I watched the lady edge ahead in the lane next to me at the pool. I tried to hold but kept losing distance and she touched the wall a good couple of seconds before me. Nothing to it you would say, except the lady in question was a 70-year-old with a lung condition called pulmonary fibrosis, where your lung tissue is replaced by fibrous tissue and becomes incapable of passing the oxygen you breathe into your blood stream.
Six months earlier she was in my office barely able to breathe. She had undergone a mitral valve replacement years back. An examination told me that the valve was the issue again, and in addition, her aortic valve was leaking. The leak on the mitral valve was so bad that it was breaking up her blood-carrying cells—the red blood cells—causing her counts to be low. She was an interesting lady, a swimmer, who was consistently on the top of her age group and she was still trying to swim. She needed two valves done, had fragile lungs and this would be a repeat surgery. The odds were against her. I told her she would be back to swimming soon and we could race each other when she got better.
I walked into the surgical lounge after her heart catheterization procedure, and ran her case by my surgical colleagues. They are an interesting bunch of fantastic surgeons, but they know when a patient needs something extraordinary, and that’s where the Maverick (no reference to Tom Cruise, we are talking real life) comes into the picture.
The Maverick is a surgeon (that’s what I call them), who will accept the toughest and the sickest patients. There are a few peculiar qualities that are consistent about all the Mavericks I have known. They are brilliant individuals, bordering on geniuses. They are very high-volume operators on specific parts of the heart, either valves, aortic surgery, or heart transplant. They always answer their phone, or get back in a timely manner. They are able to push the boundaries of medicine, as a lot of patients referred to them have few options. They are generally in a University setting, with big teams, but that’s changing—the transplant Maverick I use is in Orlando and works for a private hospital and their statistics are the best in the state.
We are a referral centre and sometimes get patients in a pretty bad state—some of them are complications of unorthodox treatments. Mavericks never judge, they are only interested in what we can do from this point on. They pass on a certain energy, even over a phone call. They are not looking for work. Most times I call them to review tough cases or for another opinion when there is a disagreement between doctors on the best treatment.
I remember dealing with a complex patient. I was in touch with Dr Martin at the University hospital, and even as I tried everything, I ran into a brick wall. He had one last suggestion, and I remember telling him, “Tom, I am wiped. I don’t have anything left.” “No problem Dinesh,” he said reassuringly. “I will send the chopper down to transfer the patient”. He had helped me do my best, and when I could do no more, he took over.
I had even called Dr Martin in the middle of a case, which was making us squirm, to make sure we were on the right track. It’s always an intellectual back and forth, and you come away feeling you have done the best for your patient.
The Maverick in the case of my swim champ was a valve surgeon at the University of Miami, Dr. Lamelas. He had pioneered minimally invasive valve replacement. He replaced both the valves through a minimal incision on the right side of her chest, without going through the previous sternal incision. She struggled a bit and had a prolonged hospital course. But she made it; she went to physical therapy, and came back to kick my rear in the pool.
As technology changes and we keep pushing the envelope of medicine, the cases become tougher, longer and the science becomes grey. I remember thinking of an out- of- the- box idea while dealing with a sick patient who was crashing, but kept it to myself as I thought my colleagues might commit me if they heard it (I am pretty sure they already want to). I sent a text to Dr Martin explaining the case. He replied saying he was on vacation but I would get a call from a certain Dr George. It was dark outside as I sauntered to the lounge.
There was no one in the surgical lounge as I leaned back on the chair and swung my legs up on the table, exhausted. My phone went off and the young energetic voice of Dr George came on the phone. I could feel his energy wake me up. He listened to the case and suggested I do exactly what I had thought of and had been afraid to say. I smiled as I put the phone down, the next generation of Maverick had arrived.
The writer is chief of staff, Florida Hospital Memorial Medical Center, Daytona Beach, US.
