Dr. Lattouf: You Better Not Kill this Baby’s Mom
It was one Saturday evening in the spring of 2014 when my wife and I and three other couples were out to dinner. The host was a VIP international patient upon whom I had performed a complex, high-risk heart operation a year earlier. His operation was unplanned, as I was on vacation in my hometown, when he had developed sudden chest pain, was hospitalized, and underwent a heart cath by his able cardiologist confirming two of the previous bypasses of 18 years earlier had blocked causing a heart attack.
My patient was a childhood friend of my older brother. They had gone to school from kindergarten to college together, and since then he had served at very high governmental and diplomatic positions.
He needed the operation. His condition was unstable. He could not possibly fly to the United States where he had had his first operation almost two decades earlier.
After ten hours of work, with two of my colleague surgeons helping, his operation was successful.
Few days later, I travelled back home to Atlanta. For follow-up in the immediate post operative period, my colleagues and me relied on “home-made” telemedicine equipment to check on his wound, and update me live on his vital signs, and jointly reviewed his X-Rays and other medical issues.
After his recovery, my friend and patient came to Atlanta for post-operative visit and further evaluation. All was well, and in celebration of his good health, he hosted a dinner in one of Atlanta’s finest Italian restaurants.
As we were about to be seated, my phone rang. It was my hospital operator informing me that I was needed for emergency operation on a 35-year-old woman who was 36 weeks pregnant and having chest and abdominal pain.
“But I am not an OB (obstetrician) doc!” I said
“Well, let me put you to the ER doc who wants to speak with you”.
“She has aortic dissection and she is having labor pain”; the ER doctor said.
Are you sure? I said.
“I have the CTA (Chest CT scan with Angiographic dye), and it shows massive Type A Dissection, extending from the aortic valve, through the arch and all the way down to the abdominal aorta. And yes she is in labor”.
“Please send me the images. I need to review the CTA, right away, please!” . I wanted to be sure. I had to see the images in my own eyes, and accordingly start making a series of very complex plans.
I received the images. The dissection was indeed extensive. To make things more critical, there was blood leaking from the torn aorta into the space around the heart. The patient could die in any moment. We had to race against time, before the aorta blew out completely, or the heart stopped from blood causing pressure on its chambers.
I immediately asked the ER doctor to summon a helicopter and to have the patient flown as soon as possible to my hospital for emergency life-saving procedures.
I called my operating room team, the cardiac anesthesia team, the high-risk OB surgeons, and the neonatal critical care specialist and requested all to head to the operating room, immediately.
One operating room was immediately readied for the pregnant mom. A second nearby was converted into newborn high-risk recovery room with highly specialized incubator, monitors, ventilators and other baby-unique equipment.
I left my party and headed to hospital expecting patient to arrive about the same time as I did, and accordingly I would immediately take her to life-saving surgery.
When I reached the operating room, the patient was not there yet! I waited for few moments; when patient did not show up, I called the referring hospital and asked to speak to the doctor.
“Where is my patient?”
“She is still here. The Air ambulance pilot refuses to take her on his helicopter! He says he cannot take pregnant women on a helicopter”.
“Please allow me speak to him”. I impatiently stated.
Pilot came on line. “Sir, please fly this lady right away to my hospital. If you don't, I will hold you responsible if she dies”.
Minutes later, the chopper landed on my hospital’s roof.
The patient, a very attractive blond, with hair made up beautifully, was rolled on a stretcher to my operating room.
“I was at the hair dresser when I felt the chest pain. I called my husband and told him about the pain”.
“My husband told me: you better go right now to the ER and get checked”, she said..
Immediately, the patient was moved into to my operating room; readied to be anesthetized, as dozen doctors and as many nurses and support staff were preparing to proceed with two high risk operation; a C-section to deliver the baby, and a complex heart operation to repair the life threatening aortic tear and control the bleeding around the heart, before either go out of control and cause immediate death or stroke.
Every one was aware of the risks. We all knew what we were up against; highly complex operations where the mortality rate could be 200%.
A major issue of operating on pregnant women and using general anesthesia was that anesthetic medications used might rapidly get into the baby’s blood stream, slow or stop baby’s breathing and slow down the heart rate putting the baby’s life in real danger.
I was nervous. So was every one else in the operating room.
Thus as soon as mom would go to asleep, the high-risk OB doctors would have only a few minutes to make abdominal incision, open the uterus, pull the baby out and hand her to the neonatal intensive care doctor.
Sure enough, like rapid fire, the young mom was prepped and draped while fully awake, two surgical teams were gowned and gloved; each ready for high-risk action. Mom was given the anesthesia medicine and three minutes later, literally only in three minutes, the baby was out. She was screaming her lungs out.
As the baby came out fully alert and healthy-looking with very strong lungs and voice, the two-dozen adults working with each intensely and quietly doing their assigned tasks. The room was quite except for the baby. She was screaming, as if she wanted to announce her arrival to the world. Every one else was quiet. No one whispered a word.
The voice of the crying baby created a new reality. We all were intimidated. We were intimidated by a newborn baby; minutes old. We felt her immense power. It was, for me, a feeling that I had never experienced anything like before.
The OB doctors closed the incision, and I hurriedly made mine by opening the breastbone using a special surgical sternal saw.
As I started to evacuate the blood from around the heart, gave the Heparin in order to place the patient on the heart lung machine, my able anesthesiologist Sofia, poked her head across the sterile drapes and in a loud and commanding voice, heard by everyone in the room, said: “Dr. Lattouf, you better not kill this baby’s mom”.
I was stunned that she would make such a statement at that very moment. I had little to say. I could not respond. I did not. I felt the pain in my guts. I was shaken by the tenseness of the moment and the immense responsibility of caring for the future of a newborn baby and a young mom’s life.
I was at near mental anguish. I was afraid for the baby and for the mom And in the very depth of my soul, I was afraid of failure, I was truly afraid of what Dr. Sofia was warning not to do. I had no alternatives. I could not back out. It was the most tense moment of my career. More likely, the most tense moment in my life!
I knew at that moment there was one powerful person in the room, only one. It was a newborn baby girl. Despite her utter weakness and total dependence on all of us, she was still the most powerful of all; she owned the moment. She had the future. We all were there to rightfully serve her, protect her and protect her interest in a future with her own mom.
I knew that I was no match for her. In front of a jury, no matter what the circumstances were, she would win the day and I would have to agree. That baby was the most powerful person I had ever encountered. She over-powered me. I gave-in and recognized that she was the master of the moment.
I knew my job. It was not just to perform a highly complex heart operation under circumstances that I had not experienced before. It was not just to repair and replace the damaged valves and arteries. My job was much more personal; I had to protect and save the mom so that the new-born girl would grow up in her mom’s arms, be taken to school by her mom and would grow up to become a teen ager who would attend her high school prom under her mom’s watchful eyes.
For me to let her mom die, in my hands and under my watch, was not an option. I made up my mind. I will do the impossible to give the baby her rightful chance to grow up showered by her mom’s care, attention and love.
In my career of twenty-five years of heart surgery, I had performed many high-risk and complex heart operations. But this one was unique. I had never done an aortic root replacement, valve replacement, re-implantation of the coronary arteries, replacement of the entire aortic arch and proximal descending aorta and re-implanting the arteries supplying the brain and arms; all in one setting on a pregnant woman. As I found later, it was not just my first operation of this kind, it was one operation never reported in the medical literature before.
For the next ten hours, my team and I worked diligently repairing and replacing torn heart and aortic tissue.
By nine o’clock the next morning, after many hundreds of stitches, the heart was working, the chest was closed and I escorted my patient to her ICU bed.
I went home fatigued and exhausted. Having painfully rehearsed in my mind what Dr. Sofia had said at the beginning of the operation; “Do Not Kill this Baby’s Mom”, I was near-beaten from mental and physical fatigue. I was terrified.
During the operation, as Sofia’s words kept reverberating in my mind, I had decided that if my patient did not survive, I would resign as heart surgeon and that would have been my last operation. I could not imagine killing the baby’s mom and yet continue to face my colleagues with the burden of a newborn child orphaned due to my failure. I could not have imagined being able to live with such shame.
I arrived home exhausted. I slept for the next six hours. My wife later told me that she had never seen me so exhausted, worn out, and speechless.
Later that afternoon, I went back to see my patient. My patient had no bleeding. Her blood pressure was stable. Her blood oxygen level was excellent, and was making good urine. All was well, except she had a new onset seizure. She was having uncontrollable shakes in her head, arms and legs.
The intensivist was worried that she may had sustained severe brain damage during the operation. Poor blood supply to the brain is known to cause seizure after complex heart operations. He was fearful that poor oxygen delivery to the brain was the reason for the seizure. That would have been disastrous.
Defiantly I said: “No way, I gave her the best brain protection throughout the long operation. I monitored her brain oxygen level every minute of the long operation.
It must be something else causing the seizure”.
I recalled from my medical school days, 25 years earlier about a condition called “perinatal ecalmpsia”; a very rare condition that may occur around delivery time. I remembered being taught to treat such rare and life-threatening cases with Magnesium to control the seizures.
I said to my intensive care doctor: “Let us give her 2 grams of magnesium intravenously, right away”.
Magnesium was given, seizure halted and hours’ later patient woke up, weaned of the ventilator and was neurologically intact. We treated her high blood pressure. The seizures never occurred again.
Once fully wake; she asked for her baby. And for the first time, the mom and her baby re-united.
A year later, my patient, her husband, the baby and three year old sister came to see me in my office.
The one-year old baby was beautiful; fair skinned, blond hair and full of life.
Mom was healthy and looked great.
Dad and sister were in great spirits and happy to have their family.
And I kept my job.
December 29, 2015
It was one Saturday evening in the spring of 2014 when my wife and I and three other couples were out to dinner. The host was a VIP international patient upon whom I had performed a complex, high-risk heart operation a year earlier. His operation was unplanned, as I was on vacation in my hometown, when he had developed sudden chest pain, was hospitalized, and underwent a heart cath by his able cardiologist confirming two of the previous bypasses of 18 years earlier had blocked causing a heart attack.
My patient was a childhood friend of my older brother. They had gone to school from kindergarten to college together, and since then he had served at very high governmental and diplomatic positions.
He needed the operation. His condition was unstable. He could not possibly fly to the United States where he had had his first operation almost two decades earlier.
After ten hours of work, with two of my colleague surgeons helping, his operation was successful.
Few days later, I travelled back home to Atlanta. For follow-up in the immediate post operative period, my colleagues and me relied on “home-made” telemedicine equipment to check on his wound, and update me live on his vital signs, and jointly reviewed his X-Rays and other medical issues.
After his recovery, my friend and patient came to Atlanta for post-operative visit and further evaluation. All was well, and in celebration of his good health, he hosted a dinner in one of Atlanta’s finest Italian restaurants.
As we were about to be seated, my phone rang. It was my hospital operator informing me that I was needed for emergency operation on a 35-year-old woman who was 36 weeks pregnant and having chest and abdominal pain.
“But I am not an OB (obstetrician) doc!” I said
“Well, let me put you to the ER doc who wants to speak with you”.
“She has aortic dissection and she is having labor pain”; the ER doctor said.
Are you sure? I said.
“I have the CTA (Chest CT scan with Angiographic dye), and it shows massive Type A Dissection, extending from the aortic valve, through the arch and all the way down to the abdominal aorta. And yes she is in labor”.
“Please send me the images. I need to review the CTA, right away, please!” . I wanted to be sure. I had to see the images in my own eyes, and accordingly start making a series of very complex plans.
I received the images. The dissection was indeed extensive. To make things more critical, there was blood leaking from the torn aorta into the space around the heart. The patient could die in any moment. We had to race against time, before the aorta blew out completely, or the heart stopped from blood causing pressure on its chambers.
I immediately asked the ER doctor to summon a helicopter and to have the patient flown as soon as possible to my hospital for emergency life-saving procedures.
I called my operating room team, the cardiac anesthesia team, the high-risk OB surgeons, and the neonatal critical care specialist and requested all to head to the operating room, immediately.
One operating room was immediately readied for the pregnant mom. A second nearby was converted into newborn high-risk recovery room with highly specialized incubator, monitors, ventilators and other baby-unique equipment.
I left my party and headed to hospital expecting patient to arrive about the same time as I did, and accordingly I would immediately take her to life-saving surgery.
When I reached the operating room, the patient was not there yet! I waited for few moments; when patient did not show up, I called the referring hospital and asked to speak to the doctor.
“Where is my patient?”
“She is still here. The Air ambulance pilot refuses to take her on his helicopter! He says he cannot take pregnant women on a helicopter”.
“Please allow me speak to him”. I impatiently stated.
Pilot came on line. “Sir, please fly this lady right away to my hospital. If you don't, I will hold you responsible if she dies”.
Minutes later, the chopper landed on my hospital’s roof.
The patient, a very attractive blond, with hair made up beautifully, was rolled on a stretcher to my operating room.
“I was at the hair dresser when I felt the chest pain. I called my husband and told him about the pain”.
“My husband told me: you better go right now to the ER and get checked”, she said..
Immediately, the patient was moved into to my operating room; readied to be anesthetized, as dozen doctors and as many nurses and support staff were preparing to proceed with two high risk operation; a C-section to deliver the baby, and a complex heart operation to repair the life threatening aortic tear and control the bleeding around the heart, before either go out of control and cause immediate death or stroke.
Every one was aware of the risks. We all knew what we were up against; highly complex operations where the mortality rate could be 200%.
A major issue of operating on pregnant women and using general anesthesia was that anesthetic medications used might rapidly get into the baby’s blood stream, slow or stop baby’s breathing and slow down the heart rate putting the baby’s life in real danger.
I was nervous. So was every one else in the operating room.
Thus as soon as mom would go to asleep, the high-risk OB doctors would have only a few minutes to make abdominal incision, open the uterus, pull the baby out and hand her to the neonatal intensive care doctor.
Sure enough, like rapid fire, the young mom was prepped and draped while fully awake, two surgical teams were gowned and gloved; each ready for high-risk action. Mom was given the anesthesia medicine and three minutes later, literally only in three minutes, the baby was out. She was screaming her lungs out.
As the baby came out fully alert and healthy-looking with very strong lungs and voice, the two-dozen adults working with each intensely and quietly doing their assigned tasks. The room was quite except for the baby. She was screaming, as if she wanted to announce her arrival to the world. Every one else was quiet. No one whispered a word.
The voice of the crying baby created a new reality. We all were intimidated. We were intimidated by a newborn baby; minutes old. We felt her immense power. It was, for me, a feeling that I had never experienced anything like before.
The OB doctors closed the incision, and I hurriedly made mine by opening the breastbone using a special surgical sternal saw.
As I started to evacuate the blood from around the heart, gave the Heparin in order to place the patient on the heart lung machine, my able anesthesiologist Sofia, poked her head across the sterile drapes and in a loud and commanding voice, heard by everyone in the room, said: “Dr. Lattouf, you better not kill this baby’s mom”.
I was stunned that she would make such a statement at that very moment. I had little to say. I could not respond. I did not. I felt the pain in my guts. I was shaken by the tenseness of the moment and the immense responsibility of caring for the future of a newborn baby and a young mom’s life.
I was at near mental anguish. I was afraid for the baby and for the mom And in the very depth of my soul, I was afraid of failure, I was truly afraid of what Dr. Sofia was warning not to do. I had no alternatives. I could not back out. It was the most tense moment of my career. More likely, the most tense moment in my life!
I knew at that moment there was one powerful person in the room, only one. It was a newborn baby girl. Despite her utter weakness and total dependence on all of us, she was still the most powerful of all; she owned the moment. She had the future. We all were there to rightfully serve her, protect her and protect her interest in a future with her own mom.
I knew that I was no match for her. In front of a jury, no matter what the circumstances were, she would win the day and I would have to agree. That baby was the most powerful person I had ever encountered. She over-powered me. I gave-in and recognized that she was the master of the moment.
I knew my job. It was not just to perform a highly complex heart operation under circumstances that I had not experienced before. It was not just to repair and replace the damaged valves and arteries. My job was much more personal; I had to protect and save the mom so that the new-born girl would grow up in her mom’s arms, be taken to school by her mom and would grow up to become a teen ager who would attend her high school prom under her mom’s watchful eyes.
For me to let her mom die, in my hands and under my watch, was not an option. I made up my mind. I will do the impossible to give the baby her rightful chance to grow up showered by her mom’s care, attention and love.
In my career of twenty-five years of heart surgery, I had performed many high-risk and complex heart operations. But this one was unique. I had never done an aortic root replacement, valve replacement, re-implantation of the coronary arteries, replacement of the entire aortic arch and proximal descending aorta and re-implanting the arteries supplying the brain and arms; all in one setting on a pregnant woman. As I found later, it was not just my first operation of this kind, it was one operation never reported in the medical literature before.
For the next ten hours, my team and I worked diligently repairing and replacing torn heart and aortic tissue.
By nine o’clock the next morning, after many hundreds of stitches, the heart was working, the chest was closed and I escorted my patient to her ICU bed.
I went home fatigued and exhausted. Having painfully rehearsed in my mind what Dr. Sofia had said at the beginning of the operation; “Do Not Kill this Baby’s Mom”, I was near-beaten from mental and physical fatigue. I was terrified.
During the operation, as Sofia’s words kept reverberating in my mind, I had decided that if my patient did not survive, I would resign as heart surgeon and that would have been my last operation. I could not imagine killing the baby’s mom and yet continue to face my colleagues with the burden of a newborn child orphaned due to my failure. I could not have imagined being able to live with such shame.
I arrived home exhausted. I slept for the next six hours. My wife later told me that she had never seen me so exhausted, worn out, and speechless.
Later that afternoon, I went back to see my patient. My patient had no bleeding. Her blood pressure was stable. Her blood oxygen level was excellent, and was making good urine. All was well, except she had a new onset seizure. She was having uncontrollable shakes in her head, arms and legs.
The intensivist was worried that she may had sustained severe brain damage during the operation. Poor blood supply to the brain is known to cause seizure after complex heart operations. He was fearful that poor oxygen delivery to the brain was the reason for the seizure. That would have been disastrous.
Defiantly I said: “No way, I gave her the best brain protection throughout the long operation. I monitored her brain oxygen level every minute of the long operation.
It must be something else causing the seizure”.
I recalled from my medical school days, 25 years earlier about a condition called “perinatal ecalmpsia”; a very rare condition that may occur around delivery time. I remembered being taught to treat such rare and life-threatening cases with Magnesium to control the seizures.
I said to my intensive care doctor: “Let us give her 2 grams of magnesium intravenously, right away”.
Magnesium was given, seizure halted and hours’ later patient woke up, weaned of the ventilator and was neurologically intact. We treated her high blood pressure. The seizures never occurred again.
Once fully wake; she asked for her baby. And for the first time, the mom and her baby re-united.
A year later, my patient, her husband, the baby and three year old sister came to see me in my office.
The one-year old baby was beautiful; fair skinned, blond hair and full of life.
Mom was healthy and looked great.
Dad and sister were in great spirits and happy to have their family.
And I kept my job.
December 29, 2015