Walk on Water Inside an Elite Pediatric Surgical Unit

by Ruhlman, Michael

• ISBN13: 9780670032013
• ISBN10: 0670032018
• Format: Hardcover
• Copyright: 2003-04-14
• Publisher: Viking Adult

Summary

Michael Ruhlman is fascinated by people at work-especially those in pursuit of perfection. The Soul of a Chefand Wooden Boatshave established him as a deft chronicler of unique cultural microcosms. Now, in Walk on Water, he documents life in the most intense environment yet-a pediatric heart center specializing in neonatal open-heart surgery. The precision needed for such delicate surgery puts "soul-crushing, diamond-making stress" on physicians and nurses every time they operate. The colorful focus of Ruhlman's narrative is the Cleveland Clinic's world-renowned, idiosyncratic Dr. Roger Mee-a virtuoso within a very select surgical specialty and a mine of information on statistics, ethics, and medical politics. A riveting glimpse into the heart and mind of a man in whose hands literally rests a young baby's life on a daily basis, Walk on Waterexplores controversial topics-from questionable referral patterns by cardiologists to physicians who are punished for doing what's best for their patients to physicians who don't do what's best for their patients-and breaks the taboo on subjects not often written about. Walk on Wateris a must for all readers of serious nonfiction that will also have health professionals and the media paying rapt attention.

Author Biography

Michael Ruhlman, author of The Soul of a Chef and Wooden Boats, has written extensively for The New York Times and numerous magazines. He is also the winner of the 1999 James Beard Award for Magazine Writing.

Table of Contents

"Roger, We Got a Problem": An Introduction to the Beautiful, Horrible World of Pediatric Heart Surgery	p. 1
The Virtuoso	p. 25
Bad Hearts	p. 51
Scaramouche	p. 83
A Beautiful Heart	p. 99
Serious Business	p. 157
The Physician's Assistant	p. 199
"The Physical Genius"	p. 233
The Good, the Bad, and the Good Enough	p. 243
The Norwood	p. 275
What's It All About, Anyway?	p. 317
Sources and Acknowledgments	p. 333
Resources for Parents	p. 337
Table of Contents provided by Blackwell. All Rights Reserved.

Excerpts

1. "Roger, We Got a Problem": An Introduction to the Beautiful, Horrible World of Pediatric Heart Surgery "Stay away from that." Fackelmann says it to Mac the way he says most things in the O.R.- matter-of-factly but definitively. The two men continue to work within the newborn's open chest, Mac dissecting out heart vessels bound in webs of delicate connective tissue. Makoto Ando, called Mac, is the chief surgical fellow at the Center for Pediatric and Congenital Heart Diseases at the Cleveland Clinic, in Cleveland, Ohio. Raised and educated in Tokyo, Mac is thirty-five years old, married and the father of a two-year-old daughter, and currently half a year into the fellowship here that will conclude his training as a pediatric heart surgeon. This morning Mac has already accomplished what is by now an almost daily routine for him: the opening of a child's chest. He has drawn a scalpel down the baby's midline, then divided the sternum lengthwise with hand shears. Mike Fackelmann, the P.A., or physician's assistant, across from Mac, has fitted the brackets of the stainless-steel chest retractor along each edge of the sternum and cranked a small handle to ratchet the arms open, exposing the chest cavity. Bob Cherpak, the scrub nurse at Mac's right, organizes an arsenal of sterilized steel tools on the setup table and hands Mac instruments as Mac first removes the thymus gland, then opens the pericardium with a bovie-an electric scalpel that cauterizes as it cuts-thus freeing the baby's heart from the blood-bright tissue, a nearly translucent sac. Mac will cut two rectangular patches of this tissue and store them in solution, for use later in the operation. Two stitches are then placed on each side of the opened pericardium and sewn into the patient's chest to hold the pericardium back and present a clear view of the heart. Roughly the size and shape of a plum, this neonatal heart is pumping at the rate of about 130 beats per minute, normal for a sedated child of this age and weight-forty hours and just over six pounds. The smooth, deep-red muscle on top, the right ventricle, is filled 130 times each minute by the saclike right atrium above it. With the pericardium tied back, Mac begins the work of distinguishing and separating the vessels from one another so the field will be clear and distinct when the chief surgeon, Roger Mee, arrives. Presently, Mac must pull apart or cut with the bovie the mesh of tissue joining the vessels that rise out of the heart, called the great vessels: the aorta and the pulmonary artery. Fackelmann says it again: "Stay away from that." Mac, hunched like a cane over the patient, the personification of Japanese silence and humility, says nothing. The bovie is about the size and shape of a pen. Mac depresses a small rectangular button with his index finger, and the generator issues a high-pitched tone, signaling that juice is running through the chisel-shaped tip. When Mac touches this tip to tissue, the tissue sizzles and pops, and sometimes a wisp of acrid smoke appears. The blip-blip-blip-blip of the heart monitor, the beeeep of the bovie, and the crackle of moist tissue are the main noises in this bright white O.R. The baby boy whose heart is open to the room, an apparently normal newborn, is named Connor Kasnik. His eyes, though, are taped closed; his short black hair is matted. His head is cocked to one side, and a ventilation tube has been inserted into his trachea just past the vocal cords; the tube is taped to his mouth. His arms are flat on the table, tiny palms up, a line running into the right radial artery at the wrist. Julie Tome, the anesthesiologist, has also placed a central line in the jugular vein, in Connor's neck, and a peripheral line in a foot vessel. Nothing of this two-day-old baby is visible; everything except his open chest and his beating heart is draped with green cloth, as is the metal cage above his head, where ho