By Bill Dienstag, PA-C
A 46-year-old man with tearing chest pain and a history of hypertension stumbles into the ER at Beth Israel Medical Center. After a quick workup, the ER physicians call Cardiac Surgery. They believe the patient is having an aortic dissection, a fancy term that means that the biggest artery in the body is disintegrating.
He will die in hours if he does not have open heart surgery.
It is 4pm. I’ve been at it since 7am, and I’m hoping to go home soon. As a Physician Assistant in cardiac surgery I’m always aware that my day is open ended. I sometimes get out at midnight, and sometimes not at all. My boss, Dr Tranbaugh, pages me. “Stick around Bill.” He tells me to round up the team. “Tell them not to go anywhere.”
Dr. Robert Tranbaugh is one of the leading cardiac surgeons in the United States, and until recently the Chief of Cardiac Surgery at Beth Israel. Almost as important as his surgical skills is his ability to put together a surgical team, and hold it together. A solid team of medical professionals (with years of experience working together as a team) is essential if our patient is to survive.
Everyone on the team must know what to do, and when to do it.
Most everyone in Dr. Tranbaugh’s Operating room is past the age of 50. In this industry that is highly unusual. They’ve been with him since he started at BI in 1991. (I am the exception.) Equally remarkable is the nursing staff in the Cardiac ICU. Most have also been with Dr. Tranbaugh for over twenty years. “This is why I can sleep at night” Dr. Tranbaugh once told me. “These nurses catch problems before they get out of hand.”
In the OR the hands all move together. It’s like a ballet. The importance of having the right people in the right positions can’t be emphasized enough. Dr. Tranbaugh, and his team have done thousands of cases together. Dr. Tranbaugh knows his team of surgeons, physician assistants, anesthesiologists, perfusionists and nurses. He knows their husbands, and wives. He knows their kids. He’s been to the weddings and funerals. He’s also operated on a few of them.
Not all cardiac surgeons can repair an aortic dissection. Our patient is fortunate. He walked into the right emergency room at the right hour. He recovered quickly and is now back at work. He left the hospital with nothing more than a new blood pressure prescription.
I saw him three weeks post op on his follow up visit with Dr Tranbaugh. To look at him you would never know anything happened at all.
Recently Beth Israel merged with Mount Sinai Medical system. While I can’t comment on the wisdom of the new arrangement, economic realities have made such mergers inevitable, and necessary for the survival of both institutions.
I fear however that Beth Israel’s crack cardiac surgery team has become a casualty of the merger. New management has had a severe impact on morale. Change is not easy. Many frustrated staffers are already planning an exit strategy. Several key people have already resigned (myself included) Mass defections are having a devastating impact on other departments as well. I have no doubt that the new department chiefs and executives from Mt. Sinai have the best intentions. The new director of cardiac surgery is an excellent physician with an outstanding record, but experience tells me that poor morale and good care do not go hand in hand.
I’ve been a resident of Greenwich Village for my entire adult life, and raised three children here. I fear for our community. I worry that this is yet another blow to the healthcare options available to the Downtown population, especially on the heels of the St. Vincent’s closure. I am hopeful that things will eventually work themselves out. I have always believed that Beth Israel is an excellent facility, but for now I believe my neighbors and I have real reason for concern.