Article about Pediatric Cardiovascular Surgeon

This in an interesting article. It was posted on an internal message board at Children's Mercy and forwarded to me from a nurse who works there. Children's Mercy has two Pediatric Cardiovascular Surgeons - Dr. Lofland and Dr. O'Brien.


What It’s LikeOperating on a Heart no Bigger Than a Strawberry

Gary Lofland‚ MD‚ Section Chief of Cardiovascular SurgeryThe Joseph Boon Gregg/Missouri Endowed Chair in Pediatric Cardiac Surgery

Pediatric cardiac surgery is completely different than any other kind of surgery. We are operating on tiny hearts that are going to continue to have to grow‚ so always in the in the back of your mind you are factoring in the ability of this heart – that you are going to rearrange – to grow.

Sometimes it is like you have been given a heart kit and are expected to rearrange it and have it work. Unlike some other forms of surgery where you allow things to heal‚ what you do in the operation has to work the first time. It has to work.

Night Before SurgeryAlways the night before‚ I go through all the surgery I’ll be doing the next day and some I go through step by step. For some patients you not only have to have plan A‚ but a fall-back plan in case you encounter the unexpected or plan A starts to go awry because of previous surgeries‚ adhesions‚ things like that.

We try to do two surgeries every day‚ sometimes three. You have to plan out and risk stratify them. We try to do some of the more straight forward ones early on and follow up with the ones that are going to demand more time and thought. But you do that by thinking through them ahead of time.

I get plenty of sleep the night before‚ but there are some operations performed upon kids that one absolutely dreads because you know it is going to be a very‚ very risky outcome with a fine balance between success and failure. Those you wake up at night thinking about.
So‚ there is sort of that kind of pressure. Some of the things I used to really fret and stew about I’ve done so many times that I look at those as sort of relaxing operations. There are so many more complicated things out there to be done.

Day of SurgeryPrior to surgery‚ I don’t talk. I like to get into “the zone.” If I don’t engage in idle chit chat‚ it is not out of rudeness‚ it is out of discipline.From the time the patient arrives in the Operating Room‚ I stay in the OR. There is a lot of preparation going on with the patient‚ so until I make the skin incision‚ I just pace and wait. I just can’t wait to get started.
I really don’t feel any pressure during surgery‚ unless I encounter something that is completely unexpected. I like to operate quickly and detest inefficiency‚ lack of focus and wasting time. I have always felt that I work better under pressure‚ thinking clearly and quickly.

During SurgeryWhen you are doing this kind of surgery‚ you are operating under significant time constraints. Once you stop the heart or circulation‚ everything is basically dying. You are working against the clock‚ so when you encounter something unexpected‚ you have to think immediately. How am I going to deal with this? How am I going to fix this? You have to process that information pretty quickly.

One of my mentors‚ Dwight C. McGoon‚ MD‚ from the Mayo Clinic‚ wrote about the responsibility of the heart surgeon dealing with the great complexity of the heart and congenital defects‚ stating‚ “He or she must feel the weight of having accepted from the parents that strongest of all possible human obligations - the profound‚ primordial‚ instinctive identification and responsibility for an offspring.”

When you are doing this‚ you are basically accepting responsibility for a life as yet unlived.
So how do you deal with it? Well‚ I haven’t thought too much consciously about it. You just do.
After SurgeryAfter the surgery‚ I go talk to the family. What I say has lots to do with how the operation went‚ how sick the patient was going into surgery‚ and how sick the patient is going to be after surgery. Even if it is a complicated operation that went extremely well and the patient is doing just fine‚ that talk can be brief because everything went so well.

It’s only when you encounter things that you didn’t know about or when you encounter anatomy that even though you’ve repaired it using everything you have‚ and you’ve done the best you can with the tissues you have‚ but the child is going to need something else down the road … that talk is a little longer.

You always try to be optimistic but you also have to be very objective. I don’t hide anything with parents. I tell them exactly what we encountered‚ what we had to do‚ how the results look now and what might be expected. I try to be reassuring and respectful.
When you are faced with complicated anatomy and the operation went great and the repair looks perfect and still doesn’t work … that’s the frustration. This is not a profession that makes you arrogant. It makes you humble.

But even though it is stressful‚ it can be highly satisfying. As Dr. McGoon wrote‚ “Surely no more depth of sincerity can be imagined than that expressed in the ‘thank you’ of a parent for a safe and successful surgical endeavor‚ nor more pain‚ frustration and despair if the outcome should be the opposite.”

Pondering the Past and the FutureWhen I look back at the end of each surgery‚ and at the end of my career‚ I hope all my patients and families know that I did the absolute best that I could with every patient upon whom I operated. I would also like to think that I did something to push back the limits of what we are able to do.