The Heart Healers by James Forrester Read Free Book Online Page A

had ever done it before? Harken was confronting nothing less than a confrontation with medicine’s most hallowed three words: primum non nocere—“First do no harm”—a principle as enduring and as sacrosanct as the Hippocratic Oath. In our story we will encounter this conundrum repeatedly: medical research pits two laudable principles against each other. Medical breakthrough versus benevolence. Progress versus compassion. Harken argued that his conscience was clear: “You have to have a diagnosis that is absolute, a condition that is incurable and, then, if you have any rational concept of how you might attack it, you have the right to try,” he said.
    Harken argued his case at U.S. Army Corps headquarters. His superiors pointed to the common surgical wisdom of centuries. They buttressed their argument with recent reports that surgeons in the French theater had failed in attempts to extract shrapnel from the heart. Harken countered that since his surgical approach was unique and untested, it deserved to be tried in these dying young men. The balance tipped in his favor when the president of the British Royal College of Surgeons unexpectedly agreed with Harken that at least his proposal was logical, that no one could say with certainty that it wouldn’t work. A tepid endorsement, indeed.
    In June 1944 Dwight Harken was brought a dying soldier with a gaping injury to his sternum and ribs. The heart’s right ventricle lies directly behind the sternum, Nature’s impenetrable bony shield. Ancients saw Nature’s logic. The word sternum descends from the Greek word sternon, meaning a soldier’s breastplate. As his assistants used retractors to widen Harken’s field of view within the chest cavity, he saw shrapnel had penetrated the right ventricle.
    For days and weeks leading up to this moment Harken had imagined his every move. First, he placed sutures in a complete circle around the point of shrapnel entry. Harken tried to grasp the end of the protruding fragment of shrapnel, with a clamp (called a hemostat). The ragged sliver of gunmetal bobbed back and forth continuously with each heartbeat, insolently waving at him, a metronome counting down the solder’s remaining hours, death by bleeding or by infection. When Harken succeeded in clamping on to the evasive shard, the two men were linked by the soldier’s only possible bridge to survival, Harken’s hemostat. I can only imagine myself with my own hand on Harken’s clamp.
    That night Harken described the terrifying sequence of what happened next in a letter to his wife: “For a moment I stood with a clamp on the fragment that was inside the heart, and the heart was not bleeding.” Harken steeled himself to commit to the act he had only imagined. He yanked. “Then suddenly with a pop, as if a champagne cork had been drawn, the fragment jumped out of the ventricle, forced by the pressure within the chamber … blood poured out in a torrent.” He tightened the sutures around the wound. But still the bleeding continued. His patient was bleeding to death on the table. “I told the first and second assistants to cross the sutures and I put my finger over the awful leak. The torrent slowed, stopped, and with my finger in situ [in place over the wound], I took large needles swedged with silk and began passing them through the heart muscle wall, under my finger, and out the other side. With four of these in, I slowly removed my finger as one after the other was tied.… Blood pressure did drop, but the only moment of panic was when we discovered that one suture had gone through the glove on the finger that had stemmed the flood. I was sutured to the wall of the heart! We cut the glove and I got loose…” Years later, in the macabre humor that characterizes doctors in close encounters with death, we joked (Did I mention, behind his back?) that Harken could have done just as well if he had cut off his finger and left it there.
    Emotions surged through Dwight Harken.