return to the operating room and resume his passion for surgery.
â
T HE U . S . A RMY HOSPITAL WAS BUILT on the grounds of Stowell Park in Northleach, England. It amounted to little more than a cluster of corrugated-steel Nissen huts housing patient wards and surgical teams.
The month of May 1944 failed to provide much in the way of casualties to occupy Harken and his team. He spent the time productively nevertheless, preparing and training his clinical staff in the new art of thoracic surgery.
They would not have long to wait to put theory into full practice; June 6, 1944âD-Dayâwas suddenly upon them. The hospital received a tidal wave of casualties, delivered by air from the European theater, first from the invasion and then a later surge after the Battle of the Bulge. Confronted by casualties arriving with missiles lodged in their hearts, Harken consulted George Grey Turner for guidance on whether or not to attempt their removal. Grey Turner gave Harken his blessing, stating that there were many good clinical reasons to remove such foreign bodies but that the neuroses that might result from a patientâs knowledge that he âharbors an unwelcome visitor in one of the citadels of his well-beingâ might give cause enough. The challenge that Harken had so meticulously prepared for had finally arrived.
â
O NE OF H ARKENâS GREAT SKILLS LAY in understanding that the technical ability of the surgeon had to be matched with an equally capable operating team. These surgeries, particularly those involving foreign bodies in the cavities of the heart, often demanded considerable intraoperative resuscitation. While Harken navigated his way through the anatomy, his anesthetist would be responsible for actively resuscitating the patient: providing massive transfusions and balancing efficient pain relief against the hazards of bleeding out, hypothermia, and shock. For the anesthetist in these cases, it was like flying a plane on fire, hoping to hold it in the air long enough for the surgeon to be able to douse the flames.
Rates of blood loss of up to a quart and a half per minute were recorded, a torrent that could empty the patientâs heart and blood vessels and precipitate cardiac arrest in a matter of seconds. That phenomenonâshock caused by hemorrhageâcame to be better understood later in the century as the compromise of the heart and circulation by rapid blood loss and the consequent failure to meet the metabolic demands of the bodyâs vital organs. Left unabated, this process leads inexorably to death, and though the physiology of shock and its consequences hadnât been fully grasped by the time World War II arrived, Harkenâs team had intuitively come to understand the great value of massive whole blood transfusion in keeping patients alive.
Blood was supplied in glass bottles. But keeping up with the torrential losses demanded far more than their gravity-driven dribble could provide. To overcome the challenge of delivering blood at speed through narrow tubes, the anesthetist would inject air into the head space of the flasks, increasing the pressure within and thus the rate of flow. Occasionally in the heat of the moment, they would overdo it, and the jars would shatter under the additional pressure, scattering shards of bloody glass throughout the operating room.
Harken meanwhile would be focused upon navigating safe routes to and through the heart. He learned that the simple act of handling the heart was enough to provoke abnormal and potentially fatal disturbances of its rhythm. Like Grey Turner, he came to recognize the peril in removing the heart from its proper position. Harken also devised techniques for incising and entering the heart while exercising at least some control over the resultant hemorrhage. He achieved this by placing sutures on either side of his incisions, leaving a pair of long trailing threads at both edges. His assistant could then hold
â
T HE U . S . A RMY HOSPITAL WAS BUILT on the grounds of Stowell Park in Northleach, England. It amounted to little more than a cluster of corrugated-steel Nissen huts housing patient wards and surgical teams.
The month of May 1944 failed to provide much in the way of casualties to occupy Harken and his team. He spent the time productively nevertheless, preparing and training his clinical staff in the new art of thoracic surgery.
They would not have long to wait to put theory into full practice; June 6, 1944âD-Dayâwas suddenly upon them. The hospital received a tidal wave of casualties, delivered by air from the European theater, first from the invasion and then a later surge after the Battle of the Bulge. Confronted by casualties arriving with missiles lodged in their hearts, Harken consulted George Grey Turner for guidance on whether or not to attempt their removal. Grey Turner gave Harken his blessing, stating that there were many good clinical reasons to remove such foreign bodies but that the neuroses that might result from a patientâs knowledge that he âharbors an unwelcome visitor in one of the citadels of his well-beingâ might give cause enough. The challenge that Harken had so meticulously prepared for had finally arrived.
â
O NE OF H ARKENâS GREAT SKILLS LAY in understanding that the technical ability of the surgeon had to be matched with an equally capable operating team. These surgeries, particularly those involving foreign bodies in the cavities of the heart, often demanded considerable intraoperative resuscitation. While Harken navigated his way through the anatomy, his anesthetist would be responsible for actively resuscitating the patient: providing massive transfusions and balancing efficient pain relief against the hazards of bleeding out, hypothermia, and shock. For the anesthetist in these cases, it was like flying a plane on fire, hoping to hold it in the air long enough for the surgeon to be able to douse the flames.
Rates of blood loss of up to a quart and a half per minute were recorded, a torrent that could empty the patientâs heart and blood vessels and precipitate cardiac arrest in a matter of seconds. That phenomenonâshock caused by hemorrhageâcame to be better understood later in the century as the compromise of the heart and circulation by rapid blood loss and the consequent failure to meet the metabolic demands of the bodyâs vital organs. Left unabated, this process leads inexorably to death, and though the physiology of shock and its consequences hadnât been fully grasped by the time World War II arrived, Harkenâs team had intuitively come to understand the great value of massive whole blood transfusion in keeping patients alive.
Blood was supplied in glass bottles. But keeping up with the torrential losses demanded far more than their gravity-driven dribble could provide. To overcome the challenge of delivering blood at speed through narrow tubes, the anesthetist would inject air into the head space of the flasks, increasing the pressure within and thus the rate of flow. Occasionally in the heat of the moment, they would overdo it, and the jars would shatter under the additional pressure, scattering shards of bloody glass throughout the operating room.
Harken meanwhile would be focused upon navigating safe routes to and through the heart. He learned that the simple act of handling the heart was enough to provoke abnormal and potentially fatal disturbances of its rhythm. Like Grey Turner, he came to recognize the peril in removing the heart from its proper position. Harken also devised techniques for incising and entering the heart while exercising at least some control over the resultant hemorrhage. He achieved this by placing sutures on either side of his incisions, leaving a pair of long trailing threads at both edges. His assistant could then hold
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