Where Do the Broken Hearts Go?
by Melissa Perrotta, MD
Her name was Skye – as beautiful as it was apropos – with her blue-tinged cast and clubbed fingers against the white bedsheets. I recall my amazement with her textbook findings of chronic cyanosis and cacophony of murmurs, but her diagnosis of hypoplastic left heart syndrome and the paragraph of acronyms that comprised her surgical history fell far outside the realm of the typical general adult cardiology service patient. She was barely an adult, only 19 years old, but because of her age, required admission to the adult hospital. I remember being the third-year medical student in the room, observing this scene, where the pediatric cardiologist we consulted arrived and began drawing complex heart diagrams of Skye’ s single ventricle anatomy, complete with red and blue arrows to map the path of oxygenated and deoxygenated blood flow, and the internal medicine residents and adult cardiology attending circled Skye’ s slight frame in a tense silence, hands in their white coat pockets.
Nobody knew what the heck was going on.
That was what I like to describe as my moment where a doctor gets“ hooked,” and fascination turns into a path forward. I remember thinking to myself,“ Why isn’ t there one person who can walk into this room and know how to take care of this patient?”
In 1944, whispered instructions from a Black gentleman in the corner of the operating theatre directed Dr. Alfred Blalock as he divided the subclavian artery, over-sewed the distal end and anastomosed the proximal end to the side of the right pulmonary artery. The infant’ s lips transitioned from blackberry to baby pink with the restoration of adequate pulmonary blood flow, and the advent of the first surgical intervention for cyanotic congenital heart disease was born – the Blalock-Taussig-Thomas shunt. An unlikely collaborator, Viven Thomas, was initially hired as a janitor for Dr. Blalock’ s surgical research lab at Vanderbilt University. He aspired to attend medical school, but instead he gained the respect of Dr. Blalock and pivoted from his janitorial role into Dr. Blalock’ s lead research scientist. While 1944 wasn’ t all that long ago, segregation and institutional racism put Viven Thomas in
18 LOUISVILLE MEDICINE