Cork team for cardiac surgery cannot be bypassed

Oh dear, the regius professor of Greek at Trinity College in Dublin should not have said that

Oh dear, the regius professor of Greek at Trinity College in Dublin should not have said that. Suggesting in an Irish Times article that only the Blackrock Clinic and the Mater Private Hospital (both in Dublin) carry out bypass surgery was inviting trouble. But looking for a third institution for such procedures - in Dublin as well - was calling for double trouble.

No question about it, Prof John Dillon meant well. He suffered a heart attack, had the bypass, recovered, and told interestingly of the whole experience. But John A. Murphy, former professor of Irish history at UCC - that's in Cork - had a bypass too and he didn't go to Dublin to have it. Neither did the Right Rev R.A. Warke, Bishop of Cork, Cloyne and Ross. So how come the good bishop and the feisty professor are still walking around?

And what about public patients in Dublin - for they also avail of bypasses, in the Mater Hospital?

The upshot was that both Prof Murphy and the bishop fired off missives to this newspaper. John A. growled from the deep south at what he perceived to be arrogance oozing from Dublin. "John Dillon says `there are still only two places in the Republic where bypasses can be carried out, the Blackrock Clinic and the Mater Private Hospital,' (in Dublin, presumably). This egregious error is repeated twice later on in the article. Does it reflect invincible metropolitan ignorance (beyond the Phoenix Park `all is a desert'), or does Prof Dillon fondly imagine that Cork University Hospital, with its renowned heart surgery centre, lies outside the jurisdiction?" he wrote.

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Bishop Warke was more understated, pointing out that the Cork hospital offered bypass surgery, adding; "I underwent the operation there in mid-August."

There are just seven consultant cardio-thoracic surgeons in the State - the people who "go in" and give people with damaged hearts a new lease of life. Of the seven, five are Dublin based. The other two are at the Cork University Hospital which services the vast Munster region.

The hospital, which used to be known as the Wilton Hilton, is the major emergency centre in the area. It is a cavernous place, but in its bowels is an oasis of calm, excellence and professionalism. This is where cardiologists refer patients who need specialised surgery. Cardiology is the diagnostic and management side of heart disease. Surgery comes when intervention is deemed absolutely necessary.

Bypass surgery has been conducted there since 1986. The surgeon who pioneered the effort in Cork was Mr Tom Aherne, who conducted up to 10,000 bypass operations during the decade when he worked alone. He was joined by Mr Aonghus O'Donnell in 1996. Now the hope is that a third surgeon will be appointed to the team. The cardiac unit is on target to perform 440 operations this year but the two surgeons say that could increase to 650 annually if its true potential was realised. The average waiting time for surgery at the CUH is six months but could be a year, "only because someone else's case is more urgent", says Aonghus O'Donnell. Surgeons and staff want to see the waiting time reduced to no more than six months.

Heart surgeons also perform aorta surgery, deal with aneurisms and narrowing of the aorta, replace damaged valves, and so on. Aonghus O'Donnell explained this cheerfully over a sandwich in the kitchen just off the area where heart surgery patients were recovering, some within hours of returning from theatre.

So what is a typical day for a cardio-thoracic surgeon?

"Yesterday, the patients' day began around 8.30 a.m. with preparation for the operation. At about 9 a.m. I was in theatre. I did three heart surgical cases, two bypasses, one valve replacement case, two pacemakers and two exploratory examinations of wounds that needed looking at again after surgery. By about 8 p.m. that day's work was done."

After that, Mr O' Donnell went home to his wife and four children, helped to put the kids to bed, telephoned the hospital at 11 p.m. to make sure all was well, because he was still on call, had one hot whiskey and went to bed.

"One concentrates very hard on the job in hand but there is an enormous sense here that we are achieving something important. Our facilities are excellent - second to none. In terms of equipment and the quality of our staff, we are right up to scratch. I want to work here because I believe that from here we can deliver an important service to a huge region," he added.

What does success mean for a heart surgeon? That, says Aonghus O'Donnell, is a loaded question. One measure of it could be in the man or woman who couldn't climb a stairs or swing a golf club before, but can do so now. Job satisfaction could be measured against the kind of night he had recently when as the surgeon on call he was woken to deal with a young man who had burst his aorta in an accident. This was life-threatening. The cardiac team was assembled and the man's life saved.

"That's the benefit of the job for everyone involved. To see someone walking around again who might have died gives us all great satisfaction. And again, I want to emphasise that it's a huge team effort. Everyone has a role to play, knows what he or she is doing, and is calm about it."