The Heart Healers by James Forrester Read Free Book Online

starched science of Rehn’s later description: “bleeding is controlled with finger pressure … suture the heart wound tied in diastole … bleeding diminished remarkably with the third suture … heart rate and respiratory rate decreased and pulse improved.” Rehn closed the chest. Two hours later Wilhelm Justus was awake and resting comfortably, with a normal pulse and blood pressure.
    Rehn immediately understood the implication of his success. He imagined that his report would galvanize a new surgical era. His lofty aspiration to be a father of cardiac surgery, however, was not to be. Although Rehn’s scalpel had laid bare the folly of centuries-old dogma that the heart was off-limits for surgery, his report became an anecdote rather than a breakthrough. In medicine, as we shall see throughout our chronicle, credit goes to the person who convinces the world, not to the one with the first idea. Harken succeeded where Rehn failed because Rehn operated on one man, whereas Harken would operate on another 133 soldiers with shrapnel in their chest cavity, some embedded directly in the heart.
    For the half century after Rehn, few dared to operate directly on the human heart, and the few who tried failed. The twin fears of condemnation by colleagues and killing patients outright stayed the hand of even the most adventuresome surgeons. And woe to the surgeon who chose to challenge entrenched authority. The voice of the great Viennese surgeon Theodor Billroth still boomed paternalistically through the decades: “A surgeon who tries to suture a heart wound deserves to lose the esteem of his colleagues.” Billroth’s eminent English contemporary Stephen Paget pronounced the final, never-to-be challenged, eternal verdict: “Surgery of the heart has probably reached the limits set by Nature to all surgery: no new method, and no new discovery, can overcome the natural difficulties that attend a wound of the heart.”
    After World War I, Harvard’s pioneering surgeon Elliot Cutler attempted to treat severe narrowing of the mitral valve, the valve between the left atrium and the left ventricle, that limits entry of blood into the heart’s main pumping chamber. His idea was to make a tiny incision in the heart wall, insert a cutting device through the incision, cut out a piece of the narrowed valve. Cutler’s reasoning was only partly correct. Although removing a portion of the valve improved forward flow across the valve, it also allowed torrential backflow when the heart contracted. All but one of seven patients in whom he cut out a portion of the narrowed valve died. Deeply discouraged by so many deaths, Cutler abandoned the procedure. One of the great ironies of research, however, is that we learn more from our failures than from our successes, more from unexpected results than from those we anticipate. Destiny decreed that Elliot Cutler would be Dwight Harken’s mentor. Harken learned the details of Cutler’s failed technique. Now he would use that knowledge to piece together the shards of Cutler’s shattered dream, transforming his failure into an initial baby step on the road to success.
    In London’s battlefield hospital, Harken devised a plan of action. His idea was simple enough. It was Rehn’s finger-in-the-dike strategy. Of course if the hole was bigger than his finger, if his finger slipped off the slick surface of the bleeding heart, if he couldn’t completely close the hole with sutures, if the taut silk sutures tore a little further through the heart muscle with each contraction, he would fail. So many ways to fail, so few to succeed. If he failed, his would be the image of a man holding a squirming, writhing, ruptured fire hose gushing five quarts of blood a minute throughout the room for a minute or two, followed by devastating, demoralizing, humiliating, condemning, awesome silence. Death on the table.
    When is it ethical to take an action that might kill a patient immediately, particularly if no one