A Pediatric Cardiac Surgeon Narrates How He “Cheats Death" To Save Newborn Lives #DoctorsForGood
By: Dr. Neville Solomon
Published On: June 26, 2018
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Standing in the middle of our postoperative cardiac surgery intensive care unit, I was surrounded by several babies recovering from complex cardiac surgical procedures. Most were less than a year old and weighed less than 10 kgs... tiny tots who had had their hearts fixed by us. Some were as light as 2.2 kgs. While discussing the condition of the sickest one with the doctor on duty, I was contemplating how wonderfully the condition had improved and suddenly blurted out, "It is nice to cheat death".
Cheating death. It sounds so apt to describe what we do in our department; and I was overwhelmed with a feeling of satisfaction and warmth. A veteran of thousands of surgeries and years of toil, I felt God had used me for a purpose and all the struggles were worth it.
Blessed with an awesome team, working in one of the most professional organisations in India, and allowed to perform all kinds of difficult operations on poor children with funding to boot, I was reminded of the Katy Fitzgerald song, "It does not get better than this."
Pediatric cardiac surgery is one of the most difficult super-specialties in the field of medicine. Make a fist and that is the size of your heart. Now find a baby nearby, and make a fist out of his or her hand, and that is the size of the baby's heart. Add a number of complex problems requiring difficult rerouting and closure of defects, the challenge is immediately apparent.
To spice up the challenge, bring in the element of time limits as baby is put on a heart-lung machine, the heart and lungs are temporarily stopped, the circulation is taken over by a machine and blood supply to the heart is stopped, one always feels one is racing against the clock.
Surgery has to be done expeditiously and accurately. The longer one takes on the heart-lung machine, the more the baby can suffer - with damage to the heart, lungs, kidneys, liver and brain.
While training young surgeons each day, I tell them taking up pediatric cardiac surgery is like joining the military; and every surgery you undertake is like going to war... a war of healing and a cheating of death and every day is a battle!
And taking up this daunting challenge requires a great team, and this starts with our cardiologists. They are our " intelligence division ". They screen the babies, study them in depth, and conduct a series of tests. Every aspect is analysed by them and the surgeons at "cath meetings" every morning. Every possibility and eventuality is factored and bailouts and contingencies considered.
This information is fed to the operating team, the "military unit" consisting of surgeons, anesthetists, perfusionists, nurses and technicians. Some surgeries are quick and comparatively straightforward; others can go on for a whole day.
The babies are brought out to the intensive care unit. These are our "military bases" where specialised pediatric critical care specialists or intensivists give round the clock surveillance to these babies as they recover from such a traumatising ordeal. Some little babies come out with the chest open; the odd one even on ECMO support. Many, particularly the bigger children are brought out breathing on their own. Some, however, will take time as their heart and other organs mend. They have to be supported during this period; kept pain-free and infection-free and nutritional requirements met.
Batsmen are often asked what was their favourite innings and bowlers their most memorable performance. If asked which patient I remember or any surgery in particular, it would not be the myriads of success stories or thousands of babies who sailed through, but the ones where we "cheated death ". A few immediately pop up in my mind.
Arterial switch operation in babies born with the circulations switched around (transposition of great arteries) are among the most challenging and satisfying. Among the many we have done, two immediately come to mind. A newborn baby was stuck on ventilator in a hospital in Madurai, blue and dying.
Our pediatric cardiologist, Dr Muthukumaran was called in. He diagnosed the above condition. The center was not a tertiary pediatric cardiac center such as ours which could undertake an emergency arterial switch operation. He did a bedside balloon septostomy-inserted a catheter through the vessels in the groin, pushed a specially designed balloon and created a hole in the heart.
This briefly stabilised the baby and he was shifted to us in an ambulance and on a ventilator. We took for emergency arterial switch operation the next day. The baby did have a rough ride in our ICU for a few days but subsequently turned around. The baby is doing is now a thriving school-going child.
Another was a baby with a mitral valve, a valve that allows blood flow from one chamber of the heart to another, that was leaking dangerously. Changing the valve is easy but has very high mortality in small babies and is very dangerous as they have to be given potentially dangerous blood -thinning agents. The baby was just 3 kgs and had been put on ventilator several times since birth with heart failure. We would have liked to wait but that wasn’t an option -the baby landed up in our ICU totally crashed and on a ventilator.
We took the baby to the operating room and with a series of innovative surgical maneuvers, repaired the leaking valve and made the valve competent. The real icing on the cake was when the child came for review last week five years after surgery with a perfect looking valve.
Total anomalous pulmonary venous connection (TAPVC) is another complex condition in newborn babies or infants where we literally drag the baby from death's door. They are often mistaken for lung infection in other hospitals and come to us with "all systems shut down ".They are often diagnosed for the first time by our pediatric cardiologists and are rushed in for emergency surgery. Among the many we have saved, the most satisfying was a case where we already knew the condition existed right from when the baby was in the mother’s womb. The mother had an elective Caesarean section at 9 am, the baby was diagnosed and taken to the operating room at 2 pm on the day of birth. The baby was back in the ICU by 7 pm the same evening with his heart permanently fixed. He is now going to school, active with a perfect heart and on no medications.
The list can go on endlessly as our team has been one of the major success stories in this very "niche speciality "...other examples being operating on children with abnormal blood supply and damaged hearts (ALCAPA - anomalous left coronary artery from pulmonary artery), being part of a brilliant team of doctors at Apollo Children's who successfully separated conjoined twins joined at the chest, being part of a team which operated on a baby shifted from Oman on a ventilator with a cardiac condition and the windpipe nearly blocked off... these have been wonderful challenges and experiences.
Some undergo staged procedures with us; the first surgery as an infant, the second and third as they get older. They become like family and think of you as their own. Many are in college and are completely unrecognisable when I meet them, fine young men and women.
Our profession mirrors life. Some days are good, some bad. There are days I have jumped in joy as we pulled off a miracle, the odd day we have lost a child and cried, but it has all been worth it - the years of struggle, the countless hours spent in the hospital, the thousands of kilometers we have travelled conducting camps, the hundreds of people we have met to raise donations so that we do not turn away a child based on financial background and the multiple administrative headaches as the team is the key and keeping them together is paramount to success. And all this has been worth it as we really have cheated death on numerous occasions.
Dr Neville Solomon is the Head of Department of Pediatric Cardiac Surgery at Apollo Children's Hospital, Chennai.
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