “blue” blood, which has already been depleted of oxygen by that trip around the body, goes from the right side of the heart, through the pulmonary artery and to the lungs for a fresh load of oxygen.

The four chambers of the heart, and the blood vessels.

The four chambers of the heart, and the blood vessels.

And here’s what a real one looks like.  Generally speaking, each of our hearts is about the same size as our clenched fist.

Heart, surgery, hospital

Heart ready for transplantation

 

Before the Beginning

Before every operation, as the patient is being prepped and anesthetized, the routine is the same.  Dr. Guleserian gathers the entire OR team around the table.  She then goes through a litany that includes the patients name and ID number, the procedure he or she is about to undergo, the name and duty of everybody in the OR (including people shooting photos like me), and other pertinent data.  If anybody hears anything incorrect, they are supposed to speak up.  No margin for error in here.

Dr. G checks the patient and does the pre-op checklist

Dr. G checks the patient and does the pre-op checklist

When One Doc Operates on Another Doc’s Kid

Occasionally, Dr. Guleserian will wind up with a young patient whose parent, or parents, both happen to be doctors.  And that, she says, can make for an interesting situation.

“I had a patient whose parents were both doctors.  One was an anesthesiologist and one was in internal medicine, and they were actually quite lovely. Their son needed an emergency operation, it needed to be done that night.  There was a pretty good risk of complications, but actually the child did very well.  The parents were incredibly lovely and understanding, and I didn’t feel at all uncomfortable.

By nature, I’m very truthful with everybody. I explain things. I will ask, if I know they have a medical background, how detailed they want me to be.  Because even if they have a medical background, if it’s not in the area of pediatric cardiothoracic surgery, they may just want me to talk to them like regular people.”

Dr. G chalk-talks the surgery she is about to perform on an 8-month old girl.

Dr. G chalk-talks the surgery she is about to perform on an 8-month old girl.

Making Life Better for Children

That’s the entire mission statement of Children’s Medical Center Dallas.  And they make life better for children through folks like Dave Bartoo.

Dave Bartoo, surgical tech at Children’s Medical Center, part of the Pediatric Cardiothoracic team, is one of a number of people who work on every case that comes to the hospital.  And Dave and his team always have only one goal – the health of the patient.

I can’t convey enough about my team, my surgeons, that they do those little things every day like we will take their favorite stuffed animal, and we’ll put a little dressing on it – They have a heart dressing just like you do and everything, and we give them these little heart-shaped pillows. I’ve had adults that are 40 years old that we work on here, and they’re like, “Do I get a pillow? I see the other kids – ” You know like, “Do you want one?” I’ll go up, and we sign it and wish them luck.

To illustrate.  Here’s a shot of two-year old Rylynn being wheeled into the OR for her transplant.

Nurse (l) tells Rylynn they will take care of her baby doll for her.

Nurse (l) tells Rylynn they will take care of her baby doll for her.

Dr. G. is on the right.  On the left is a nurse who tells Rylynn that she will take care of her doll for her, and when she gets back to her room, her doll will be there.

So, how did the very busy Cardiothoracic Surgical Nurses, prepping for an long, intense operation, take care of a little girl’s doll?  Did they put it in a plastic bag, write her name on it and put it aside?  No… they did this.

Rylynn's doll waits for her to come out of surgery.

Rylynn’s doll waits for her to come out of surgery.

 

Around the Table

Two surgeons, two techs, and an adviser hover over the OR table.

Two surgeons, two techs, and an adviser hover over the OR table.

During a procedure to implant a Berlin Heart ventricular assist device, Dr. Kristine Guleserian (2nd from left) is assisted by a fellow surgeon, two surgical techs, and an adviser.

Despite the high stakes involved in the OR during a pediatric cardio-thoracic procedure, it’s a surprisingly calm place.  This is the major leagues of pediatric heart surgery, all these people are all-stars and the job is done efficiently and quietly.