Under the metallic glare of operating theater lights, a middle-aged man lies on a surgical table at Inova Fairfax Hospital, naked and unconscious. At 180 pounds, he is not overweight, but elevated cholesterol and high blood pressure have choked his coronary arteries with plaque, a fatty substance that accumulates on the artery walls and impedes blood flow to the heart. In preparation for surgery, nurses have covered every inch of the patient's skin with a saffron yellow antiseptic film, giving him a jaundiced glow. Blue drapes conceal his face and genitals, but his hairless chest is laid bare, awaiting the touch of the scalpel.
While the surgical team reviews X-rays, prepares instruments and monitors vital signs, 13 high school seniors from the Arlington Career Center gaze at the patient through the windows of "the Dome," one of the only cardiac surgical theaters in the United States open to middle and high school students. They've come with their teacher, Sheila Napala, as part of a course in physical therapy and sports medicine. She wants to see if the students, some of whom are interested in medical fields, can "handle a situation where they're going to see blood or the aftermath of surgical procedures." Most are bundled up in hooded sweatshirts because the room is a cool 62 degrees, a temperature necessary to preserve tissues during surgery. At 7:30 a.m., they sit in silence, nursing bottles of soda and cups of coffee, about to witness a surgery that is necessary for more than half a million Americans a year.
Students from a summer school program watch surgery at Inova Fairfax Hospital's "Dome."
(Photograph by Chris Hartlove)
They are joined by nurse Marsha Taylor, director of education programs in the Dome, which has hosted 16,000 students from the Washington area over the past nine years.
Classes come for many reasons, ranging from career education to learning about the human circulatory system. The hospital has its own agenda, says Edward LeFrak, the cardiac surgeon who's been the driving force behind Inova Fairfax's educational program. It invites students to the Dome to preach a heart-healthy lifestyle to teenagers whose love affair with junk food, television, video games and the Internet may already be putting them at risk for heart disease.
"Most young people think they're immune to all of this," says LeFrak. "Or that it's going to happen to somebody else. Or that it's too far in advance, so it's not an issue to worry about." As the students from the Arlington Career Center are about to learn, it's never too early to start protecting your heart from the ravages of cigarette smoke, fatty foods and couch-potato tendencies.
TAYLOR, A 10-YEAR VETERAN of the cardiac operating room, cradles a plastic model of a heart in her hand and explains the patient's condition to the bleary-eyed students.
"The heart has five major coronary arteries," she says, tracing her finger along the tiny red vessels that branch out like tributaries over the surface of the plastic model. "This man has blockages in three of the five."
If a clot forms on top of one of these blockages, blood flow to the heart can be slowed or interrupted, causing everything from chest pain to sudden death from a heart attack. More than 1.1 million Americans suffer heart attacks annually, and for nearly half of them, the event is fatal.
To stave off this danger, the occluded arteries can be rerouted, or "bypassed," using healthy artery or vein tissue harvested from the leg and chest wall. These vessels will be sewn above and below the area of blockage, providing an alternate route for blood to flow. Inova surgeons performed 1,800 bypass operations in 2002, sometimes as many as 15 a day.
When the surgical team is ready, a nurse swabs the patient's sternum with a betadine-soaked sponge, leaving a rusty streak. The surgeon leans over the patient's chest holding an "electric scalpel," a tool that looks like a soldering iron, and burns a vertical line on the skin. Wisps of gray smoke rise from the tip of the instrument, which cauterizes as it cuts, creating a wound that's almost bloodless. As the incision deepens to an inch, a thick yellow layer emerges. "That stuff is fat," Taylor says. "We all have some of it."
As a gap opens in the patient's chest, some students grow wide-eyed before the panes of soundproof glass; others back away from the windows, looking at the floor or pacing around. Taylor, dressed in a white lab coat, stands behind the group and offers reassurance. "If anybody feels weak," she says in a hospitable North Carolina lilt, "just sit."
Placing the scalpel aside, the surgeon parts the incision with his fingertips, revealing the clamshell-white sternum. Then, grasping an electric tool that looks like a modified saber saw, he eyeballs his next cut. With a steady hand, he raises his elbows and engages the power switch; the whirring of the saw penetrates the thick glass that separates the students from the operating room.
Lowering the blade onto the notch at the throat, he guides the saw toward the base of the rib cage, slowly cleaving it in two. Sighs and groans spread across the room as the breastbone pops. John Crone, a broad-shouldered fullback from the Yorktown High School football team, hides his face in a hooded sweatshirt and mutters to himself. Alex Brazell, a lanky Yorktown soccer player with a gelled-up crew cut, looks pale and distressed as he sits before the window with his elbows on the counter and his palms pressed into his cheeks. "It just doesn't look real to me," he says, speaking to no one in particular.
ALTHOUGH HEART DISEASE IS THE LEADING CAUSE OF DEATH IN THE UNITED STATES, it mainly afflicts the middle-aged and elderly. As one Arlington student aptly points out, "There's not that many teens dying of heart attacks."