“I’m a glorified plumber,” Quaegebeur says, “though I emphasize glorified.” Still the artistry may be understated. “Most normal mortals would measure a lot. Dr. Q will look at the pericardium and then look at the patient and then cut some crazy shape that looks like a grand-piano top,” says Chen. “When you fold it all up and sew it in, it actually reconstructs the aortic arch, and you think, How does he do it?”
Quaegebeur lowers the pericardium onto the heart and starts sewing. Pediatric heart surgeons sometimes sew vessels not much larger than the diameter of a pencil lead, and they have to get it just right. Too loose, it leaks; too tight, it kinks.
in any heart operation, there is, as Mosca puts it, “a moment of truth.” It’s the moment when, the repair complete, the limp heart must again take over. The pump team turns off the artificial heart and lungs—“Bypass off,” you hear. Inside the plastic casing, wheels stop spinning. In the OR, people think of the heart as having a will, a desire. They say the heart wants to work. Or it doesn’t.
Just 24 hours earlier, Quaegebeur had walked into a case with a stubbornly uncooperative heart. From the start, it had been a disaster. As soon as 8-month-old Joey (this name has been changed) was put to sleep, his heart had stopped. The OR team had to crash him onto bypass, cutting his chest open and sewing a couple of tubes into his heart, and simultaneously keep him breathing. Dr. Sorin Pusca, the fellow assisting that day, compressed Joey’s tiny chest, one-two-three-four, then paused so Quaegebeur could quickly make an incision. They repeated the drill: resuscitate, pause, operate. With the chest open, Pusca massaged the heart directly, then paused while Quaegebeur sewed.
By the end of the repair, echocardiography showed that Quaegebeur had established good blood flow. And so he instructed the pump team to take Joey off bypass. Within minutes, his heart muscle collapsed, as if exhausted. Quaegebeur tried five times to get him off bypass. “Whatever we did, the heart didn’t want to recover,” said Pusca.
Maybe, as one perfusionist put it, “not all kids are meant to live.” Still, a fatality, says Chen, “sucks the life out of everybody.”
At 3:30 p.m., Dorothy’s repair is done, and Quaegebeur instructs the pump team to bring her off bypass. Time for the flabby muscle to kick again, which it seems to want to, though not regularly. “It’s bouncing all over the place,” says a concerned anesthesiologist. An out-of-kilter heart can be dangerous.
“We need a bit more volume in the heart,” says Quaegebeur, who plucks it with a finger, stimulating the heart’s electric impulses. The echo shows a good repair. Still, for a few anxious minutes, the heart won’t settle down. When finally it finds a regular rhythm, one observer unconsciously starts to shake her leg in time.
Upstairs on the ninth floor, Kimberly had tried to sleep during surgery but couldn’t. She’d refused the offers of relatives and friends to accompany her. She would have just had to comfort them, she felt. She wasn’t really upset, or didn’t think she was, anyway. She told herself that she was glad the day was finally here. Still, when a member of Quaegebeur’s staff stopped by to tell her the surgery was over, she burst into tears for the second time that day. Perhaps heartbreak was behind her now.
By 5 p.m., Dorothy had reached the ICU. She was dressed again in the yellow robe, though this time there were two drain tubes poking out of the new scar in her chest. Already she looked pinker.
Quaegebeur breezed by. “This is hopefully the last. There were no surprises. An excellent result, I think,” he told Kimberly. “I hope the one pump stays as strong as it is now,” Quaegebeur said.
No one has any experience with what happens 25 or 30 years out; the operations haven’t been done that long. But so far, most kids who have had similar procedures lead normal lives, without limitations. “She’ll be fine,” Kimberly said. “That’s all I can think.” For the next two nights, Kimberly slept on a foldout chair next to Dorothy’s bed. Occasionally, Kimberly would hover over her. “I’m a little teapot,” she would sing, just in case Dorothy could hear.
It’s Halloween night in Brooklyn Heights. Dorothy arrived home eight days after surgery, and preparations have been going on ever since. Dorothy’s godfather made a crown that looked beautiful even with the staples showing in the back. Her mom found a wand for $3, which lit up and played music. Kimberly and Dorothy picked up a dress at a tag sale. It wasn’t pink (authentic Glinda), but Dorothy loves it just the same.
Before stepping into her costume, Dorothy rests on the couch in a T-shirt and tights, keeping an eye on the Harry Potter movie that plays on the TV. Her scar peeks out just over her T-shirt. She says it doesn’t hurt, and it hardly looks like anything at all. Her color is terrific. She really is peachy.
“When are we going trick-or-treating?” Dorothy suddenly wants to know. She jumps off the arm of the couch. “Where’s my wand?” she asks.
Her mom does her makeup. Dorothy expertly smacks her lips together.
At 5:30, Dorothy grabs her wand in one hand and Kimberly’s hand in the other. On a block of brownstones, families sit on just about every stoop, while hundreds of kids file by. There are baby Batmans and kids in pirate costumes and a Santa Claus. And there are ghosts.
“What do you say, Dorothy?” Kimberly asks as they approach a stoop.
“Trick or treat,” Dorothy shouts and opens her bag.