My Book Review

I feel myself about to get long-winded. I couldn't resist digging into my new book as soon as it came: "Walk on Water: Inside an Elite Pediatric Surgical Unit." The author, Michael Ruhlman, is fascinated by people and work, in particular people who excel at their jobs. Apparently, he has written a lot about top chefs. He switched gears back in 2000, when he was introduced to Roger Mee, the well-known and well-respected pediatric cardiac surgeon at the Cleveland Clinic. Ruhlman, a Cleveland native, shadowed Mee and his surgical team for a year in 2000 to see for himself what a great surgeon was made of. And the book was published in 2003, and Mee retired from the Clinic in 2005.

The books wastes no time getting into some harrowing moments of surgery, telling the stories of babies born with complex congenital heart defects who are on the brink of disaster ("running toward the goal line in a full out sprint" is I believe how they put it). And this surgical team, for better or worse, manages to tackle them at the one yard line and keep them in the game. The book weaves in and out of different families lives, while pausing to give historical accounts of the development of CHD surgeries. It's written really well and flows easily. The extensive research that Rulhman did was evident, and a lot of the conversations he had with CHD surgical pioneers, some of who still practice today, was interesting. It is a reminder of how young heart surgery is and how crazy it evolved (example: the first heart cath was performed by a German doctor on himself because his boss wouldn't let him try it on someone else!).

The surgeon himself, Mee, seems still kind of an enigma to me. He described himself as a regular bloke who didn't love to operate. He had some of the best success rates in the world for some of the most difficult CHD surgeries and was excellent at what he did (one of the staff says in the book that his surgeries look like God himself did them). He demanded perfection from his team- surgical residents, fellows, his P.A., the anesthesiology team, and nursing staff. He had a family, but in essence was wed to his job. The pressure on him, placed by the families of these sick babies and children, must have been enormous. I've been there as a parent. In fact, it took its toll on his surgical partner, Jonathan Drummond-Webb, who committed suicide after leaving the Clinic to head a pediatric heart surgical center in Arkansas (after the book was published)

While the book was really interesting and I was engrossed, I started to get depressed by it around 2/3 of the way in and made myself take a mini-break from it before finishing it. Being the mom of a heart patient, there is only so much you can read before you start to be saddened by it all. There have been some amazing strides made in the outcomes for these patients, but there is just so much that is unknown.

The book also focuses on some disturbing things I suspect that the author himself did not expect to find, which is that decisions aren't always made based on what is best for the patient. Let me back up a minute. CHD (heart defects that someone is born with) and acquired heart disease (coronary artery disease) are very different from each other, and Mee advocated for a very distinct separation in the hospital between the two. I have read this in other places and have read it here that the numbers prove that the more CHD surgeries a center performs, the better they will be. As one cardiologist says in the book: anyone can be taught how to remove an appendix, but not everyone can be trained to do complex CHD operations. Even within the roughly 35 possible CHD diagnoses, every heart is different. Mee was an experienced surgeon and was still seeing things he had never seen before. The book follows a few of the patients who have come to the Clinic because they had previous surgeries done at other centers and were now in heart failure, and Mee sorted things out and often corrected those surgeries. Children were being operated on at centers that weren't experts in CHD. Cardiologists weren't referring parents to the best centers because they possibly faced being reprimanded for referring out of their own hospitals (although not many would admit to that). Surgeries were the money maker. What good is it to have all the cardiology patients, but not capitalize on the surgeries because you're referring them out? The focus was not the patient and the best care for them. It was often about surgeons attempting surgeries they weren't the best at or sometime not even capable of doing. And, competition between hospitals got in the way of what might have been best for the patient. At one point, as one of the cardiologist explains to Ruhlamn, UH's Rainbow Babies and Children's Hospital didn't have a pediatric heart surgeon and teamed up with Columbus Nationwide hospital, and surgeons were coming up from Columbus to perform surgery. According to UH, they were only performing low risk heart surgeries and not the most complex, but I'm sure there were parents that may not have realized their surgeon was going to perform their kid's surgery and then go back to their home hospital 2 hrs. away, all the while there was a surgeon at the Clinic 5 minutes away that was world renowned. Of course there are two sides to every story and who knows what really happened. I do believe parents are at the mercy of what they're told, and the information they may need to make the best decisions is not always readily available or given to them. I have tried to look up mortality rates for different hospitals and they are hard to find, especially if the hospital doesn't voluntarily publish them. Parents in a desperate situation (imagine thinking your newborn baby was healthy, but then within hours needing to be transported to another hospital to have surgery) rely on the information they are given by the diagnosing doctor. I know that's how it was when Sofia was born. Things happened very quickly and were not afforded time to research who the best surgeon was. And at the time, I kind of though, maybe naively, thought a surgeon was a surgeon. Not that I didn't think heart surgery wasn't complex, but I certainly didn't realize the differences between acquired heart surgeries and congenital, nor the difference between CHD surgeons and how this can impact the child for the rest of their life.

It leaves me now thinking about our decision to have her surgery completed at the Cleveland Clinic. Hearing a few months ago that the chief surgeon left the Clinic had me on edge. I trust her cardiologist, Dr. Edwards, and I hope he would give us advice based on what he would do if it was his own child and do what is best for Sofia. I liked the surgeon, Dr. Stewart, and I have to have faith that he is good at what he does. There is certainly a lot that goes on behind the scenes that parents don't know about. As a side note, the Clinic ranked 1st in the U.S News and World Report hospital in acquired heart surgeries (for something like the 19th year in a row), and the pediatric congenital program ranked #28. It's based on a number of factors (like volume of surgeries, nurse to patient ratio, reputation with specialists, infection prevention, etc.)

The patient stories were good and I can certainly relate to a lot of parents. I only cried once and it was in relief at how one of the patient stories turned out (there were definitely other moments where I could have cried my eyes out though). Given what I now know, I might have chosen to wait until after Sofia's surgery to read it, but what's done is done and now I know the good, bad, and ugly at least. It leaves me a little sad that this team is no longer in existence. What I need is a sequel made in present time! It was quite interesting reading a book where the "characters" were doctors and staff that we've met.