Fragile Lives: A Heart Surgeon’s Stories of Life and Death on the Operating Table. Stephen Westaby

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      5

       the girl with no name

      Dream that my little baby came to life again, that it had only been cold, and that we rubbed it before the fire and it had lived. Awake and find no baby.

      Mary Shelley, author of Frankenstein

      The girl was hauntingly beautiful, with eyes that burned like lasers – as if the blistering desert heat were not enough (50°C during the day). When she fixed those eyes on mine she delivered a message – eye to eye, pupil to pupil, retina to retina – straight into my cerebral cortex. As she stood there holding her bundle of rags I understood perfectly what she was saying: ‘Please save my child.’ But she never spoke. Not to any of us. Ever. And we never even knew her name.

      The Kingdom of Saudi Arabia, 1987. I was young and fearless, seemingly invincible and massively overconfident, and had just been appointed as a consultant in Oxford. So why was I in the desert? Heart operations cost money. We’d worked hard to build Oxford’s new cardiac centre and clear a backlog of sick hearts, but the annual budget was gone in five months so the management closed us down. Bugger the patients. The cardiologists were told to send them to London again.

      On the day before I was locked out of the operating theatre I took a call from a prestigious Saudi cardiac centre that served the whole Arab world. Their lead surgeon needed three months sick leave, and they were looking for a locum who could tackle both congenital and adult heart surgery, an extremely rare species. At the time I wasn’t interested but the following day I was, and three days later I jumped on the plane.

      It was Jumada al-thani, the ‘second month of dryness’ in the Middle East, and I’d never felt heat like it, blistering, unremitting heat with the hot shamal wind blowing sand into the city. But it was a great cardiac centre. My medical colleagues were an eclectic mix of Saudi men who had trained overseas, Americans rotating from the major centres for experience, then the band of mercenaries from Europe and Australasia.

      Nursing was very different. Saudi women did not nurse, as the profession was regarded with suspicion and disrespect, and was culturally taboo because it required mixing with the opposite sex. So all female nurses were foreign, most with contracts for just one or two years. Their accommodation was free, they paid no tax and stayed just long enough to save for that elusive mortgage back home. In turn they were not allowed to drive, had to travel in the rear of buses and be completely covered in public.

      I was intrigued by my new environment: the repetitive calls to prayer from the minarets, the tantalising aromas of sandalwood, incense and amber around the hospital, Arabian coffee roasting on the frying pan or boiling with cardamom. It was a very different life and important not to step out of line – their culture, their rules, harsh penalties.

      This presented a unique opportunity for me as I could operate on every conceivable congenital anomaly. There were innumerable young patients with rheumatic heart disease sent from remote towns and villages, mostly without access to anticoagulant therapy or drugs that we take for granted in the West. The rural health care was out of the Middle Ages, and we had to innovate and improvise to repair their heart valves rather than replace them with prosthetic materials. I remember thinking that every cardiac surgeon should train here.

      One morning a bright young paediatric cardiologist from the Mayo Clinic, the world-famous medical centre in Minnesota, came to find me in the operating theatre. His opening gambit was, ‘Can I show you something really interesting? Bet you haven’t seen anything like this before,’ swiftly followed by, ‘Sadly, I doubt you can do anything about it.’ I was determined to prove him wrong even before I’d seen the case because for surgeons the unusual is always a challenge.

      He thrust the X-ray onto a light box. On a plain chest X-ray the heart is simply a grey shadow, but to the educated eye it can still tell the story. The message was clear. This was a small child with an enlarged heart in the wrong side of the chest, a rare anomaly called dextrocardia. Normal hearts lie to the left. In addition there was fluid on the lungs. But dextrocardia alone does not cause heart failure. There had to be another problem.

      The enthusiastic Mayo cardiologist was testing me. He had already catheterised the eighteen-month-old boy and knew the answer. I offered an insightful guess to show off – ‘In this part of the world it could be Lutembacher’s syndrome.’ This is a dextrocardia heart with a large hole between the right and left atrium, together with rheumatic fever that narrows the mitral valve, a rare combination which floods the lungs with blood, leaving the rest of the body short. The Mayo man was impressed. But no cigar!

      He then wanted to take me to the catheterisation laboratory to see the angiogram (moving X-ray pictures with dye shot into the circulation to clarify the anatomy). By now I’d become fed up with the quiz but I still went along with him. There was a huge, sinister mass within the cavity of the left ventricle below the aortic valve, almost cutting off the flow of blood around the body. I could see this was a tumour, and whether benign or malignant the infant could not survive for much longer. So could I remove it?

      I’d never seen surgery on a dextrocardia heart before. Few young surgeons had and most never would, but I did know about heart tumours in children. Indeed I’d published a paper on the subject in the United States that the paediatric cardiologist had read, making me the expert on the subject in Saudi Arabia.

      The most common tumour in babies is a benign mass of abnormal heart muscle and fibrous tissue called rhabdomyoma. This is often associated with a brain abnormality that causes epileptic fits. No one knew whether the poor boy had suffered fits, but he was certainly dying from an obstructed heart. I asked the boy’s age and whether his parents understood the desperate nature of the condition. Then his tragic story began to unfold.

      It happened that the boy and his young mother were close to death when the Red Cross found them on the border between Oman and South Yemen. In the searing heat both were emaciated, dehydrated and in a state of collapse. Apparently she’d carried her son through the desert and mountains of Yemen, frantically seeking medical help. They were airlifted to the Military Hospital in Muscat in Oman, where they’d found that she was still trying to breastfeed. She’d nothing else to feed her son but her milk had dried up. When the boy was rehydrated with fluids into a vein he became breathless and was diagnosed with heart failure. In turn the mother had severe abdominal pain and a high temperature from a pelvic infection.

      Yemen was a lawless place. She’d been raped, abused and mutilated. Not only that, she was African, not an Arab. The Red Cross suspected that she’d been kidnapped from Somalia and taken across the Gulf of Aden to be sold as a slave. But for one curious reason they couldn’t be sure. She never spoke. Not a word. And she barely showed any emotion, even in response to pain.

      When the Omanis saw the boy’s chest X-ray and diagnosed dextrocardia and heart failure they transferred him to our hospital. Now, the Mayo man wondered whether I could conjure up a miracle. I knew that the Mayo Clinic had a great children’s heart surgeon so I tentatively asked my colleague what Dr Danielson would do.

      ‘Operate, I guess,’ he said. ‘Not a lot to lose, as it’s all downhill from here.’ That’s what I expected him to say.

      ‘Right СКАЧАТЬ