Team Players : They are the menders of broken hearts. Follow the doctors, nurses and technicians through heart surgery as their clockwork precision saves a man’s life.
It is not quite 6:30 on a chilly Monday morning, but already Operating Room 14 at St. Joseph Medical Center in Burbank is flooded with light.
The stark, white-walled room is crammed with monitors, intravenous lines, a heart-lung machine and other expensive equipment. But oddly, it’s the boombox that’s secured from thieves.
On the operating table, Ed Gillespie is drowsy but still conscious as he awaits coronary bypass surgery.
In an hour, the 63-year-old retired Burbank letter carrier will be joined by an often overlooked and underappreciated group of medical workers: the surgical team.
Each day in the United States, these teams of men and women, their faces almost obscured behind masks, enter operating rooms. And when they emerge, a baby’s been born, a brain tumor removed or, in the case of Ed Gillespie, a heart’s been fixed.
Who are they?
This morning, 13 people--doctors, nurses, technicians and technologists--will tend to Gillespie. Despite their diverse personalities and backgrounds, they will blend into a harmonious unit over the next five hours as they work feverishly to improve the blood flow to Gillespie’s heart. During the procedure, Gillespie’s heart will be stilled while a heart-lung machine takes over, and blood vessels will be borrowed from other parts of his body and stitched to the coronary arteries so that clogged vessels are bypassed.
As preparations for surgery continue, the operating room is transformed into a kind of sterile stage. Team member after team member arrives, their noses and mouths covered by sterile masks. Age ranges are wide, with seniority claimed by Dr. Taro Yokoyama, the head surgeon fondly dubbed “the King of Hearts,” and nurse Betsy Stocking, both 60.
Most members have worked on the St. Joe team with Yokoyama for the past four years, ever since he expanded his practice from St. Vincent Medical Center in Los Angeles.
Each team member is handpicked by Yokoyama, and competition to join is stiff. Some workers are hospital employees, others are employed by Yokoyama and still others are independent contractors.
Some are gregarious; others quiet. And proving that vanity is alive and well even when the fashion statement you’re making consists of dull green scrubs and caps, the men groan that they should have shaved when a photographer asks to snap their picture; women beg off until they can find their eyeliner.
Beneath the joviality and differences lies a shared passion for what they consider a miracle. No matter how many times they go into an operating room, the results still amaze them. On this particular Monday, here’s how the team managed the miracle one more time.
*
6:45 a.m. If surgery were politics, the anesthesiologist would be the advance man. Dr. James Wickham is standing at the head of the operating table, overseeing anesthesia administration. But earlier this morning, a nurse had already followed his orders to administer a sedative to Gillespie in his room on 3 North.
Soon after, Rosa Ordenes, the surgery technician assigned to wheel Gillespie to the operating room, arrived. Ordinarily she tries to make small talk, figuring conversation eases anxiety. “But he didn’t talk much,” says Ordenes, guessing that the sedative had already done its work.
Now the operating room is filling up as nurses and others take up their posts. Sarah Campbell, a registered nurse and clinical coordinator, sits at the foot of the operating table. Her job is to record details of the procedure and keep tabs on which supplies are used.
Sandy Wu, the scrub nurse, stands near Yokoyama, ready to provide him with instruments. Stocking, the circulating nurse, will assist Wu.
Nurses wrap Gillespie’s lower body in sterile dressing, leaving the chest area exposed.
Off to the side, perfusionists Joseph Berendt and Fred Ferguson are preparing the heart-lung machine. Berendt and Ferguson have worked together for 21 1/2 years--so long, Berendt says, that “we sometimes come up with the same solutions for problems, even though we were thinking independently.”
Percy Tapia, the monitoring technician, will keep an eye on the monitors displaying blood pressure and other parameters of body function.
*
7 a.m. Melissa Radley, a physician assistant (trained to perform routine services such as outpatient exams and specially trained in surgery), arrives at the sinks outside the OR to scrub up. Her job is to “harvest” one of the veins to be borrowed. “We’ll take the saphenous vein from the right leg,” she says. The vein lies just beneath the skin on the inside of the leg and can be removed without significantly affecting blood flow.
“Dr. Yokoyama will tell me in advance how much he needs.” She guesses eight to 10 inches, but the exact amount is Yokoyama’s decision. “We call him the magician,” Radley says.
Like other team members, Radley openly admires Yokoyama. He understands, for one thing, that physician assistants are there to help doctors and not replace them, she says.
Near the scrub sinks, pulmonary technologist Frank Espino stands by a bank of monitors. He will keep tabs on blood gases throughout the surgery, supplying the perfusionists with running reports of the patient’s blood oxygenation and other important indicators. He’s the self-described new kid, having joined the team just three months earlier.
*
7:15 a.m. The King of Hearts arrives. Although he performs 300 to 350 open heart procedures a year, each case is unique, he says. And a preoperative angiogram--an X-ray of blood vessels--can only tell so much. “Occasionally we find additional coronary artery branches that are not visualized by angiogram that are clogged,” he says. “Sometimes the coronary artery is covered with fat or scars.”
Most likely, Yokoyama predicts, they will do four bypass grafts on Gillespie, but possibly five. “You have to determine that when you open the chest.”
Dr. Ann Connor, an assisting surgeon, arrives in the scrub area to confer with Yokoyama. It’s decided that she will make rounds and return later to relieve another assisting surgeon, Dr. Mark Dworak.
A generation separates Connor and Yokoyama, but it’s far from a professor-student relationship. In fact, when Connor was fresh out of training, eager to put into practice the surgical methods she had just learned, Yokoyama, she says, “was willing to listen to the new techniques.”
*
7:20 a.m. With his team assembled, Yokoyama begins 10 minutes ahead of schedule. He speaks softly to scrub nurse Wu: “Saw, please.”
Working with Dworak directly across the operating table, Yokoyama uses a scalpel to make an incision down the chest and exposes the bone. Next, the medical saw is used to divide the breastbone. After inspection, Yokoyama decides the left internal mammary artery is usable.
Dworak and Yokoyama often seem to rely more on glances, gestures and nods than words. Yokoyama is the undisputed orchestra leader in this theater; everyone awaits his cues.
The minute he enters the OR, he is--and remains--the center of attention. Clearly in his element, he is totally absorbed and focused in the moment. In the hospital corridors, he often walks so briskly he leaves colleagues in his dust. But in the operating room, he works slowly and steadily, depending on such unhurried attention to yield the perfection he seeks.
Says one observer: “It’s like every surgery is his first surgery.”
Says another: “Dr. Yokoyama would stay in the operating room all day if he could.”
*
7:45 a.m. The perfusionists get ready to operate the heart-lung machine, which takes over the job of the heart and lungs. The machine must oxygenate blood taken from the body and pump it back, and the system must be airtight to avoid complications such as embolism.
Now, the mood grows more intense as the team prepares to go “on bypass.”
*
8 a.m. Suddenly, soft music wafts from the boombox, which Wickham has turned on. The tune is “I’ll Be Watching You.” Anesthesiologists are the unofficial deejays of the operating room, so Wickham often picks the selections but is open, he says, to requests. Yokoyama prefers classical but Wickham says he finds him easy to please.
*
8:15 a.m. The saphenous vein has been retrieved and Radley holds it up for inspection. “Store it,” Yokoyama says with a nod of approval.
The team works in relative quiet now, the spell broken only by clinking of instruments, soft-spoken requests and beeping monitors. Then the wall telephone rings, and nurse Stocking answers it. She turns to Yokoyama: “You want Dr. Connor now?” He nods.
*
8:40 a.m. Yokoyama is looking for a suitable site on the heart muscle to attach the first graft, poking and probing, as Connor returns to relieve Dworak as assisting surgeon. Yokoyama has found his first attachment site.
Over the next 90 minutes, he will stitch the four grafts, a painstaking and exacting process made easier by the magnifying lenses, similar to a jeweler’s loupe, that he wears attached to an elastic headband.
*
10:15 a.m. Gradually, after the rest of the grafts are completed, Gillespie is beginning to be weaned from the heart-lung machine. Wickham reinflates the lungs. Slowly, the connections from the machine to the body are removed. The blood is rewarmed.
The heart, which had been motionless during the graft suturing, is beginning to beat again, slowly at first and then more rapidly.
*
10:35 a.m. The surgeons are sensing success: The EKG is normal, blood pressure steady. Brain waves, blood gases and urine output all look normal. Surgeons check for bleeding within the chest cavity and discover none. Gingerly, they insert drainage tubes into the chest area, where they will remain for a day or two.
Only then is the decision made to close the chest.
*
10:50 a.m. The intense mood becomes a bit more relaxed, reflected by conversations. “Very nice gases,” says Wickham gleefully, reacting to the latest blood gas report.
Connor asks Wickham if he’s on call later and, when he says he isn’t, she jokingly offers to find the anesthesiologist some work. No thanks, he counters quickly. He has plans.
While some team members socialize on a regular basis, the whole team rarely gathers outside the hospital. “If we did,” says one, “we’d only talk about work.”
At least twice a year, Yokoyama throws a party for the whole team. One’s usually a barbecue at his home, another a Christmas party. Other than that, most team members say they use their precious off time to catch up with family or friends.
*
11 a.m. The retractor that has held the chest open is removed. Wires are used to close the breast bone. “Two more layers,” says Dworak, referring to the two skin layers that must now be sutured closed. He’s one of the quieter team members, at least on the job. Later, asked about his bright green footwear, he launches into an explanation of the benefits of his special clog-like shoes that can be autoclaved.
*
11:15 a.m. Gillespie is ready to be transferred to the ICU.
“This is the most dangerous time,” Connor notes. The next 24 hours are considered crucial.
*
Postscript: Ed Gillespie was discharged eight days after surgery. “I feel great,” he reported 2 1/2 weeks after surgery. In an effort to keep his arteries healthy, he has given up cigarettes. His son Ed, who helped him out after surgery, is encouraging him. Gillespie is planning a trip to Las Vegas as soon as his physician allows it and is looking forward to another hospital date in January: His daughter Heather is having a baby.
WHO’S WHO IN THE OPERATING ROOM
* Joseph Berendt, 42, a perfusionist since 1972, operates the heart-lung machine during bypass surgery. “I was always interested in medicine, but finances prevented medical school.” The reward? “Seeing someone very sick go on to lead a full life.”
* Dr. James Wickham, 34, was drawn to anesthesiology because patients require a great deal of close attention. Open heart surgery still amazes him: “A recent patient was able to watch ‘Monday Night Football’ (just hours after the surgery).”
* Melissa Radley, a physician assistant for 10 years, first worked as an emergency medical technician on an ambulance but soon grew tired of the sexism. “They would only let me drive at night,” says Radley, 34. So she went back to school. The rewards, she says, are endless.
* Dr. Ann Connor, a “thirtysomething” assisting cardiac surgeon, is the first physician in her family. A cardiac surgeon for five years, she recalls dreaming of this job at age 5. “Doing this is a miracle. It’s just like flying: You wonder how the planes stay up.”
* Sarah Campbell, 52, a registered nurse and the clinical coordinator for cardiac surgery, was on her way to becoming an anthropologist, working part time as a hospital admitting clerk. “On a slow night they asked if I wanted to observe a C-section and I was hooked.”
* Fred Ferguson, 47, a perfusionist, emigrated from Scotland after college. After serving in the Army, he trained to be a perfusionist, a job he has had for 25 years. “It doesn’t get old, especially when we’re working with children.”
* Frank Espino, 40, a pulmonary technologist, has been in the profession for 20 years. He decided to enter medicine after both maternal grandparents passed away from tuberculosis. “Medicine does work,” he says. “It’s truly incredible.”
* Betsy Stocking, 60, a circulating nurse, has been an RN since 1955. She says the profession has been good to her: “As a single parent, I raised two girls, now 32 and 35.” In her job, she is on call to assist the scrub nurse during surgery.
* Percy Tapia, 52, has been a monitoring technician for 14 years. He received training on the job after he wanted to progress from his previous hospital job. During the surgery, he carefully watches the operating room monitors that display blood pressure and other data.
* Rosa Ordenes, 49, a surgery technician, has been working in the field for 14 years. She wheels patients from their rooms to the operating room, often trying to make conversation to ease their anxieties.
* Dr. Taro Yokoyama, the primary cardiac surgeon on the team, has performed open heart surgery for more than 30 years. Says Yokoyama, 60, who knew he wanted to be a cardiac surgeon in grade school: “You do something that helps people and I feel good about it.”
* After 20 years on the job, Dr. Mark Dworak, an assisting surgeon, is as enthusiastic as a newcomer. “I love my job,” he says. He decided on surgery as a specialty during medical school. Asked his age, Dworak playfully suggests “above 40,” then “45.” He’s 51.
* Sandy Wu, 37, a scrub nurse, knew she wanted to be an RN in high school, inspired by an aunt in the profession. The draw for the past 12 years? “You have to be prepared for the unexpected.”
THE PATIENT
Ed Gillespie, 63, a retired postal carrier, first underwent open heart surgery in 1979, but it was declared necessary again this year after his cardiologist, Dr. Mohammad Daood, performed an angiogram and discovered the old grafts were blocked.