HEART BEAT Maurice NeliganThere is nothing new in the health sector. Week by week things get worse. One is reminded of Lord Rothschild's aphorism; "the promises and panaceas that gleam like false teeth in the party manifestoes". Anger is stirring at last, people expect something to be done and they will not forget or forgive the inaction and stupidity of the past. I would hope that salvation for those politically responsible will only come through quick and substantial achievement.
Back to the past and times when patients could be treated and were to the best of our ability. In wandering back to my earliest experiences of heart surgery, I remember the variety of problems. Many of the patients then presenting for surgery were as a result of congenital lesions, ie holes in the heart, blue babies or adults, and a myriad of other defects.
Another large group were patients with disease or malfunction of the valves of the heart, often the sequel of rheumatic fever, which was caused by the Group A streptococcus organism. They may have presented initially with merely a sore throat. The spread of the infecting organism was facilitated by poor social conditions.
Better housing reduced overcrowding and slowed the passage of infection, and also the availability of Penicillin almost wiped out the disease. The time lapse between the infection and the heart damage meant that large numbers of patients with faulty heart valves presented subsequently for surgical treatment.
The surgery of these congenital and acquired lesions was in its infancy and new techniques and better materials were constantly introduced. The early heart valves were quite primitive by the standards of today and could give rise to a host of problems of their own. Such problems contributed to disappointing early results.
A new understanding of the development and anatomy of the heart had to be acquired to deal with the many varieties of congenital heart disease. This was only done through the worldwide study of countless hearts obtained at post-mortem and illustrating all the difficulties to be encountered, and pointing toward possible repairs. Without such organ retention and study there could have been no progress.
Rheumatic fever, tuberculosis and the infectious diseases were being controlled through the advance of science and medical knowledge. New problems and conditions simply filled their place in the lexicon of diseases. "Death has a thousand doors to let out life," (Massinger). It was so; our struggle was to prolong useful life in relative comfort. Like it or not we are all destined to exit one of the doors.
Theatre days were long but in retrospect they seemed to pass quickly. It was not at all unusual to spend 48 hours without going to bed but this never seemed to register as something bad. The hours were the least of our problems, the patient outcomes were our major concern. Ward, operating theatre, intensive care, the effort was unremitting in this new and exciting field. The next step following theatre was intensive care, then a discipline also in its infancy.
The development of dedicated intensive care units and specifically trained staff allowed not only cardiac surgery but all forms of complex surgery to develop. Such units became the frontline in care of the critically ill whether medical or surgical and they were busy places to be. I did not realise at the time the integral part they would play in my life.
Meanwhile, other things were happening in the world and we tried to ensure work did not swallow us entirely. We were usually successful. We were actually earning money; in limited amounts it is true, and we escaped from the hospital whenever possible to do the usual things, tempered by the realisation that we lived in the hospital and would have to get up in the morning and face a long day. A hangover became a luxury but occasionally happened, particularly after parties in the residence. These were forbidden but occurred on a fairly regular basis, leading the next day to a zombie-like house staff. Well, "all work and no play", we didn't want to appear dull, after all we owned the world.
Then suddenly we all acquired religion. Not that we had been particularly irreligious but in the words of the medieval proverb, "Ubi tres medici, duo athei", where there are three physicians there are two atheists. So how come we all simultaneously saw the light?
And almost everyone when age,
Disease or sorrow strike him
Inclines to think there is a God
Or something very like Him,
- A. H. Clough
The particular sorrow that brought repentance about was the Cuban Missile Crisis. The supply of nuclear missiles to Cuba by the Soviet Union was faced with great determination by President John F. Kennedy. The Americans blockaded the island, the Soviet ships moved onward inexorably. For 13 days the world held its breath and Mater interns rushed to confession. No point in taking chances, was there?
It was real and the fear was real. "Nuclear catastrophe was hanging by a thread and we weren't counting days or hours but minutes," said Anatoly Gribhov, Soviet General and Red Army Chief of Operations, much later. We were a craven lot especially as our religious revival rapidly lost momentum with the abatement of the crisis. I hope God is well used to prodigal sons and in this politically correct age, I suppose I have to include daughters.
mneligan@irish-times.ie
Dr Maurice Neligan is a cardiac surgeon