Indiana, PA - Indiana County

Student, AGH collaboration not for the faint of heart

by MARGARET HARPER on February 19, 2012 3:30 AM

PITTSBURGH -- As a thin stream of blood spurted up from the beating heart, a group of students gasped in shock and excitement.

Retired cardiac surgeon Dr. John Burkholder, speaking at the Open Heart Observation Program at Allegheny General Hospital, used it as a teaching moment.

It's not uncommon for small leaks to occur during bypass surgery, he said, explaining how the surgical team would control the situation.

Moments later, with the leak corrected, they continued with the triple bypass under the watchful eye of curious high school students, including eight from the Blairsville-Saltsburg School District.

They were the first Indiana County students to attend, said Pat Wolf, coordinator of the program.

The Open Heart Observation Program is the idea of Dr. George Magovern, chairman of AGH's Department of Thoracic and Cardiovascular Surgery.

"It's a good way early on in your life to decide if you enjoy the hospital environment or you don't," Magovern said.

Occasionally, he or colleagues would receive requests from interested students they knew asking if they could observe surgery to consider a medical career. In 2008, AGH formalized the program, opening it to high school students.

Through the program, students observe an open heart procedure. On Wednesday, it was a triple bypass on a male patient in his 80s. Other days, it may be valve repair, or implantation of a device to assist the heart.

Students watch with a bird's-eye view from the observation deck, which Magovern said is the only functioning one in a city hospital.

"It's a great way to see complex surgical procedures without really being in the room," Magovern said.

Since 2008, 70 schools and more than 4,000 students have participated, Magovern said. Wolf routinely sees students from 10 counties in the Pittsburgh area, and about 1,500 come through each year. The program runs four days per week, and about 15 students can attend at one time.

While the majority of the students who participate are in high school, Wolf said she has hosted gifted students from middle schools.

It allows students to explore a variety of hospital careers. And it's not just about the surgeon, Magovern said. Surgical teams include a cardiac surgeon, cardiothoracic resident, anesthesiologist, nurse anesthetist, physician assistant, perfusionist, registered nurse and surgical technologist.

"There's all sorts of professions represented in each case," he said. "Depending on the student's background, interest and aptitude, there are plenty of opportunities for them to think about."

Megan Miller, 18, a senior at Saltsburg, is headed to St. Francis University in the fall to begin preparing for a career as a physician assistant. She enjoyed seeing how the PA worked with the surgical team.

This trip rounded out an experience over the summer of shadowing a PA in a family practice setting, she said. Here, she got to see surgical aspects of the job.

Zachary Cravener, a 17-year-old junior from Saltsburg High School, is interested in a medical career, maybe in surgery.

It surprised him how much was going on at the same time, he said, like when someone harvested a vein from the patient's leg, and another opened his chest.

Jessica Harper, 16, a junior at Blairsville, said there were more people than she expected in the operating room.

Seeing all those from the team work together in harmony teaches the lesson of teamwork, Magovern said. On any open heart case, he said, there are close to a dozen people working in concert. That's an important lesson.

"It's not a field where you can operate on you own," he said. "You really need a whole team behind you. In order to be successful, you have to know how to communicate well with your colleagues."

And no matter what a student's interest is, they can all learn organization, anticipation of needs, punctuality and leadership.

"All of the characteristics that make for a successful adult," he said.

For most, seeing a beating heart is the epic moment.

"That really is quite an eye-opener," Magovern said.

It always fascinates people, he said, and can spark curiosity in a student to learn more about science, chemistry and biology.

Students were mesmerized while the team worked to restart the heart after it was paralyzed in a state of relaxation using potassium and electrolytic ice.

Placing it in that state allows the team to move the heart around more freely for surgery, explained Burkholder, who occasionally attends to narrate surgeries for students. The lungs are also stopped, though they are inflated artificially every 15 minutes or so while the patient is hooked up to the cardiopulmonary bypass machine.

With a series of jolts from a small set of paddles, the heart was successfully restarted. Students expressed delight at the now-beating heart.

As the end of the surgery neared, tubes that had connected the heart to the bypass machine were removed.

"It's starting to look like a heart now," Wolf pointed out.

Other tubes were inserted through the chest, usually for about two days, to allow excess fluid to drain.

The expected stay in the hospital for this type of procedure is five to seven days, Wolf said.

Students watched intently as they wired the chest bone closed, and closed the incision in the leg where the vein was removed.

Viewing the surgery also gives students a chance to think about their own heart health at a young age.

Burkholder talked about keeping your heart healthy, and said maintaining a healthy diet is crucial. He encouraged students to cook their own foods, and to stay away from unhealthy, processed and fast food choices.

Wolf said sometimes the experience is life-changing.

"I've had students say 'I'm never eating french fries again,'" Wolf said.

The students all considered the trip a success, even if they thought it was a bit more graphic than expected.

Nathaniel Porter, 17, a senior at Saltsburg, wanted to see "if medicine is something I could do for the rest of my life." He's considering an eventual career in pediatrics.

Now, he knows.

"I learned I can take it," he said. "I'm not as squeamish as I thought I was."

For others, the program served as a way to show them that a surgical career isn't a good fit.

"Some come in and realize they don't like the hospital environment," Magovern said.

Courtney Kanyan, 16, from Blairsville High School, said it was interesting, but not what she expected. She didn't like seeing what was necessary to get inside a patient's body.

"Now, seeing this, I don't think I could really handle a career in the health field," she said.

And while Mitchell Fox, 16, a junior at Blairsville, was grateful for the "once-in-a- lifetime" experience, he thought it was "a bit more graphic and gory" than expected.

Samantha Harsh, 17, another Blairsville junior, was debating whether she could handle "all the blood and stuff."

She had been thinking of careers in optometry and surgery, and will stick to optometry, she said.

"I didn't expect to see everything as much," she said.

Others agreed that the trip will help guide their career choices.

Mackenzie Livingston, 17, a junior at Blairsville, is interested in a career in anesthesiology. She thinks the experience will help her decide.

"It's definitely more graphic than I thought it was going to be," she said. "I didn't think we'd get this kind of view."

The students from Blairsville-Saltsburg attended the program as a job-shadow experience. It was offered to students enrolled in higher level math and science courses, such as advanced placement chemistry.

The students had all expressed interest in a health-related career, said Lori Baker, guidance counselor at Saltsburg.

She and Blairsville guidance counselor Karen Thomas were excited to have students attend.

Students have previously visited hospital settings at Indiana Regional Medical Center and Conemaugh, but this is the first time for the opportunity to observe surgery.

"We will learn, as counselors, a lot from the experience as well," Thomas said.

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