When cardiac surgeon John Eugene catches his first glimpse of the heart patient, he starts to giggle.
"I'm sorry. I didn't mean to laugh," he says to another doctor. "But these guys always make me laugh."
The patient is an 8-year-old English bulldog with enormous eyes and flaps of furry skin hanging from his jowls. His name is Clouseau, as in inspector, and he has the kind of face that begs to be loved. It is hard to stifle a chuckle.
The doctors and assistants are gathered in a small operating room at UC Irvine's Beckman Laser Institute to save the dog's life. But if it weren't for procedures performed on humans at the institute, Clouseau wouldn't stand a chance.
At a time when some animal rights activists are protesting what they consider inhumane treatment of laboratory animals, the Laser Institute has come up with a new twist: it has developed laser techniques on humans and applied them to animals.
If the institute and the doctors were charging for their services, the operation would cost more than $2,000. But as it is, the facility and the doctors are donating their time not only to spare Clouseau's life, but to gain experience in laser medical techniques.
"We experiment with people first, then we do (the procedures) on animals," says Michael Berns, Ph.D, head of the institute. "Turns out local vets got wind of our facilities and operating room for research, and asked, 'Can we bring our dogs and cats over with cancer and use your fancy lasers to cure animals?' "
Berns says the facility has spread the word to veterinarians that laser treatments will be offered to animals one or two days a month at little or no cost.
The 30,000-square-foot institute--founded in 1982 by Berns and Orange County industrialist Arnold O. Beckman--is the world's only laser treatment and research center. The lasers--light amplification by stimulated emission of radiation--are piped via fiber optics throughout the building, to be tapped into whenever needed. Opened in June, 1986, the center employs a staff of 40 and houses some 40 different lasers.
"It's been a teaching, research and patient treatment center," Berns says. "Now we're opening it up to four-legged patients."
It's not just to help the animal kingdom that the institute is offering its services. Humans, after all, still come first at Beckman as they do elsewhere. The principal motivation behind offering the facility to vets is ultimately to help people. Because veterinary work yields nearly as much information in laser use as human procedures, the experience gained from the animal operations will be applied to people. And, as Berns points out, there are plenty of folks in Orange County who don't flinch at the notion of seeking surgery for their pets.
Berns also talks of the "town and gown" separation that often exists in university communities. He hopes the institute and its services can help bridge the gap.
"It's a unique service," he says. "It gives us experience, it helps the animals. And it's good PR for the institute."
Clouseau's cancerous tumor is pressing against his trachea, causing him pain and hampering his breathing. Eugene, who has performed laser heart surgery on humans for five years but has yet to treat a dog, hopes to reduce or remove the tumor with the infrared beam of a YAG (yttrium-aluminum garnet, the elements that make up the active material) laser. Conventional surgery would cause too much bleeding.
"This is a very rare treatment and a rare tumor," Eugene says. "We are the only ones to do it, that I've ever heard of. Not many other places are set up for this."
As Clouseau perches on the operating table, his baleful pink and brown eyes follow the doctors as they huddle in conference. Assistants stack equipment in corners, on shelves and atop tables, and the room starts to shrink. Overhead, a surgical light hangs like spider legs, illuminating the patient.
Clouseau's enormous nose is covered with a mask pumping oxygen and Isoflorane, and soon his legs begin to buckle as he falls asleep. Soundless, he is slumped on the table, looking adorably helpless.
A relatively new and expensive anesthetic gas used almost entirely on humans rather than animals, Isoflorane was chosen for Clouseau because it is easier on the heart than some gases. Because the surgeons are working so close to that organ, it was the first choice.
It's 10:15 a.m. A monitor records Clouseau's vital signs and during pauses in the doctors' medical play-by-play, the only sound is Clouseau's thundering heartbeat.
Everybody in the room is asked to wear paper hats and masks.
"Sorry, but this is somebody's kid," says Robert L. Rooks, the Fountain Valley veterinary surgeon who has been treating the bulldog. "We'll go by the books."
As a YAG Laser model 4000 is wheeled into the room, Clouseau's chest is sliced open by Eugene and Yvon Baribeau, a cardiac surgeon from Montreal who is attending the operation to assist and learn about laser surgery. As the surgeons cut, they burn the flesh with a cauterizer, releasing the stench of sizzling skin.
The small room, now filled with 12 people and the dog, is growing warm and crowded. Eugene is still slicing, carving a hole about five inches wide, and cauterizing the wound to burn dead tissue and prevent infection. His hands are probing inside, a sightless search for the tumor. Clouseau's open chest continues to heave with his breathing.
"The suction's not working," Eugene says. "I hate these things."
Everyone in the room seems calm, although beads of sweat are forming on the brows of two assistants.
"This is a helluva tumor," says Eugene, probing inside Clouseau's chest. "Is he alive? I didn't mean that facetiously, but this is a big tumor."
Now there is a lot of blood and the gauze wraps are soaked with red.
Clouseau's heart rate slows dangerously. Rooks and his assistants adjust his catheter and the bag of blood hanging near the operating table. The monitor grows silent, its signal flattens.
"Is he OK?" Eugene asks.
For what seems like several minutes, no one answers.
"Yeah, he came back," Rooks says.
"He's holding pretty good now," Rooks says.
"I'm just trying to get to the base of this tumor," Eugene says.
The doctors pull out chunks of what looks like chicken fat from Clouseau's chest.
"This is a huge mass," Eugene says of the golf-ball-sized tumor. "I'm going to shrink it down. I'm not going to take it out. That would need a bypass."
Eugene is providing a running commentary as an educational tool for the others. They have decided to use the argon laser rather than the YAG. The argon allows selective destruction of blood vessels while leaving surrounding or overlying tissue unharmed. Its blue-green light, which courses to the patient through a fiber-optic tube from a source on the wall, is so intense that everyone is told to wear goggles.
The doctors are disappointed by the size of Clouseau's tumor, but they are still hopeful they can buy the dog several months of life.
"I don't want to cause this fella grief," Eugene says of Clouseau. "I kind of like him."
It's 11:15 a.m. The laser is off now and Clouseau's chest is restitched.
"The cancer was growing into the heart sac," Eugene explains. "We shrunk it down and bought him a couple of months."
Eugene says that because the tumor is so large, it could not be removed except by heart bypass surgery, a more complicated and costly procedure than what the institute and the doctors are prepared to undertake.
Eugene turns to Rooks. "I'm sorry. But at least you've got a live patient."
With the institute well on its way to becoming the nation's premier laser research facility, Berns, who is a professor of surgery, cell biology, ophthalmology and radiology at UC Irvine, has another pet project brewing on the back burner: He has proposed to university administrators that a laser veterinary hospital be built on three or four acres next to the institute.
"There is a real need," says Berns, who hopes to raise most of the money for the $10- to $20-million facility through private donations. The Beckman Institute cost $7 million, built entirely with private money. The director envisions a clinic for treatment of large and small animals on land now slated for a parking lot.
"People have a lot of concern for their pets, so there's a high level of interest out there."
Last week Berns received word from the university's vice chancellor for physical planning that the land is tentatively being reserved for the vet clinic. The professor still has to go through several channels before final approval is granted, but Berns is hopeful that ground will be broken in about a year.
After his surgery, Clouseau is transferred to an ICU. Three days later, part of the tumor broke loose and lodged in the arteries of the heart. He died instantly.
"He had a great will to live," says George Sutton of San Juan Capistrano, who with his wife Lois became owners of the frisky puppy in 1980.
"We were trying to save his life," says George. "We did everything we could."
Now buried at a pet cemetery in Huntington Beach, he will be remembered by his owners as a beloved member of the family, and by the institute as a brave little bulldog whose terrible tumor may help advance the field of laser technology.