Nursing: Behind the Masks

Bedside nurses become familiar faces to a patient recovering from surgery. But the operating-room nurses on whom his life once depended are at most only masked, nameless figures, seen dimly, if at all, through an anesthetic haze. Last week, at the usually unremarkable annual meeting of the Association of Operating Room Nurses, five of them were in attendance, unmasked and uncapped—and they were hailed as celebrities. They were the head nurses who had played key roles in the world’s first five transplants of human hearts.

Fellow nurses jostled for their autographs. Much as they obviously enjoyedthe limelight, they discussed their experience in cool, shoptalk tones, insistingthat a heart transplant is really just another open-heart operation—an areaof medicine in which they all are veterans.

A Few Questions. South Africa’s Peggy Jordaan had heard talk of a possible transplantseveral weeks before the event. “So,” she says, “I got hold of a couple of the boys—surgical residents —and asked them a few questions. I wantedto know how the heart might be excised, and then how the new heart would besutured in place. I also did a bit of reading up in the library.” Like the rest of Dr. Christiaan N. Barnard’s team, Peggy Jordaan had been on standby for three weeks,and was at home on the memorable Saturday night of Dec. 2. She had to call the rest of the girls from a party, at which she had warned them not to drink much or they would be “chopped.”

“I was a bit nervous until I started to scrub and had my work to do, and then I hadn’t time to be nervous,” says Peggy. The big moment that she remembers most clearly was seeing “the Prof,” as she calls Barnard, carrying in the donor heart, in a stainless-steel pan. When he removed Louis Washkansky’s heart, Barnard put this in a pan and handed it to Nurse Jordaan. This moment had no emotional impact. The heart seemed like just another organ to be sent to the pathology department—but in this case, the next stop was the hospital museum.

Familiar Routine. It was also a Saturday, but a sunny morning, when Mrs. Ludmila Davis’ secretary phoned from Stanford Medical Center: “This place is a mess, and we’re doing a heart transplant!” The “mess” meant that surgery was even busier than usual, with 15 operations scheduled; four were still in progress when Dr. Norman E. Shumway Jr. began the four-part series to remove the donor’s heart and transplant one of her kidneys, and implant her heart in Mike Kasperak’s chest.

Mrs. Davis, a capable organizer like her colleagues, had forearmed herself with a list of the nurses and technicians who would be available. So the double team of six “scrub nurses” (the only ones who are allowed to handle sterile instruments during surgery) and two heart-lung machine technicians were soon assembled. Of the great moment itself, Mrs. Davis, says calmly: “We were happy to be doing what we’d been waiting for so long.” Nurse Peggy Hartin, who headed one of the double teams, recalls: “I stopped being nervous when we stepped into the familiar routine that Dr. Shumway likes.”

Open-heart surgery has become so routine at Brooklyn’s Maimonides Medical Center that Supervisor Grace Ray did not rush down to the O.R. when Dr. Adrian Kantrowitz was rounding up the team for his first transplant. Mrs. Ray had previously picked the nurses for the job, and although she admits that she was torn, she decided to leave them alone. The second time, Barbados-born Mrs. Enid Collymore was designated as first scrub nurse, while Mrs. Ray supervised the whole operating-room team. After each transplant, says Mrs. Ray, nurses who had not been selected would plead: “Think of me for the next one.”

One transplant team was not represented in Boston. Just as the nurses were gathering, Dr. Prafulla Kumar Sen performed the world’s sixth human heart transplant in Bombay. The donor was a woman who had received fatal brain injuries in a fall from a train. The recipient was Bodhan Chitan, 27, an untouchable who had suffered for years from a progressive form of heart failure that is virtually confined to the Orient. Dr. Sen’s technique differed from other surgeons’; he connected the donor heart, as soon as it was removed, to his patient’s mechanically assisted circulation so that it was not left without pulsating blood for any length of time. But Chitan died three hours later—from failure of his diseased lungs, rather than his transplanted heart, under the added burden of drastic surgery.