An Unforgettable Experience

The crew have been preparing for nearly four hours now. Every last detail is looked after. The setup reviewed, checked again and again, dozens of measurements taken. They’re ready.

The “driver,” he gears up. I can sense in him a different level of focus as the time nears. He steps in. The crew know he’s their man. I can sense their absolute confidence in him. He is a “world champion” – one of the very best.

I’m fortunate to be able to observe this firsthand. I’m right there next to him. But instead of a race car driver, a career I’ve experienced and written about often, this is different. I’m walking into an operating room with one of the best pediatric cardiac surgeons in the world, Dr. Gordon Cohen. We’re in Seattle Children’s Hospital. And he’s about to perform heart surgery.

I’m in the middle of an experience I’ll never forget. And yet, for Dr. Cohen, it’s another day at the office, one that he’ll experience perhaps eight or ten times… this week! Yeah, to think that there’s a need for Cohen to conduct heart surgery that many times, every single week, is mind boggling. To know that there is that much need… well, I can only be grateful that Cohen and others are there to look after these kids.

My day began with Cohen’s delightful assistant, Deana, raving about the way he treats people, his incredibly tough work schedule, and the wonderful things the hospital does. I then walked through the Cardiac Intensive Care Unit with Cohen, and heard how they look after babies just minutes old right up to teens, some on something called the Berlin Heart. Essentially, it’s an external heart keeping a kid alive until a transplant is available. The buzz of activity, nurses, doctors, support staff – all moving, discussing, disinfecting their hands every minute it seemed. And working as a team. Huddles, short mini-team discussions being held around the ward, mostly just outside a patient’s room. From my position of an outside observer, I could sense how important these briefings are to the overall performance of the CICU.

Cohen and a fellow doctor begin an in-depth, and at times heated, discussion about the best way to treat a patient. It reminded me of a conversation between a race driver and his engineer – passionate, determined, and committed to doing whatever it took to convince the other their way of making the car… I mean patient better. It made the doctor-to-doctor discussions on TV shows seem… well, unreal. In fact, I’m not sure the public would buy into the level of determination I saw in Cohen – they would not think someone could care that much. But it was real. They were discussing the life of a real young child.

After a short stop in Cohen’s office where he handled at least three activities all at once – email, phone calls, answering my dumb questions – we headed for a necessity. Yep, Starbucks. See, from the time Cohen gets to the hospital before 7AM and the time he finishes surgery in the afternoon, he doesn’t get to eat. I couldn’t help but think that a union rep would go crazy looking at Cohen’s daily schedule. A quick bite and a cup of water and he’s off to the OR. Wearing scrubs, hat and mask, I’m right behind him.

The OR is a buzz of activity. No, buzz makes one think of fast, almost frantic activity, and yet this is all calm, controlled, but busy. Preparations continue. Just like a race car pit crew. And I can tell these are the best of the best, too.

Earlier, sitting in Cohen’s office and watching the preparations going on in the OR on a screen mounted on the wall, I witnessed a special moment. Just prior to putting the patient asleep, the anesthesiologist leaned in towards the patient’s face just a little, and very gently stroked her face. It was a touching moment in more ways that one. I knew the patient was going to be okay; just before going asleep, the patient knew that “everything is going to okay.”

Throughout the three-and-a-half hour operation, there were between seven and ten people in the room. One or two anesthesiologists at all times, one or two people running the external heart and ventilator machine (for some time during the surgery, this machine is the patient’s heart), a couple of people looking at some type of ultrasound-looking screen, nurses, a scrub nurse and Cohen’s surgical partner.

Observing all these people, a couple of thoughts came to mind. First, this is just like a race team, where the driver is nothing without his or her team supporting them. And second, while they moved and acted in a way that made me know they knew what they were doing, it wasn’t in a “Oh, I’ve done this a thousand times before” kinda way. It was confident, but focused. I could see how some of the activity could become routine and almost mindless, and yet there seemed to be a process that focused them on the task.

An anesthesiologist was using an iPad, so I moved in closer to find why. She uses it as a teaching tool for the fellow working with her: sketching diagrams of what’s going on and then emailing them to her right there on the spot; and looking up articles relevant to the specific case they were working on.

Teamwork was obvious throughout the OR, but especially visible between Cohen, his surgical partner, and the scrub nurse.

In fact, if I didn’t know better I’d have thought there were times when Cohen wasn’t sure what to do next, until the scrub nurse handed him his next instrument. She knew what was coming next, she knew the surgery as well as anyone. There were times when Cohen would practically drop an instrument to the side, his hand would begin to rise, and before it got near the opening of the child’s chest, there magically appeared another instrument in his hand – the perfect one for the next task.

The choreography between Cohen and his surgical partner was like watching a mini version of Cirque du Soliel. Four hands working inside the chest of child, one picking up where the other left off, team cutting and sewing, holding, feeling, prodding, like catching the other in mid-air from the trapeze.

I saw another sign of a great, high-performing team: in the middle of the surgery, during a time of some stress over some heart recovery issue, the team joked and kidded, taking fun jabs at each other. But it was serious at the same time. It was the kind of humor that I’ve seen in other high-pressure, stressful situations where team members will help each other relax. As the stress level rose, so did the joking; when the stress level came down, less joking. It was serious fun that comes with a great team.

It was evident to me that amongst team, there was a strong respect for each other and what they contribute, and immense trust in each other’s role. They demonstrated that respect and trust are the backbones of a great team.

For me personally, though, to be standing a few feet from an open chest, a living, pumping, moving, red heart, was simply something I’ve not been able to get out of my head since that time a couple of weeks ago. There are so many different ways to describe the feeling of seeing a heart so close-up: It’s so mechanical – just a pump; it’s what keeps us alive, and yet here was a surgeon cutting and sewing it; it needed such a subtle, sensitive and delicate touch to repair it, but how incredible it was that it can recover from this trauma.

That last point made an strong impression on me: how the human body can recover, repair itself, heal after what seemed at moments to be almost brutal work on it made me once again marvel at what we as humans are capable of. Yes, Cohen has a delicate touch and feel for what he’s doing. But at moments during the surgery, one could almost describe it as forceful.

I’ve been fortunate in my life to observe super high performers up close and personal. I’ve driven an Indy car inches away from World Champions at 230 MPH. I’ve observed and listened to one of the great pianists in the world from fifteen feet away from. I even had Gordie Howe pass a puck to me right in front of the net. And it’s much different to observe a performance at this level from this close up – different than watching from the stands or on TV. You can see the subtleties that make these people what they are: superstars. One doesn’t get to be that close to that level of performance very often in life.

One of the things that makes Cohen special is his ability to interact with others. He knows that he can only perform at the level he does if he has the support of other people, and that they will perform better if he treats them as humans. And yet, because I’ve seen it so often with race drivers, and experienced it myself, I could see Cohen change the closer we got to surgery time. He became just a little more intense, a little more focused.

And yet, he thinks it’s nothing. What Cohen does has become so matter of fact that he doesn’t think he’s anything special. Oh, he’s confident. Supremely confident. But not cocky. No out of control ego here. Just a strong inner belief in his abilities. Just like a world champion race driver, an Olympic athlete, a superstar musician. Not like Dr. House on TV!

Cohen is like a world champion race driver. His team prepares everything, he comes in and performs at a level that very few people in the world can, and then leaves his team to clean up afterward. And yet he knows – everyone knows – that no one could do this alone.

The similarities between Cohen and a race driver, his team and a race team, are many. But there is one huge, and critical, difference: They’re saving lives.

Thank you Dr. Cohen, for an experience I’ll never forget; for doing what you do and doing it with humility, calmness, and confidence; for building a team and support system that provides the very best care for children. Thank you Seattle Children’s Hospital. I wish we didn’t need you, but I’m glad you’re there.

(Just in case you’re wondering…;

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