“The Big One” and Dr. John Kirklin
Dr. John Kirklin (1917 to 2004) was admired by many. As a young open-heart surgeon focused on the problem at hand, blue babies, he took over the first heart lung machine. IBM purchased it from Dr. John Gibbons, who developed it based on his original concept. Dr. Kirklin was able to improve its design and used it to gain more time inside the heart of his dogs in the research lab. In October 1955, Dr. Kirklin, reported his series of eight blue baby patients undergoing intracardiac repairs with 50 % mortality. The heart lung machine was the cornerstone piece of technology, a machine that could relief theoverworking stressed blue baby heart of its perpetual duty to pump, for enough time for a surgicalrepair. The forty-year timeline of the blue baby repairs, mid 1920’s to mid-1960’s, was boosted by this technology and Dr. Kirklin.
The forty-year blue baby timeline excludes the rare, transposition of the great vessels. The complex versions of transposition have all the heart chamber septal defects, valve defects, and anomalous venous defects in one child’s heart. Transpostion also involved the great vessels. Drs. Berg and Lang admired Dr. Kirklin and followed his work closely. Both Drs. Berg and Lang were influenced by Kirklin every step of the way. All three doctors were cautious, thoughtful, scientific, devoted, successful, and experienced grief at each failure that is not easily described.
From 1969, Drs. Berg and Lang managed Jason and kept Dr. Kirklin in mind. The complex versions of transposition of the great vessels were not eligible for the first repairs where the upper chambers were surgically switched. The mortality was high for any surgical option on a transposition defect. In fact, the third cause of death for children with this defect was any surgical intervention. On Jason’s first day of life in 1969, Dr. Lang performed a procedure to create a defect between the upper chambers. This allowed time for Jason to grow and for both Drs. Berg and Lang to contemplate the magnitude of the situation. Diagnostic imaging of the heart at that time, a heart catheter with intravenous contrast was focused on the coronary arteries. Dr. Berg chooses to hold, for as long as possible, hoping the science would advance and a repair would emerge. Jason was doing okay.
Then, in 1980, towards the end of the pivotal decade, Dr. Berg was convinced by another pioneer, Dr Augie Senning, to get the best imaging available for Jason. Dr. Senning, a friend and colleague, found Berg at the May Thoracic meeting in San Francisco. Dr. Berg was there, with his family, to present his work proving how to treat the various types of heart attack with acute coronary revascularization. Augie pushed Ralph hard to not wait any longer for heart imaging on Jason. Both heart surgeons knew at some point, Jason would need another heart procedure.
The “fancy heart Cath,” was done the next day in San Francisco. Jason
began to not feel well in the days after. His mother Mary worried.
The smoldering infection found in Jason’s blood came to light over the July 4th weekend. Ralph, knowing how serious a heart infection was for Jason called Dr. Kirklin, who gave succinct advice for both the medical and surgical management. The Berg family went to Birmingham, Alabama for Dr. Kirklin’s surgical skill at the end of July. Jason had responded to the antibiotics, Dr. Kirklin recommended. But it was expected the infection would return without a surgical repair. Despite the harrowing twists and turns, Dr. Kirklin came through, and Jason was able to come off the operating table and was admitted to the intensive care unit after surgery. Ralph said, “Dr. Kirklin was the best chance for Jason’s heart repair.”
Wow, what an operation. We as readers might assume Dr. Kirklin knew enough detail about Jason’s heart to have a firm plan for repair.
However, this operation was done as an exploration with the heart catheter procedure and Jason’s history as his guide. Dr. Kirklin learned about the hidden details of Jason’s heart as he worked inside Jason’s heart. The valve defect was most challenging. The repair took Dr. Kirklin at long time. Then Jason struggled to come off pump, off the heart lung machine. He stayed on pump for 57 additional minutes after the repair was done. Dr. Kirklin struggled to not panic, after doing everything he knew to get Jason’s heart to pick up its perpetual duty to pump. Finally, Jason’s heart picked up a rhythm and he could come off the machine.
During Jason’s recovery, his dad Ralph paced the hospital during breaks sitting bedside with his son. Ralph explained there was typically twenty-five patients, like Jason in hospital under Dr. John Kirklin’s care. Ralph found this impressive, such a rare defect and so many patients.
When Jason turned eleven, at the end of August that year, he did two things. Understanding he had a second chance at life he lived his life big, unencumbered by etiquette, claiming eleven as his lucky number. He had been told over the years, by his pediatric cardiologists, he likely would not live beyond age ten. Second, Jason saw how his second chance at life had rocked both his parents, to their cores. He called his surgery with Dr. Kirklin, “the big one.” Jason and his dad made bird hunting season the next year.
Each Blog on this website supports my book, “Blue Baby and Acute Coronary Revascularization”
publishing December 16th, 2024. Voting on the two book cover designs is coming next month. If you are
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With love, Author Dr. Tracy Berg
Publication of “Blue Baby and Acute Coronary Revascularization,” December 16th, 2024.
