Saving Tom Kadesch
A seemingly healthy man experiences terrifying chest pain-and two doctors at Suburban Hospital experience a horrific sense of déjà vu.
Bobbi Kadesch felt nervous but confident. She’d had two knee surgeries and thyroid treatment at Suburban; her husband had had gallbladder surgery there. Both knew of the hospital’s affiliation with Johns Hopkins Medicine and the NIH. Months earlier, Washington Consumers’ Checkbook had named Suburban’s emergency department one of the area’s best, and its cardiothoracic staff had won a national nursing magazine’s award for best nursing team.
Tom Kadesch barely registered the doctor’s words. Having a mechanical bent—he and his engineer father once spent months dissecting a 1965 Volvo—he tried to follow the discussion of arteries and valves but found the situation surreal. Make me well, he was thinking. Fix this problem. Make me well.
Upstairs, a surgical team was assembling: a scrub nurse, circulating nurse, physician’s assistant, anesthesiologist and a technician to run the cardiopulmonary bypass machine. Meanwhile, Horvath arrived and shook hands with Kadesch and his parents.
“Sorry to wake you in the middle of the night,” Kadesch mumbled.
“All part of the deal,” the surgeon replied. His father had died from a ruptured abdominal aneurysm—a condition very similar to his patient’s.
The CT films clinched it for him: aortic dissection, just like a few days before. To avoid the risks of death, paraplegia, stroke or heart attack, Horvath would have to replace the first part of the aorta, up to the arch, with an artificial one.
Kadesch’s parents rode the elevator to the fifth floor with Horvath and their son. “See ya later,” Kadesch told his folks before the doors to the operating rooms swung shut.
One of the OR’s digital wall clocks read 3:52 a.m. as a second clock started counting off the minutes in large red numerals. Horvath was all but unrecognizable behind the blue gown, hair covering, white mask, gloves and black-rimmed glasses with a loupe. A camera and $650 xenon headlight on a fiber-optic cord were affixed to a kind of stripped-down helmet.
The patient flinched as cool wraps were applied to his calves. Connected to a Venodyne machine, they would gently inflate and deflate throughout the operation to prevent blood clots. A blue grounding pad on his hip would allow the use of an electric cauterizing knife.
Around the gurney stood six medical personnel, a beeping anesthesia machine, a humming bypass machine as tall as the staff, the Venodyne machine, a warmer and ice machine for laparotomy sponges and a kick bucket for used sponges. Nearby were a stainless-steel instrument table and a computer station for the circulating nurse, who would track everything from scalpels to sutures.
Anesthesiologist Rojack Tan of Rockville inserted an echo probe down Kadesch’s esophagus to check the condition of his heart and aortic valve.
Horvath made an incision along Kadesch’s sternum. Using an oscillating saw, “like a saber saw you get at Strosniders,” he split and spread the rib cage. The sac around the heart was bulging. “That gives you pause,” Horvath says. By cutting it, “you may relieve whatever pressure is keeping things in place.” Instead of bursting out, though, the surplus blood simply drained into suction devices, and Kadesch’s blood pressure improved. They’d passed the first test.
Rather than off-white, as it should be, “the aorta looked like a big red sausage,” Horvath says. It was also two to three times its usual width. As blood swirled behind the outermost section, the team clamped the artery and quickly shifted Kadesch’s heart and lung functions to the bypass machine. Technician Sherian Brown of Montgomery Village checked that her machine’s green balloon was “breathing” properly and the three drainage tubes were working.
With his iPod piping blues over the sound system, Horvath began replacing part of the aorta with a Dacron tube. He attached the tube to the aortic root above the valve—small strips of Teflon bolstered the nylon sutures—and refastened the aorta’s layers with surgical glue.
Once the cross-clamp came off, Kadesch was weaned from the bypass machine. Blood filled his heart, and the repaired valve held. No suture lines were bleeding. Tubing was removed and drains put in for fluid that might collect later. Kadesch’s sternum was held together with stainless-steel wire, and the soft tissue sewn up. It was 7:48 a.m. Nearly four hours had passed.
For the next three days, one or both of Kadesch’s parents sat by his side. Relatives and neighbors put him on prayer lists. Gradually, catheters, tubes and wires came out, until all that remained was a 6-inch scar. A walk across the room became a walk around the building.
Almost two weeks recuperating with the folks, eating donated casseroles and receiving friends overlapped with a weeklong holiday shutdown at the office, so Kadesch lost few sick days. Coworkers fussed over him when he returned to work in early January. By contrast, home seemed oddly silent. The 3-foot tree’s cord still dangled where he’d left it on the kitchen table.
Kadesch sent notes of thanks to both physicians. Leonard attached his to the bulletin board that staffers scan while drinking coffee in the wee hours. “It’s a good thing to see a rare case,” he says. “It keeps you vigilant.”
More than a year later, Kadesch remains grateful to Suburban Hospital—and to his health insurance, which picked up all but about $3,000 of his $51,000 adventure. “After you go through surgery like that, you realize life is short,” he says. He has made some changes: Though never known to be hypertensive, he takes low-dose, blood-pressure medicine as a precaution. He makes a point of biking long distances and rocking out on his guitars. He has become closer to relatives and traveled more. So far, the steel in his chest hasn’t set off any metal detectors.
The doctors attribute Kadesch’s strong recovery to his age, general health, quick damage control and perhaps a laid-back attitude. “Not getting caught up in the rat race is a good approach,” Horvath says. Kadesch thinks those are words to live by.
Ellen Ryan is a freelance writer living in Rockville.