Ten Years with An Open Heart

In the summer of 2007, I accepted an internship at the legal department of the Cleveland Clinic, a legendary hospital, known around the world for treating heart problems, among others.The internship included an opportunity to attend an open heart surgery in the actual operating room, where you, the legal intern, stand next to the medical professionals and observe everything.

I accepted the generous offer to attend.

On the day of the surgery, I arrived at around 6:45 am and received a key to a locker that a medical resident would typically use. I put on blue scrubs, a mask, and a cap and went straight in.Then, for about five and a half hours, possibly more, I remained alongside two surgeons and watched them place a bypass into a woman's heart after removing a vein from her own leg. They also added an artificial valve into her heart.

Let me share with you about what I observed in these deeply empowering hours of my life.

The patient was lying on the table and her skin looked a shade of orange. This apparently happens to some people under anesthesia, who may turn a yellowish color that borders on orange. One of the nurses gave me a stepping stool, like the ones they have in libraries, so I could be up next to the surgeon and see better.

They removed a vein from the patient's leg and discussed it over speaker phone with another surgeon. "The vein looks good," they determined. They decided that the bypass would be from the patient's own vein.

Then, they cut through the patient's chest and pushed her ribs to the side to open it up. Our ribs look no different than ribs we barbecue on July 4th, I thought, except that the smell is another story. At this point I felt dizzy and felt that my hands were getting warm. I asked if I could step down from my stool and sit down. I fully expected that someone would say, "Why have you come to observe surgery if you can't stand the sight of human ribs?"

Instead, one of the nurses said, "I am sorry you feel sick. Did you have breakfast?"

So here I was. I am the person who, at age 6, had her adenoid removed with local anesthesia and watched the doctor waive it in front of her face. But here I was, feeling dizzy, and someone who I'd never see again said she was sorry that I got sick. I told the whole operating room team that I  had had a croissant and a latte for breakfast, and minutes later, I asked if I could resume my spot on my stepping stool because I was fine.

At that point the medical technician told me that they would stop the heart and explained how the machine that would  instead circulate the blood works. He made a drawing for me, too. "Though you don't need to know this, because lawyers have no hearts," he said.

Then I watched them put in the bypass, and the artificial valve. The two surgeons seemed completely ambidextrous and I thought their hands were moving way too fast. But they were also calm, and made jokes about Albania, because they thought I was from Albania instead of Bulgaria. At some point one nurse signaled another nurse to come and tie up my mask which was coming down.

There was also a lamp next to me which I nearly knocked down because I was, I admit, standing on my tiptoes on the little stepping stool like an awkward, nosy, barely breathing bird. Overall, I felt so proud not to have puked on top of the patient. You know, the little things. I haven't figured out the big ones yet, but the little ones, those I got totally covered even back then.

Completely mesmerized, at some point I heard someone say that they will now "restart the heart." It would be too crazy for me to wish that all of my readers observe surgery, but, I have to tell you: the feeling you experience when you hear the words "restart the heart" isn't the imaginable kind of happiness. I do sincerely wish that feeling upon you all because it is one of very pure and powerful joy.

Then, I watched them close the chest and watched a nurse do stitches. Before  the patient was wheeled out of the room, I checked on the monitor and saw  that her blood pressure was 11 to 8 and her body temperature was 36.1.

All of this felt as if it took shorter time than it is taking me to write about it now. I would say 5 hours feel like 20 minutes or so.

No other experience, not even falling in love, can even  remotely come close to the exhilaration I felt while watching open heart surgery unfold.  Watching open heart surgery unfold feels like standing on a rock of indestructible hope,  like coming face to face with both life and death in a relentless, organized confirmation of humanity.

Many have written about faith, fate and about rational choice. Here is a fact of life, though: there are people, who, for many reasons, wake up one day and consciously chose to devote their time and efforts to doing surgery on others. This doesn't happen merely because they want the rewarding feeling of helping people. This choice certainly is not about financial success either. Think about the hundreds or thousands of ways in which one can be both helpful to others and successful financially, but without having to push open people's rib cages and make their hearts stop.

Think about the millions of us who would never ever agree to attempt any of this, not for any price.

Choosing medicine is about being good, and about being the best at what is good;  it is also about being good at what is most difficult. A life-changing choice, but also one of the biggest risks one can take. So many things can go wrong while medically treating another human being that I would not know how to convince anyone to take this risk.

What do we call the part of us that allows us to stand for five hours, to cut others open and put them back together? Is it bravery, is it ambition, is it strength, or confidence, or a special kind of kindness? Call it what you wish, it's the best part. It has to be the best part of us because we would never have gotten this far. So far, in fact, as to allow some clumsy tax lawyer to observe heart surgery.

I feel so sad to know that some people reject medicine, whether by rejecting vaccines, by refusing blood transfusions, or in other ways, though that attitude has been around for many years. But the fact is that when someone walks into an emergency room bleeding (because you can't stop bleeding with chamomile tea and meditation), she will receive care. This affirms my position of joy: life can be saved  and will go on; life goes doggedly on despite all stubborn ignorance.

Hospitals take all patients and we all have the liberty to make medical decisions based on theories that are anything but logical. I just hope that one day people who support these other theories will also stop and think about what medical professionals give to the world. It is fine, and perhaps even life-saving, that those of us from other occupations never have to shoulder the immense responsibility that medical professionals carry. Doubt is fine, too, when reasonable.

I, on the other hand, observed an open heart surgery. And I am done doubting that human beings can do absolutely amazing things. For 10 unforgettably wonderful years now I have known that they can.

I have also opened my heart to the truth that, while we choose who we want to be, we don't get to choose what others become. We can only marvel at their choices, and occasionally, feel shock at some of them.

The choice to work in medicine is no sacrifice or noble deed. It means constantly rising above fear and above the potential for failure. It means holding a shield of caring forgiveness against the likelihood of guilt. It requires both objectivity and courage. When I think about this astounding choice, I have no desire left to criticize the choices of others.

So all I have to say to those who reject medical care is this:

I forgive you.
Seventy seven times multiplied by seven, I forgive you.

The most human of angels, the best chances we got before we depart,  in their scrubs and white garments, are standing strong. They wouldn't be here for us all if they were not ready. They soar above weakness, ours and their own. And that's salvation.