Healing Hearts: A Memoir of a Female Heart Surgeon - Hardcover

Kathy E. Magliato, MD, is currently the director of women’s cardiac services at Saint John’s Health Center in Santa Monica, California, and an attending cardiothoracic surgeon at Torrance Memorial Medical Center in Torrance, California, where she is developing a women’s heart center to address the cardiac needs of female patients. She lives in Pacific Palisades with her husband and their two children.

Chapter 1: Every Sixty Seconds
 
MAT: MAGLIATO-ADJUSTED TIME. IT’S GREENWICH MEAN time adjusted for the atomic clock plus twenty minutes. Which means it’s your time plus twenty minutes. It’s the clock I run on except, of course, when it’s an emergency. Then I am there in a heartbeat (pun intended). Otherwise, it’s whatever time you say you want me there—for dinner, for a playdate with the kids, for an eyebrow waxing—plus twenty minutes. And don’t roll your eyes at me when I get there. You’re lucky that I even showed up at all.

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It was a still spring morning. The kind of morning that makes you yearn to be lazy. To languish in the comfort of your home while sipping coffee outside and smelling the morning ocean breeze of the Palisades, salt mixed with night- blooming jasmine. How I wish I could be lazy. Just once. When my alarm clock goes off at 5:03 a.m. (I always set it for an odd number), it’s like a starter pistol for my day—assuming I ever went to sleep in the first place.

So I found myself that morning running on MAT. I desperately wanted to drop my son at school so I could maintain at least some semblance of motherhood. We were running late by everyone else’s standards—twenty minutes late. I was surrounded by signs of road rage everywhere as I was trying to make my way safely to Nicholas’s school. Everyone was on a cell phone, everyone was blowing a horn in a cacophony of rage, everyone was pissed off, everyone was yelling or gesturing to a neighboring car, and everyone was driving while intoxicated on Starbucks sugar- free vanilla lattes with regular milk. Yes, it was a typical three- mile commute to my son’s school. My only hope was that there would be no accident so I would at least stand a chance of getting to school before they were singing the good- bye song under the good- bye tree. If there was to be a motor vehicle accident that day, perhaps it would be between two organ donors so that the whole day wouldn’t be a wash.

I was making my way through an intersection on San Vicente Boulevard when a guy holding a cell phone under his chin, a coffee in his left hand, shifting with the right hand, driving with his knees while blowing his horn with his left elbow, and yes, folks, flipping another driver off with the middle finger of his free shifting hand nearly struck me. Multitasking at its best—and worst. I careened out of the way, missing him and the joggers and bicyclists along the side of the road (don’t those people have jobs?). In the process, however, I spilled my coffee, which I had been balancing between my thighs (a trick my husband taught me), all over my lap. My entire car smelled like coffee and my thighs were on fire. Great. What else could go wrong today?

BEEP! BEEP! BEEP! BEEP! BEEP! BEEP! BEEP! BEEP!

It does that incessantly, you know, until you retrieve the page and turn it off. It’s a sound that makes blood run from my ears. The first page of the day and it was from the cardiac catheterization lab, or cath lab as we call it, which is where patients get an angiogram to look for blockages in their coronary arteries. It is a place of pain and discovery for me and the patients. Thankfully, I was just pulling into the parking lot of the hospital when my pager went off.

The call was about a female pediatric patient who was having a heart attack. Pediatric, by my standards, is a patient in their thirties or forties, since most of our cardiac patients are well into their eighties and nineties. She was having a cardiac arrest, meaning that her heart had ceased to beat, and she was undergoing CPR. Any other information about her was irrelevant to me, including her name. I needed to get to the cath lab stat and further information over the phone would have just delayed me, as I can sprint from the parking lot faster with the phone on my belt clip than at my ear. Little did I know at the time that I would have the next three months to get to know everything about her and her family.
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Dorothy was a vibrant forty-seven year-old woman who successfully balanced raising six children while holding down a full-time job as a nurse for a gastroenterologist. She carried stress around like an American Express card. She never left home without it. It was her constant companion and she learned to just “live with it.” It was simply woven into the fabric of her being.

For several months, she had been experiencing indigestion—a gnawing pain located in her upper abdomen, which was worsened by stress and relieved with rest at night. Recently, however, she was even waking at night with indigestion and kept a constant supply of antacids at her bedside, which she chewed like candy throughout the night. She told the gastroenterologist for whom she worked about her symptoms and he said, “It’s probably an ulcer caused by stress. You should have an endoscopy to check it out.” When all you have is a hammer, the whole world looks like a nail.

She was admitted to the hospital the following week for an upper gastrointestinal endoscopy—a simple outpatient procedure that uses a scope to look at the esophagus, stomach, and proximal small intestine. The gastroenterologist felt that as long as she was having an upper endoscopy, she might as well have a lower endoscopy, or colonoscopy, during the same appointment. It would be a waste of time and anesthesia not to check for colon cancer.

Her upper endoscopy was performed and found to be normal. Her lower endoscopy didn’t go as smoothly. Inadvertently, her colon was perforated during the examination and a general surgeon was called to evaluate Dorothy. She required urgent surgery to repair the small hole in her colon. The abdominal surgery was straightforward and went well. Dorothy would make a full recovery and be out of the hospital in a few days. Or so she thought. But less than twelve hours later, while seeming to recover, Dorothy had a massive heart attack. She had the type of heart attack that, in medicine, we nickname “the widow maker” because it does one thing: It kills. No one had bothered to ask Dorothy about her risk factors for heart disease. She had four. No one bothered to check her preprocedure EKG. It was abnormal. Why not? She was young. She was otherwise healthy. She was only having a “minor procedure” to look for an ulcer. But 1 in every 2.4 women will die from cardiovascular illness. Put another way, if you are reading this book and there is a woman seated on either side of you, look to your left. Look to your right. One and possibly two of you will succumb to heart disease. The American Heart Association estimates that one woman in the United States dies every sixty seconds from cardiovascular disease. In other words, the widow maker prefers women.

Dorothy was rushed to the cardiac catheterization lab for an emergency angiogram to evaluate the status of her coronary arteries—the arteries that bring life- giving blood to the heart. During an angiogram, dye is injected into the arteries and traces the path of blood flow. Like a road map, it reveals where the blockages are.

And there it was. The widow-maker lesion that causes a blockage in the main artery of the heart that essentially eliminates blood flow to the entire front and left side of the heart. Death takes on many forms, great and small. In this case, death was a three- millimeter collection of calcium, fat, and platelets beyond which no blood flowed.

By the time I arrived at the cath lab, Dorothy had arrested three more times. From the viewing room just outside the cath lab, I watched the team work to resuscitate her with the same efficiency as a NASCAR pit crew. Clear! Shock. Chest compressions. Adrenalin injection. Breathe. Repeat. And so the battle goes.

While I watched the resuscitation, I was faintly aware of two things: the pungent smell of the coffee I had spilled on my lap and the scent of charred flesh from the voltage being passed through her skin. The combination smelled like roasted marshmallows whose edges had been singed by a Lake George campfire.

The cardiologist who had performed the catheterization approached me in haste. Sweat formed on his upper lip and brow. He had been working hard to save her.

“Is surgery an option here?” he said, his eyes drifting to my wet lap. I was accustomed to men addressing my breasts before, but this seemed really awkward. Then I remembered the coffee spill and realized he must think that I had wet myself in fear or that I have a serious incontinence issue. “Let’s get this out of the way right now,” I said, forcing eye contact. “I have not peed my pants in fear, and as long as we’re on the subject of bodily fluids, I have never cried in the OR. It’s spilled coffee. Now, to answer your question, yes, surgery is an option here. It’s her only option.” At this point it’s fair to say that, in general, I can be a very blunt person. Comes with the territory.

The look of relief on his face changed his whole demeanor—from tense and apprehensive to relaxed and comfortable in his own skin again. Someone would save her when he couldn’t. Medicine is always like this. We work as a team. We run a course of treatment, and when that course is exhausted and doesn’t work, we hand the baton to another doctor with another course of treatment to run a different leg of the race to save a life. And we do this one life at a time.

It was while Dorothy’s life hung delicately in the balance before my eyes that I decided that surgery was her only hope of survival. Without surgery, she would die. With surgery, she had a small chance. But it was better than no chance, and it was not time to give up. Not yet.

When it is my turn in the handoff to take the baton, I make a point to grab it with confidence and a firm grip. A feeble grip and a s...