I have had an interest in medicine since my early teens, partly driven by the fact that my late brother Sven was born with congenital heart disease. I went to St Brendan’s College in Killarney and then to the Royal College of Surgeons in Ireland, where I did my medical degree. That took six years.
During medical school, I spent some time doing electives in Germany, one of which was at a cardiac surgery centre in Bad Krozingen in southern Germany. That was my first proper exposure to open-heart surgery and transplantation.
Following medical school, I spent a year working as an anatomy demonstrator and did a masters in medical science, a diploma in sports medicine and my fellowship examinations to become an FRCSI. Then I did two years of basic surgical training before getting a post on the Irish higher surgical training scheme in cardiothoracic surgery.
I spent two years as visiting assistant professor at the department of cardiac surgery at UCSF Children’s Hospital in San Francisco, where I gained further experience in congenital heart surgery and transplantation.
In 2005, I took up my current post as consultant cardiothoracic surgeon with a special interest in congenital heart surgery and transplantation in 2005.
My job is split between Our Lady’s Children’s Hospital in Crumlin and the Mater hospital. I also do some private practice in Blackrock Clinic and occasionally the Mater Private and the Beacon hospital.
My working week varies significantly depending on my on-call commitment. I’m 47 and my wife, Norma, and I have three children: Max is 19, Ben is 17 and Lara is 14.
Paediatric surgery
A recent week started at 7.30am on a Monday with a thoracic aneurysm multidisciplinary meeting in the Mater. At 8.45am I was operating in Our Lady’s on two children; one is a four-month-old baby with Down syndrome and an atrioventricular septal defect. The other child is also four months old: he was born with a single ventricle and is having his second surgery of a three-surgery palliative pathway.
On Tuesday, I left Dublin at 6am to drive to Belfast to cover the paediatric cardiac catherisation list in Royal Victoria Hospital. Prof Mark Redmond and I have been driving regularly to the Royal Victoria to support the service there. Cardiac surgery operating for children stopped last December and the cardiac catherisation is due to stop next month and transfer to Our Lady’s. Back in Dublin, I examined applicants for the Irish higher surgical training programme in cardiothoracic surgery, of which I am the director.
On Wednesday, I had a thoracic meeting before the outpatients clinic and had surgery at 9.30am. I had two patients; one for insertion of a subcutaneous implantable cardioverter defibrillator and the second, with severe coronary artery disease, needed coronary artery bypass grafting.
Donor heart offer
That Wednesday, I was also on call for cardiothoracic surgery and heart transplantation. During the late afternoon, one of the transplant co-ordinators told me about a donor heart offer so the process began: confirming blood group, height, weight and choosing two potential recipients based on this information.
Both potential recipients were inpatients but one had three shocks from her ICD and was being transferred to the coronary care unit for an intra-aortic balloon pump insertion. The cross-match would take at least four hours and the donor operation was due to start at about 11pm when a theatre was available in the donor hospital, so I went home for a couple of hours’ sleep.
The cross match was confirmed to be suitable and theatre was set up for 1am. Timing is critical with heart transplants and we aim to have the shortest possible ischaemic time (that is, the time from when the heart is stopped in the donor to beating in the recipient). Therefore, the surgeries in both situations need to be co-ordinated.
I started the transplant operation at 1.30am, opened the chest, put the patient on to cardiopulmonary bypass, removed the massively dilated abnormal heart and then began to stitch in the normal-sized heart. Surgery finished at 6am.
Checking in
The next day, I went to Our Lady’s for the weekly congenital cardiac MDT meeting. I have a lot of paperwork for the heart valve bank as I am the director and am responsible for the Irish Heart Valve Bank based at the Mater hospital.
Later, I went back to the Mater to check in on the heart-transplant patient. Their aortic and pulmonary valve have been harvested and they will be processed and stored in liquid nitrogen for up to five years to be used to repair someone else’s heart.
On Friday at 8am, I attended the weekly transplant meeting in the Mater and then at 9.30am, my surgery began at the Blackrock Clinic.
The next day I did my ward rounds in the Mater. The transplant patient had some fluid compressing the new heart and I needed to return them to theatre to evacuate a clot.
This week I did a heart transplant with my colleague David Healy. What makes this transplant interesting is that it was a patient with congenital heart disease who was born with their heart the wrong way around – that is, with all their veins connected into the wrong side or, as in this case, with the veins from their lungs not connected into the heart directly at all.
This surgery was extra interesting as we have used very new 3D modelling and printing to try to plan the surgery. The model was made in UCD from a CT scan done in the Mater. The model is partially colour-coded to show the vessels entering and leaving the patient’s heart. The patient is doing reasonably well so far.
Not having the answers
The most difficult part of my job is not always having the answers or being able to fix the problem. My brother Sven died five years ago, following his second open-heart surgery at 39. Until then I thought I understood what families go through, but his death showed me how little I really understood, and yet he has given me new strengths to help others.
The best part of the job is seeing patients going home or back in the clinic and doing well. I love getting cards from patients or their families letting me know that they are well. This week I got a card from the parents of a child I operated on as a newborn; he is now five and they send me a picture every year.
It is a reminder that as long as I and the team can beat the odds most of the time, and can achieve results as good as or better than everywhere else, then we are doing a good job.
Organ transplants in Ireland
- This year marks the 30th anniversary in Ireland of heart transplantation, which is carried out at the Mater hospital, Dublin. The hospital is also celebrating the 10th anniversary of lung transplantation this year.
- More than 700 people in Ireland are waiting for lifesaving heart, lung, liver, kidney and pancreas transplants.
- More than 3,000 people in Ireland have had their lives extended by organ donation.
- There was a sharp decline in the number of deceased donors, from 86 in 2013 to 63 in 2014. A total of 251 people received organ transplants in 2014, compared with 294 in 2013.
- Despite 2014’s mediocre performance in liver, kidney and pancreas transplantation, the Mater hospital carried out 18 heart transplants, the highest number for a decade.
The Irish Kidney Association is the national organisation charged with the promotion and distribution of the organ donor card in Ireland, on behalf of Organ Donation Transplant Ireland.
Organ Donor Awareness Week runs until April 4th. To donate, text "kidney" to 50300 and €2 will be donated from your mobile phone account to the Irish Kidney Association.
For more information, see ika.ie or LoCall 1890-543639
