A Day in the Life of a Pediatric Heart Surgeon

Operating on the heart of a child requires extreme discipline and focus. This is in many ways a form of priesthood, a devotional exercise, handing oneself into the hands of God, to be employed as a tool of healing on the seat of life in a child. A pediatric cardiac surgeon is akin to an athlete, requiring constant focus, ability to improvise, mental agility, physical fitness and stamina, punctuated by periods of rest and recovery- physical, mental and spiritual.

There is a lot of discipline and self-control involved. Pediatric Cardiac Surgery has evolved over the years. Simple cases are now done in the cardiac catheterisation lab as interventions (non-surgical procedures) and even some of the challenging cases as well. This leaves the most challenging cases for surgery. We often do very complex cardiac surgeries on new-born babies, sometimes on the first day of life or weighing only 2-2.5 kgs. A team-oriented concept wherein we coordinate input from cardiologists, execute the procedure with anaesthetists, perfusionists, technicians and nursing staff and manage the post-operative course which can be unpredictable and sometimes, lengthy alongside the intensivists, nursing staff and the rest of the team. Open heart surgery on a baby or child requires a lot of planning, preparation, team coordination, personnel management and once the aortic cross-clamp has been applied on cardiopulmonary bypass, the surgeon is “on the clock”. He or She cannot take a break whatever the reason, has to be fast and accurate, be ready to think on one’s feet as these surgeries and hence, by rational extension, results are time-sensitive.

This puts the surgeon under a lot of pressure and each copes in a different way to overcome the task at hand. Often, these children hail from the lower socioeconomic classes and are below the poverty line and unable to afford surgery. Fundraising and negotiating with management to support the program also comes under the purview of the surgeon. It is a blessing to work with an organisation that wholeheartedly supports a program like this.

A busy pediatric cardiac surgeon operates every day. Preparation starts the previous evening with diet, exercise and meditation and a good night’s sleep. Discipline extends to sleeping at the same time and waking by 6 am and prayers and a fixed starting time transmits to the entire team the same level of discipline, focus and expectations of professionalism. The surgeon should go through all the steps of the surgery the previous day (as each child has a different diagnosis and steps and techniques vary). Communication skills are very important and each member of the team is vital to the success of the procedure and has to receive guidance and instructions relevant to that particular child’s diagnosis and planned procedure. Endurance and resilience are vital as surgeries involve long hours and a team-oriented approach assures the best outcomes. There are many safety checks to be done before surgery and some more after, to ensure the best possible surgery has been done with the most perfect and predicted outcome.

The work is never done with just surgery. Post-operative care is a separate entity in itself and results have considerably improved with the involvement of critical care specialists, who in liaison with the surgeons, cardiologists, anaesthetists and nursing staff, take the onus of managing various aspects of the child’s needs- not only cardiac function but every organ needs fine tuning after open heart surgery, be it lungs, brain, kidneys, liver, etc., as well prevention of infection, pain management and nutritional maintenance!

One must love what one does to excel in something so demanding as pediatric cardiac surgery. Every member of the team is vital and must be excellent at what they do and laser-focused. A supportive management and administration is vital. When all this falls into place, with the blessing of God, everything clicks and a wonderful pediatric program forms and is sustained.

Featuring insights from Dr. Neville Solomon, Senior Consultant, Pediatric & Adult Congenital Cardiac Surgeon, Apollo Children's Hospitals, Chennai

For Queries or Appointments: +044 40401066.