24 hours at Johns Hopkins

“Because your whole world can change in 24 hours.” – The Paper (1994)

Tuesday, November 28, 1944: Sometime during the evening of the 28th, Dr. Alfred Blalock places a telephone call to the Surgical Laboratory at Johns Hopkins Hospital. His Surgical Assistant, Vivien Thomas, has recently developed a surgical correction for the heart defect known as Tetralogy of Fallot, also known as Blue Baby Syndrome. The two men have planned for Thomas to teach Blalock the steps needed to successfully complete the surgery during an operation on a dog. Blalock has done the operation only once and many more teaching sessions are needed.

Blalock is calling with grim news: Earlier he had asked Thomas about the possibility of operating on 19 month old infant Eileen Saxon. Weighing only nine pounds and often cyanotic, the dusky blue color that gives this malady its name, she is deteriorating rapidly. At the moment she is so cyanotic that she is purple and is struggling for every breath. Dr. Blalock tells Thomas to meet with Elizabeth Sherwood, the operating room supervisor, first thing in the morning. Thomas has invented several surgical tools specifically for this operation and he is to make sure that they are available.

Thomas is stunned and reminds Blalock that he doesn’t know the operation very well. “But if you don’t get ahead of yourself, break it down into smaller and smaller steps as you work, it can be done.” It is one of the familiar sayings Thomas uses when he is teaching proper surgical procedure and for a moment, Blalock feels as if he is the assistant.

After Blalock hangs up, Dr. Helen Taussig orders him home. Blalock protests, but she reminds him that he plans to operate in the morning – an operation that could very well be emergency surgery. The hospital has his telephone number should he be needed during the night. At roughly the same time, Thomas and Blalock leave for their respective homes. Segregation is still prevalent at the time and Thomas leaves by a back entrance; neither man knows the other one has left.

Dr. Taussig spends the night on the ward; Eileen’s parents are also there. Although they don’t know it, this is an ominous sign: in the 1940’s, visiting hours rules were strictly enforced unless a patient was seriously ill.

Wednesday, November 29, 1944: Too nervous to drive, Blalock asks his wife Mary to take him to the hospital. She lets him out of the car in front of the towering Johns Hopkins dome. Dr. Blalock enters the building, walks through the rotunda (rubbing the toe of the Statue of Christ for luck, an old Hopkins tradition) and turns left. From here he exits the building through a side door, walks approximately 50 yards, and into the Harriet Lane Home for Invalid Children. Vivien Thomas enters the Hopkins complex from a side entrance and goes immediately to Elizabeth Sherwood’s office. Miss Sherwood knows nothing about Dr. Blalock’s plan to operate but immediately shows Thomas the selection of items that will be available to Dr. Blalock. Thomas adds custom-made clamps and needles to the collection. These needles are no more than 1/2 inch long. Thomas insists that the clamps and needles not become part of the general operating room supplies – they have been custom made for this operation only.

Blalock and Taussig examine the child and confer. Eileen has not improved during the night, and Taussig concedes that there is nothing else that she can do. She leaves the meeting as Thomas arrives, perhaps to return to Eileen’s bedside or for a quick trip to the Cafeteria. Blalock and Thomas discuss the upcoming operation. They go over some of the more critical steps, and also discuss “routine” points such as where the incision should be made. Thomas informs him that Miss Sherwood has promised that the large operative theatre will be available but needs to know when the operation will begin. Blalock decides that the operation will take place after the morning rounds, unless events dictate otherwise. He leaves to confer with Eileen’s parents and to conduct Rounds. Thomas did not normally participate in Rounds so he would have gone to the Surgical Lab, although he may have gone to his office. He calls Miss Sherwood and informs her of Blalock’s decision.

The operative team convenes in the Scrub Room annex connected to Room 706. Although first chosen at random, the majority of Hopkins’ early heart surgeries will take place here and the room will come to be known as “The Heart Room.” Dr. William Longmire and Dr. Denton Cooley will assist. An unknown person sets up a movie camera pointed at the operating room table; this film still exists in the Johns Hopkins Hospital Archives.

Blalock continues to discuss the upcoming operation with Thomas as he prepares for surgery. Thomas is not scrubbed in and has no intention to – he is not allowed on the Operating Room floor. He will be seated in the raised seats of the theatre, however. Helen Taussig will be in the Operating Room, even though she is not a surgeon. She’ll spend most of her time at the head of the table, monitoring the patient.

A few minutes before Eileen arrives, Blalock quietly asks his scrub nurse to find Thomas and help him get scrubbed in. As expected, Thomas is seated in the bleachers above the OR. Blalock also orders a milk crate and has it placed behind him. Thomas stands on the crate, peering over Blalock’s shoulder at the operative field.

The operation begins with a curving incision near the 4th rib on the child’s left side. With Thomas guiding him, Blalock gently works past the lung and cuts a path to the heart. The heart is small, dark, and obviously struggling. William Longmire later said “I remember watching him open the patient and just thinking it was impossible.”

Blalock works patiently, finding the Left Subclavian Artery and the left branch of the Pulmonary Artery. He places a clamp on the Subclavian to cut off blood flow – using one of the clamps designed by Vivien Thomas for this procedure – and cuts it. He then places two similar clamps on the left branch of the Pulmonary Artery. Making a small opening in the Pulmonary Artery, Blalock uses the tiny needles Thomas has prepared to sew the Subclavian Artery into the Pulmonary Artery. After double checking his work, Blalock removes the clamps. He is unable to feel blood flowing through the new connection.

Legend has it that Helen Taussig said “Al, the child’s lips are a lovely pink color!” The Johns Hopkins online exhibit about the operation states that the anesthesiologist said “The boy’s a lovely color now!” at a later date, during the third operation. Blalock’s operative notes comment that the circulation in the nail beds of Eileen’s left hand “appeared to be fairly good.”

The difficult segments are complete but the operation is far from over. Sulfanilamide (an antibiotic) is introduced into the incision and Blalock begins to close. He sews the soft tissue closed with silk sutures and is finally done. The operation has taken about ninety minutes. (CLICK HERE to perform the Blalock-Taussig Procedure yourself. Read Blalock’s operative notes here:  PAGE 1 PAGE 2)

Eileen is moved to the Recovery Room, where Dr. Henry Bahnson is responsible for her care. As one might expect, Blalock and Taussig look in on her often.  Bahnson’s opinion is that the little girl is still very blue but improves over time. Eileen’s mother comments “When I saw Eileen for the first time, it was like a miracle… I was beside myself with happiness.” Very little is known of Thomas’ movements after the operation. He is seen in Recovery and also in his Lab.

As the sun sets on the city of Baltimore, Eileen remains in critical condition but she is stable. The operation is a success, but in a few months it will fail and she will need another Blalock-Taussig Procedure, this time on her right side. She will die just before her 3rd  birthday.  The doctors determine that the surgery is more suited to an older child whose blood vessels have had a chance to grow. In early 1945 Blalock and Taussig co-authored a medical journal article about the first three procedures. Hundreds of patients would flock to Johns Hopkins Hospital to receive the life-saving surgery, even though the odds were long: an article in the February 17, 1947 issue of The American Weekly noted that 14 of the first 70 patients had died.

But parents noted that 56 of them had lived and were growing up, something that had never happened before. The era of Congenital Cardiac Surgery has begun.

Good Nurses

NOTE TO READERS: We’re off on a Secret Mission tomorrow, so there may not be a post on Thursday. You’ll hear all about it later, though!

I was looking through my 1967 Johns Hopkins records and especially looking over the nurse reports. The nurse reports make up over half of my total file – neat sheets with handwritten measurements gathered at certain times. This was long before electronic records and most monitoring equipment. Nursing was really a hands on profession, not that it isn’t now. I’ve been cared for by some awesome people over the years, and a lot of them are nurses. You see and interact with the nurse a lot more than you do with the doctor, so when you are assigned a really good nurse it is a Great Thing and a Big Deal.

A big part of the job is observation and reporting, and in the ’60’s you were doing this constantly. There weren’t many automatic alarms that would go off when something was wrong; it was the nurse’s job to almost see problems coming. You were looking, observing, and making notes on every patient, so a good nurse had her head on a swivel. The nurses reports in my file I’ve nicknamed my “pee and poop sheets” because that was a major part of what was recorded: My temperature, amount taken in (input), amount expelled (output), and what I was doing at the time. Remember I was five months old; at any time of day I might be “playing”, “sleeping”, or more than likely, “crying”. Hey, I was a baby, and you people had just cut my chest open and tinkered around in there. You’d cry, too!

The order of the day was “Observe the patient.” You can almost hear the nursing department answer OK… what are we looking for? Trouble is, Cardiac Surgery was only about 25 years old then – they knew they had to prevent Pneumonia but after that, no one was really sure what to expect. So the Surgical Department just told them to observe the patient closely.

I had a fever on my 3rd day post-op. Hopkins called in a doctor who specialized in combating fever. “We see this a lot,” he told my parents. “Many patients spike a fever on the third day after their surgery, we don’t know why. If this is a 3 day fever, it will last about 24 hours and then it will disappear. We don’t know why that happens, either.” And he was correct – it was a 3 day fever, and it was gone 24 hours later. But he also told the nurses to keep a close eye on me, just in case it wasn’t a 3 day fever.

How do I know? The nurses report for that 24 hour period is crammed with notes. The best I can figure, they were checking on me every fifteen minutes for almost 30 hours.

Good nurses are lifesavers – literally!

 

 

 

…And say ‘To-morrow is Saint Crispian’

If you are a fellow heart surgery Survivor, a Heart Parent, or just want to help rid the world of Congenital Heart Defects, feel free to link to Monday’s post. It will appear very late on the night of Sunday, October 24.

A disturbing report

Funky Heart reader Cindy forwarded THIS .PDF FILE that you need to read. Titled Forty Years of the Fontan Operation: A Failed Strategy, this report contains information that you should consider. Download it, print it, and read it carefully. But I’ll warn you: this report will make your hair stand up.

Forty years ago a heart defect that eliminated the Right Ventricle was “uniformly lethal” but today that same patient is “not only likely – but expected – to survive.” One of the major weapons in our arsenal is the Fontan Operation, the the Fontan comes with its own set of difficulties. The author, Dr. Jack Rychik of the Children’s Hospital of Philadelphia, considers it “a failed strategy.”

Dr. Rychik lists detailed statistics concerning the decline of Fontan patients, then explains why they tend to deteriorate: elevated central venous pressure coupled with a reduction in cardiac output. He then explains three important issues for a Fontan patient: liver damage; Plastic Bronchitis, and Protein Losing Enteropathy (PLE).

This report may be disturbing to many readers, but please remember: outcomes aren’t pre-determined. Dr. Rychik states that 40 years ago single ventricle defects were “uniformly lethal” – but I just turned 44. Heart defects aren’t like math, the answers are not so cut and dried. 2 +2 =4; 4 x 4 = 16. That’s a constant. But each defect affects the patient slightly differently, and the “standard answers” may not apply. When you are talking about a defective heart, 2+2 may equal 66.4.

Just making a guess, I believe that I know 12 to 18 people who have had the Fontan. That includes close friends, people I have met just once or twice, and some I only know through email and blogs. These people are in all stages of health – a few are doing wonderfully, most of them are doing good with occasional Bad Days, and a few can barely go. When you rank test subjects based on general health, Fontan survivors won’t be grouped around one point. They’ll be all over the place. To quote almost every Cardiologist who has ever discussed future options with a patient: It’s certainly not perfect, but it is what we have to work with.

Rychik concludes that in the past, giving a single ventricle patient the ability to live 30+ years was a noble goal. Today, it is unacceptable. He contends that Cardiologists and surgeons need to think outside of the box, and come up with new options – either redesign the Fontan (again); scrap it in favor of something else; or develop a Right Ventricle Assist Device.

Either way, every heart deserves to live a lifetime.

Hearts in the fast lane!

Life in the fast lane

Surely make you lose your mind

Life in the fast lane

Everything, all the time!

— Life in the Fast Lane, The Eagles (1977)

I found this information through Facebook friend Mary Ellen:

London’s Great Ormond Street Hospital (which has the unusual acronym GOSH) had a problem. One of the most critical times in heart surgery is the transfer – the process of moving a patient from the operating room to the recovery room. It is not a simple task of just moving the patient from the operating table to a gurney and rolling it down to the recovery unit; monitors have to be unplugged and reconnected to portable equipment, IV’s have to be prepared for transport, and any life support must be switched to portable units. It is a complicated, involved job that has to be done perfectly – the first time, and every time.

Patients weren’t doing so well, and some were running into real problems after surgery, so GOSH Surgeon Marc De Leval asked a group of “Human Factor Specialists” to study a series of Arterial Switch operations and try to determine what the problem was. The Arterial Switch is one of the more difficult Congenital Heart Surgeries and one that seemed to be causing more than its fair share of problems.

The evaluators determined that both the surgical unit and the recovery team was up to the task; the problem was based in the transfer. Too many things to do, too many things that could be missed, and it could be slow. But it had to be done slowly and carefully, because if you missed something, things could go very wrong for the patient. So even though they recognized the problem, the surgeons of GOSH seemed to be unable to do anything about it.

Until the day when a surgeon and the head of the Pediatric Intensive Care Unit were watching TV. What they needed, they realized, was a team approach – a group of people who could work together to get the job done correctly and the patient on their way to Recovery.

So they asked a Formula One race team for help.

Americans (especially those of us in the South) are more familiar with NASCAR racing. A Formula One pit crew is just as fast as their NASCAR counterparts – and considering that Formula One allows more people working on the car simultaneously, they are probably better.  So the race team came in, and spent some time with the hospital staff. The speedsters made many suggestions, and while not all of them could be implemented, several important ones were: One person was placed in charge of the transfer process and everyone involved was trained on their new task. Problems don’t just happen, they learned. A small error that slips by can turn into a larger problem, which can become an even larger problem. So if the small problems are eliminated, the larger problems should not occur.  They were also trained to have clear, concise plans on what to do if something went wrong. “Plan B” works best when everyone is familiar with what Plan B involves.

So far, the “Pit Stop” approach is working. GOSH reports medical errors that occur during the transfer period are down 30%!

You’ve come a long way, baby

Jill and Shane continue to report on Joshua. Diagnosed prenatally with Hypoplastic Left Heart Syndrome (HLHS), Joshua was delivered at a major medical center and was immediately sent to a Neonatal Intensive Care Unit. By contrast, I was born in a community hospital of less than 100 beds. My grandfather – only an occasional smoker – was so nervous that when I didn’t show up on time, he unwrapped the celebratory box of cigars that he planned to give away and lit up. He was chased outside (smoking was accepted almost everywhere in the mid 1960’s, but a nurse wasn’t comfortable with anyone smoking around the newborns) so he stood under a dogwood tree and smoked until he just had to find out how things were going. Then he jammed his cigar into a fork of the tree and rushed back inside. He never said anything about retrieving his cigar, so for all I know, it could still be there.

Joshua’s parents knew they would be on a roller coaster ride from the moment he arrived. I looked normal. There were no prenatal tests in the 60’s, not even a way to tell if the unborn child was a boy or a girl. Only my mother’s intuition led her to notice that something wasn’t exactly right, and she consulted a pediatrician. The pediatrician that they had used for my older brother was out of town so they talked to the New Guy.

The New Guy realized he was looking at a heart problem but wasn’t sure of the details, so he sent my parents and me to the BIG HOSPITAL 200 miles away. The Doctors at the BIG HOSPITAL figured out that I had Tricuspid Atresia… and stopped. They had never successfully treated a Tricuspid before, so they gave my folks the diagnosis and told them to take me home and enjoy the time I had. I was not long for this world.

New Guy hit the roof. BIG HOSPITAL may not be able to do anything, but he knew of places that would at least try. He found one, and to make a long story short, I was a patient of New Guy until I was 20 years old. The “new” had worn off by then, but he’s one of only two doctors to really understand what is going on inside of me – him and my current Cardiologist. I still see him around town every so often!

By contrast, Joshua was pegged as a Cardiac Kid long ago, while he was still being knit together in his mother’s womb. The moment he was born he was handed off to a skilled care unit. Their only job is to keep him stable until it is time for his repair. And while we thought 200 miles was quite a way to travel to a hospital, that’s no longer true. 200 miles is a short trip.

We’ve literally come a long way.

Pacemakers without batteries

My pacemaker battery wears down pretty quick. Not because I am that active (What do you mean, you don’t chop down a dozen trees with a steak knife every morning?!?) but because of a combination of things. I am “100% paced” – meaning my pacemaker is on the job all of the time.

Also, my pacemaker is not in my shoulder. Usually the controller unit is in your shoulder with the leads traveling down the Superior Vena Cava into the heart. (CLICK HERE for a diagram of the standard pacemaker placement.) So my pacemaker is in my abdomen with the leads leading up through the Inferior Vena Cava.

As you look at that pacemaker diagram, you see that the pacemaker leads extend down into the Right Ventricle. That’s not happening in my heart – remember, with Tricuspid Atresia you don’t have an opening where the Tricuspid Valve normally is. So my pacemaker leads end in the Right Atrium, and the pacer needs a bit more of a “Jolt” to push my heart along. So I usually have to get my battery replaced every three to four years.

The initial surgery is hard, they do have to cut you open. The replacement is easier – they make a two-inch incision above your control unit, disconnect the leads, and remove it. Then they attach the new unit, test it, and if all is well they sew you up. Long time readers will remember that my doctors are worried about what might happen if I am put to sleep, so they give me a sedative. I call the sedative Happy Juice for a reason: I’m awake and can talk (and make pretty good sense!) but I am flyin’. Let me tell ya, Happy Juice is some good stuff, and next time I’m going to ask for the recipe!

Of course, the Happy Juice will wear off in a few hours, and then I won’t be quite as happy. So before I was discharged the Outpatient OR gave me a prescription for some painkillers, and that is when the trouble started.

Sometimes ordinary things cause the strangest reactions in people. I have a friend who will not drink Orange Juice – it makes him hyper! A small glass of OJ hits him like a sugar rush, and you almost have to sit on him to get him to be still! Now usually, meds work the way they are supposed to when I take them, but this painkiller never killed any pain… all it did was make me sleepy.

Ugh. Sleepiness wasn’t helping, because I was hurting so bad that I couldn’t lie down or sit up without help. And because the incision was in my abdomen, I couldn’t even roll over. I was trying to sleep sitting up in a straight-backed wooden chair, and a local ER doctor wouldn’t help me. Apparently he thought I was trying to work the system, since his advice was to “grow up.” I had to go back to my Cardiologist in Atlanta to solve this problem.

Thankfully he’s seem me enough over the years to realize that I wasn’t kidding around or trying to scoop some free drugs. He changed the prescription and for the first time in a week, I could lie in bed and sleep.

At one of my worse moments I declared (loudly) that if getting the pacemaker changed was going to hurt like this, then the next time I would just let the battery go dead and take my chances. Thankfully that was just the pain talking, I haven’t lost my sanity. But maybe I can get lucky and get one of those new pacemakers that generates its own power!

Researchers at Princeton University are working on a flexible rubber sheet that can power a small electronic device. The rubber sheet is coated with ceramic nanoribbons and generate energy by movement. In theory, a pacemaker control unit could be placed near a lung (the two current pacemaker placement locations – shoulder or abdomen – should do the trick) and as you breathe, the motion of your lungs would generate the power needed to operate the device.

Meanwhile, they are taking a slightly different approach at the University of Michigan. Tiny generators can “capture” motion and use them to generate power – more than enough to power a pacemaker. This really isn’t new: There are already “Self-winding” watches that create their own power from the back and forth motion of our arms as we walk. This generator can use vibrations from smaller, less rhythmic motions to create their power. The problem right now is energy storage – the research team needs to find a way to store the power generated for the times when motion is low. I know that I would hate for my pacemaker to run dry just because I was sleeping!

All joking aside, I would love to have one of these pacemakers. Even though it is a simple operation and (usually) there isn’t much pain involved, a pacemaker replacement is still a surgical procedure. And as a wise man once said, “Minor surgery is any surgery that they do to someone else!”

Cut ’em off at the pass!

It’s a common scene in old Western movies: The good guys are in hot pursuit, but the bank robbers are getting away. “Quick, let’s cut ’em off at the pass!” someone shouts, and all the good guys gallop off through a shortcut. A few moments later, they’ve managed to get ahead of the evildoers!

For ten years now, Children’s Hospital of Boston has been working on cutting Hypoplastic Left Heart Syndrome (HLHS) off at the pass – by doing heart surgery while the baby is still in the mother’s womb! One of the early signs of HLHS is Fetal Aortic Stenosis; a small Aorta present before birth. (This can be detected through a Fetal Echocardiogram.) Boston Children’s has developed a procedure in which a probe is inserted into the mother and passes through the womb, into the unborn child, and enlarges the Aortic Valve. This is known as Fetal Aortic Valve Dilation.

An article in the June 2010 issue of Congenital Cardiology Today details the procedure and reports on an analysis of 70 attempts to repair the defect. 52 of the procedures (70%) were “technically successful.” If the Left Ventricle is small (and it almost always is) when the operation is done, the Ventricle will not grow. However, it will support growth of other Left Ventricle structures and HLHS can usually be avoided. Aortic regurgitation (backward blood flow through the Aortic Valve) happened in about 40% of the cases. And unfortunately, death occurred 13% of the time.

But the good news is we are starting to be able to fight a severe Congenital Heart Defect before the child is even born – and stopping a severe Congenital Heart Defect almost before it starts!

The wrong question

The question we should be asking isn’t “Is it right to consolidate centers that offer Congenital Heart Defect (CHD) surgery in favor of larger centers?” but rather, “How do we get a CHD patient that presents at a non-surgical facility to one of the large surgical centers?” This question really has no good answers.

At 11:21 PM last night, a mother delivered a child at a smaller facility that does not offer Congenital Heart Surgery. The child, a five-pound, six-ounce boy, appeared to be showing the signs of Cyanosis. There has been no indication of any potential for cardiac problems noted in the medical records, and the child was immediately evaluated by the Cardiologist on staff.

The Cardiologist noted the presence of several unusual heart sounds, which along with the Cyanosis, lead him to believe that the child may very well have a Congenital Heart Defect. However, he is not sure of the exact diagnosis. For further testing the child needs to go to a facility with advanced imaging equipment, and there are two hospitals that can provide this service: Hospitals A and B. Hospital A has imaging equipment but no Congenital Heart surgeons; Hospital B (304 miles away) has both. The Cardiologist chooses Hospital B – perhaps the easiest decision that will be made all night.

Meanwhile, the parents have been informed that there may be a health issue with their child, and they may need to travel to a larger facility. In a small room with a Hospital Counselor, they discuss their options, which at the moment are largely unknown. In a few moments the Cardiologist enters the room and states that their child may have a serious heart problem but he is not sure. He recommends the child be taken immediately to Hospital B and possible surgery.

Now our questions multiply: Is the infant stable enough to fly? If yes, is the weather suitable for helicopter transport? Is a helicopter available? What kind of medical skills will be needed for the journey? Does the hospital have someone who is qualified to provide that level of care? If not, can someone be found quickly?

Is the mother able to travel? If not, how will the mother travel to Hospital B when she is well enough to travel?

These are the medical questions that need to be answered. Non medical questions could include anything from how will the family arrange for their clothing to be delivered to them at Hospital B, where will they stay, do they require any financial assistance, and what will happen to their vehicle? After all, when they arrived at this hospital, they never expected anything but the miracle of childbirth. Now they have been thrown into a world they do not want to visit, but have been informed that this will be their permanent home.

At 2:13 AM the phone rings in an office of Hospital B. The person who answers the phone knows that the Cardiologist on Call has been discussing a case with a fellow doctor at a small facility and that the child in question is being transported by helicopter. The phone call informs him that the helicopter about fifteen minutes from landing.

In turn, this person calls the Catherization Lab, Hospital Social Services, and Cardiology to relay the news. With great reluctance he calls the number of a home near Hospital B. Apologizing again for waking the family, he tells the woman who answers the phone that the helicopter is near.

The woman represents the local Congenital Heart Defect support group and is a Heart Mom herself, and has volunteered to work with new parents and try to guide them through their first journey into the CHD world. Just before leaving the house she looks into the room where her young daughter sleeps, her personal reminder of why she answers the phone in the middle of the night.

Obviously, this story is fiction – or it may not be, as 1 out of every 125 children are born with a Congenital Heart Defect. Many of them are born at smaller facilities that offer little to no Open Heart Surgery experience, and need to be relocated to “Hospital B” for evaluation and possible surgery. In my opinion, asking if closing smaller facilities in favor of larger, more experienced hospitals is the wrong question. We need to concentrate on smoothing the transition from smaller hospitals to the larger centers where help is more readily available.

Isaac

Isaac is having surgery today at Duke Children’s Hospital! I met Isaac and his mom at the Saving Little Hearts CHD Symposium I attended last year, he’s a pretty cool kid. He has to be at the hospital at 8:30 AM Eastern Time (1230 GMT) and he’s the second scheduled operation of the day. I’ll be updating when I find out what’s going on, so keep refreshing this page!

11:04 AM: No update as of yet. Surgical schedules do run late, I’ll keep checking!

12:48 PM: First update! Things were going really slow – Isaac was called back to the Prep Room at 11:30 AM! He’s finally in the Operating Room.

1:14 PM: Surgery has begun!

3:23 PM: Surgery still going on, everything seems to be under control. Isaac’s mom is beside herself waiting! Keep thinking about both of them, please!

6:21 PM: THE SURGERY IS OVER! The Surgeon said everything went exactly as planned. Isaac is on a ventilator and is in Recovery; his mom is on her way to see him right now!

She’ll probably report once she sees him; if nothing unusual is going on I’ll end this post after that update.

11:48 PM: A final update from Isaac’s mom: HE’S PINK!