The Knife’s Edge. Stephen Westaby

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The Knife’s Edge - Stephen  Westaby

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department, just three heart surgeons would perform 1,500 heart operations each year and we’d cover the chest surgery between us. Now in the same modest facilities we had five heart surgeons performing half that number of cases, alongside another three chest surgeons operating on the lungs. This was the price of progress – twice as many highly trained professionals doing much less work amid a disintegrating infrastructure. But hey. A hospital delegation was trying to recruit nurses in the Philippines that very week, so all would be well one day.

      But the anaesthetic room was empty. The anaesthetist was sitting in the coffee room eating breakfast.

      ‘Have we sent yet?’ I asked with an air of resignation.

      She shook her head. We had to wait for the paediatric intensive care ward round to decide whether they could give us a bed. No bed, third cancellation. It couldn’t be allowed to happen, yet the round hadn’t even started. It was an 8.30 start at the other end of the corridor, so I went there directly. With rising blood pressure, I still tried to remain polite. The staff had desperately sick children to care for and my little patient was just another anonymous name in the diary, followed by the words ‘atrioventricular canal’. The whole centre of her heart was missing and her lungs were flooded. With every day that passed, her chances of survival decreased.

      Every one of the cots had a little body in it, with fretful family groups gathered around. My eyes fixed on a pair of gangrenous arms – the meningococcal meningitis child I’d watched for weeks, hanging on to life. The mother knew me well enough by now, seeing my babies come and go with happy parents. I always asked her how things were going, she always smiled. Today they were going to amputate those black, mummified limbs. No more little hands or tiny fingers. They would just drop off, with a little help to tidy things up.

      I asked whether there was any chance of a bed by lunchtime, so that we could at least send for the baby. Sister really didn’t want to let me down. One of her day-shift nurses was already in the radiology department with a head-trauma victim who’d been hit by a speeding car on the way to school. Should the injuries prove as severe as feared, ventilatory support would be withdrawn. Then my case could go to theatre. I enquired whether the organ donor phrase had been mentioned.

      For comfort I picked up a bacon sandwich, then wandered off in my theatre gear through the hordes who arrived for work at nine o’clock. These were normal people who didn’t have to split breast-bones, stop hearts or give desolate parents bad news, such as ‘Your child’s operation is cancelled again.’ Now the dilemma. Should I give up on the little girl, then send for the VIP and her mitral repair? The lady wouldn’t have been starved long enough or had a pre-med, but at least I could take off to Cambridge to see my daughter afterwards without the worry of leaving a newly operated infant when I wasn’t on call. Or should I hold out for the possibility of a bed for her parents’ sake?

      Striding purposefully back to the operating theatres, I requested that they send directly for my first case. The agency anaesthetic nurse hadn’t the faintest idea who I was and confronted me with the usual crap, saying that they hadn’t heard if there was a bed yet.

      Uncharacteristically, and because I didn’t know the woman, I lost the plot and shouted, ‘I’m telling you there’s a fucking bed. Now send for the child.’

      The anaesthetist stood in the doorway and gave me a long, hard stare. The nurse picked up the phone and called the paediatric intensive care unit sister. At that moment, I worried that others had not been informed that the trauma case was not for ventilation. But I got lucky. The response confirmed my outburst. Yes, we could send for the cardiac case.

      To put the baby asleep and insert cannulas into her tiny blood vessels would take an hour, so to avoid the transmitted anxiety from the parents’ tearful separation from their baby girl, I slipped into the anaesthetic room of the thoracic theatre, carrying a plastic cup of ghastly grey coffee. This time I was warmly greeted by an old friend, whom I asked to measure my blood pressure. It was 180/100 – far too high, despite the daily blood pressure medication I had been taking for ten years.

      Would a concert pianist prepare for an important recital by first enduring three hours of intense frustration? Would a watchmaker have to face a blazing row before assembling a complicated Rolex movement? My job was to reconfigure a deformed heart the size of a walnut, yet I enjoyed zero consideration for my state of mind from those around me. I wouldn’t so much as get on a bus if the driver was subject to that much irritation. The first time I stood as the operating surgeon looking into the void at the centre of an atrioventricular canal defect, I thought, ‘Shit, what the hell do I do with this?’ Yet I always succeeded in separating the left and right sides of the heart with patches, then creating new mitral and tricuspid valves from the rudimentary valve tissue. It’s complex work, but I never lost one on the operating table.

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