The Virtuoso - The Miracle of Saving Children's Lives

Excerpted from
Walk on Water; The Miracle of Saving Children's Lives
By Michael Ruhlman

I'd been hanging out at the Center for Pediatric and Congenital Heart Diseases at the Cleveland Clinic for two months when the shell-shocked Kasniks arrived. It had been a busy time for the center's staff, filled with all kinds of drama and tragedy, deaths and saves, errors and grace, and mostly a lot of work and stressful nights on call-the routine stuff of intensive-care units, critical-care medicine, and peds heart centers across the country. On one of my first days, while I was speaking with Roger Mee in his office, a call came in, and he answered it and then said to me, "Arrest in the cath lab," with little more urgency than he might exhibit if he were commenting on the weather. Just before jogging oil, he paused, turned back to me, and asked, politely, "Do you want to come along?" His partner, Jonathan Drummond-Webb, had left his O R. patient to Frank Moga and raced down there before Mee, the cord to his headlight trailing behind him like a banner; by the time I got there, he had already begun mighty chest compressions in an effort to resuscitate the patient-a teenager who'd been undergoing a catheterization procedure, and whose feet now lifted off the table with every push-successfully, as it would turn out. The last time this had happened-happily, it was a rare occurrence-the patient was a baby, and Mee had had to open its chest right there on the cath lab table.

There had been a lot of sick babies at the center during those two months, and the trend would continue all the way through December, with all manner of the worst kinds of heart problems a baby could survive; in three instances the problems were so bad they had to put in new hearts altogether. But this one case, that of Connor Kasnik and family, was a microcosm of the world of peds heart surgery, an emblem of the progress that's been made in the field of congenital heart disease-and not just in open-heart surgery, which began in the 1950s, but more recently, through the 1980s and 1990s, in echocardiography, interventional cardiology, cardiopulmonary' bypass, and neonatal surgery. The repair of this particular baby's heart defect was an elegant description of congential heart disease generally, not least because it was a success, as is most neonatal heart surgery today. Connor was extubated the day after the switch, was taken off the ventilator, and soon awoke; when I saw Bruce, he looked rested and had a big grin on his face. "It's a great day," he told me, brimming with exhilaration. Exactly one week later, Connor lay in a crib in the ward, wearing jammies and covered by a red blanket shaped like a Christmas stocking-"what he was supposed to go home from the hospital in a week ago," said Karyn, evoking the powerful joy-sorrow that most parents here feel. ("I would never call this a cure for life," Mee says of the neonatal switch operation.) Above her son, a blue Elmo propped below a crucifix decorated the curtained-off area, along with "It's a Boy" and "Get Well Soon" balloons and four wooden snowmen with "Mommy," "Daddy," "Kyle," and "Connor" written on them. The Kasniks were preparing to take their baby home. This was the norm at most big heart centers.

Finally, Connor was an emblem, for me, of a remarkable truth that never left my mind in all the time I spent in the O R.: when a baby or a child or an adult is on the table with his or her chest open, disaster is never more than a breath away, no matter how routine or simple the case may be. One small breath. None of this, however-not the medical advances, the drama of the O.R., or the pathos of the families' stories-was why I'd asked to be here in the first place. I'd originally come to learn more about the craft of surgery and better understand the people who make it their daily work.

Story ideas evolve from all kinds of sources, and this one had its beginnings in a conversation over dinner with a family friend named Stu Eilers. Stu is a big guy with a big voice and a dramatic sense of story that serve him well in his courtroom appearances as a civil defense lawyer. He had a friend I ought to meet, he said-a heart surgeon. A pediatric heart surgeon, to be precise. Roger Mee operated on babies' hearts every day, Stu explained, and was reputed to be one of the best such surgeons in the world. Stu, as usual, had some choice stories to tell in support of his claim that this Mee fellow was indeed worthy of interest. There was the time, for example, when the Israeli government "kidnapped" Mee while he was on vacation in Italy with his wife, flew him to Israel, and all but forced him to operate on a dignitary's child: the time he was flown to Saudi Arabia to perform surgery on the king's grandson; and the time when, after word got out that he was considering moving to the United States, two men from the Cleveland Clinic (operatives in dark glasses and black trench coats, in Stu's portrayal of the scene) arrived in Melbourne, Australia, to make him a generous offer.

All this made for excellent dinner chat, but it wasn't what hooked me. The thing that stuck with me after that evening those few years ago, when I first heard Roger Mee's name, was Stu's simple comment, uttered with almost hilarious disbelief: "I mean, what a job. Imagine it."

What a job, indeed. This was interesting to me. Here was a man who operated on babies' hearts for a living most days of his life, often doing two or three operations in a single day. And he was not just good at fixing hearts that were sometimes no bigger than a walnut; he was one of the best in the world. For a quarter century he'd been doing this. Imagine the stress of that work, Stu had said. Look at the questions bound up in it: What child don't you try to save? What if a patient can't pay, what do you do then? Not operate? And if you do operate, how many free operations do you do? How-do you get to be the best in the world at one of the most difficult surgical specialties there is? Who do you become when you do this work? And how do you respond to the job's ultimate responsibility: the fact that your personal skill and intelligence, or lack thereof, will determine the quality of this child's life from there on out, may decide whether he or she lives or dies, will change the lives of the parents who have entrusted you, a stranger, with their most precious treasure? Who was this guy Mee, anyway?

At the time, in the winter of 1999, I was about to move my own family to the East Coast, where I would work at a boatyard in Vineyard Haven, Massachusetts, and learn more about the people who build boats out of wood, craftsmen and sailors whose livelihood is based on their ability to bend planks around frames. For the three previous years I'd been writing about professional cooks and the work of cooking, had even for a short time became a clock-punching cook myself. I wrote about people at work; work was important. But not just any work or anyone at work: I tried to concentrate on those few who were considered by their peers to be among the very best in their professions. I'd developed at cooking school a fascination with people who were exceptionally skilled at what they did, had discovered that people who pursue perfection, date-on-a-dime clarity, and impossibly high standards are the most compelling human beings alive, and I'd decided that if I was going to spend my life watching and writing about people at work, I was not going to focus on what was merely average or, worse, mediocre. I wanted to see the best. By chance or by unconscious design, my chosen subjects were people who used their hands for a living, people who worked with natural products, food and wood. And now my friend Stu had planted in my mind a vision of a different kind of laborer, a man who like the others worked with his hands for a living, another genuine craftsman, but one whose "product" was living tissue and whose trade was plied on the hearts of children, often while those hearts were beating.