Defective ventricular septum
“Suction,” his open palm in a rubber glove awaiting forceps squeezing a piece of white gauze. He gently placed it in the pericardium and dried up a droplet of fresh blood. Again, and again. “…it’s somewhere here. Give me one more, Jitka.” The nurse set another forceps into his hand and Dr. Říha removed another droplet. “I see it now, it’s bleeding here…,” mumbling under his mask in a calm voice, “…give me a cautery.” Electro cautery hissed again, let out a faint smoke in the wound and the vein ceased bleeding.
“There, nothing’s bleeding in there anymore, said Říha to himself, making a mental ‘check’.
The respirator kept a steady rhythm, the clinking of instruments audible above the brightly lit surgical table reflecting in the glasses of everyone present. One of the nurses was monitoring the oxygenator.
“Can I speak to you,” asked quietly Dr. Janík, who was preparing for his postgraduate examination that spring of 1997, and was now completing his pre-examination practicum.
“That depends, how much you want to reveal about yourself to us.” The nurses knew Říha’s sense of humor well.
“What’s the boundary between an indicated suture and a patch?” Maybe Janík didn’t articulate his question too well, but Říha understood.
“With small defects of the septum,” he opened, as though in a lecture hall, “suture may be sufficient, but in this case it is a defect of moderate severity, and that requires a patch.” Říha was quiet for a moment, and so was young doctor Janík. Říha realized he hadn’t quite answered the question. He was focusing on the symmetrical application of the patch. “You have to keep in mind the resulting volume per minute and also the potential deformation in a more extensive suture.”
Piece by piece, Dr. Říha checked the patch he had just applied on the right side of the chamber’s septum, mumbling something under his breath.
“Oxygen is at ninety-four, pH seven point thirty-seven,” announced the anesthesiologist seated behind the young patient’s head.
“That’s quite alright. It will be plenty sufficient,” replied Říha calmly.
He was everything a cardiologist should be. Composed, knowledgeable, experienced, with a steady hand, responsible but with a sense of humor, level-headed, and able to decide quickly and correctly. The illuminated operating room echoed with the sound of instruments, the hushed commands, and the heart pump. All that was left to do was renewing the heart’s activity, and soon they could all talk about their plans for the near and distant future.
“Will you attend the conference, Dr. Říha?” asked surgical nurse Jitka.
“I prefer the other needle-holder; can you pass it to me? You mean Munich? I’m not sure if my car will be repaired by then. I’m still thinking about it.” Říha paused for a moment and automatically, without having to ponder each stitch; he carried on finishing up his work. Ivana broke the awkward silence.
“And have you found out who’s doing it to you?” Instead of answering, Říha shook his head, the operating room glistening in his glasses.
“How is the pressure, Ludva?”
“One-eighteen over sixty-six. Oxygen is now ninety-seven,” answered the anesthesiologist.
“Would you like to finish closing, doctor?” said Říha, turning to the young physician preparing for his exams under Říha’s supervision.
“If you’ve got any thread left, I’ll gladly get right to it,” joked Dr. Janík.
“If I had any left, I’d finish it myself. Continue, and I will be your assistant. It’s now fully in your hands. As if I weren’t here. You have Jitka and Ivanka, but only if I permit it, doctor. Are we clear?” laughed Říha.
Dr. David Říha was a highly successful and skilled cardiologist. This fact was well known, and his reputation heralded success to anyone undergoing a surgery under his knife.
Dr. Janík’s hands were visibly shaking. He tried to hide his nervousness, but everyone noticed. Jitka and Ivana looked at each other, then again at the wound.
“Stop,” commanded Dr. Říha calmly, gently raising his hand to signal a pause. “I hear you play the piano quite well, doctor, is that right?”
“You play very well. You are a great pianist, dear friend!” Dr. Janík let out a bashful smile; the room was quiet, only the respirator kept breathing steadily.
“Thank you,” whispered Dr. Janík.
“And now I want to see your hands on the keyboard. Show me, how you place your hands on the piano. You’ll play. Ready?”
Janík lifted both his gloved hands above the chest, as though he was about to play Rachmaninoff. He stood motionless for a moment, and everyone could see that his hands were no longer quivering but were rock-solid.
“Needle, and let’s get to it, doctor,” said Říha calmly. Ivana and Jitka once again exchanged glances, visibly impressed. Now Janík proceeded successfully and with confidence. He sensed Říha was not his nemesis – an examiner waiting for an error – but a solid place of security that wouldn’t fail him and is on his side. Because by not failing him, the patient wouldn’t be failed either.
Before too long, Říha called on Jitka: “I think the parents are outside. We are done here, so you can tell them that everything went according to plan and nothing surprised us. Let it beat now. Nature made it that way. Without a heart, a person can’t live.” He didn’t like saying such clichés as ‘the surgery was a success’. Only after a few weeks or even months can a procedure be called a ‘success’.
“Yes, doctor,” replied Jitka with her signature smile.
“Ivanka, you asked me earlier,” continued Říha as he pulled down his rubber gloves with a smacking sound, “who’s doing it, right? Can you untie my back? Thank you. But what good would it do me, if I knew?”
“Well, you could….”
“What? Go to the police and tell them that someone robbed my car and cut the wires for the third time? Or lurk behind the bumper?” His accumulated frustration was apparent in his voice.
“You think it’s someone from the hospital?”
“I don’t know, Ivanka. I really don’t know. I’m trying not to think about it.” Říha was shaking his head, staring at the ground, and Ivana felt sorry she re-opened the wound.”
“I would like to help you, somehow. We all would.” Říha looked at her for a moment, then nodded.
“Thank you. You’re good people. Thank you. Please, when you get to post-op, we’ll take new samples for the lab. I will need to test blood gases and minerals immediately.”
“Yes, doctor,” whispered Ivana.
At forty-three, David Říha accomplished more than most others. Excellent cardio-surgeon, coveted jazz musician and baritone saxophone player, and a well liked lecturer at the medical faculty with a gift to engage and motivate his students. On his bicycle he explored half of the country and only his closest friends knew about his charitable foundation for physically disabled children. At home, he always said: ‘if I’m going to be celebrated on stage, then let it be for the saxophone, not the foundation’.
But the world knew even more about Říha. He’d started a small business, and in doing so, he’d separated from the crowd.