Luke C. Yu and Joe Utley

What was curious about the nurse as she moved expertly about the room, preparing my wife for surgery, was that her forearm was in a fresh cast. I noticed that it didn't hinder her in the least; she might have been born with it, for the way she arranged my wife on the bed and handled the trays of equipment and tore open a sponge-packet of Betadine, the curry-yellow antiseptic, with which she scrubbed Jane’s abdomen for five full minutes by the clock. So absorbed was she in her duties that I became absorbed in them, and never thought to ask how she’d happened to break her arm.

Jane and I had been assured that the operation was to be routine, albeit a little hurried and unexpected. Since this was Jane’s first pregnancy, and since she was carrying twins, her doctors at the Kaiser Hospital on Zion Street, in Mission Gorge, had suggested we take a class on caesarean section, which would help her to endure the operation and prepare me to witness it. Caesarean comes from the Latin caedere, to cut, and according to Roman historians, the ancient family Julii added the surname Caesar when one of its own was born through a cut in the womb. The first recorded instance in which the mother survived the operation occurred in 1500, when a Swiss pig gelder, Jacob Nufer, is said to have operated on his own wife. Today in this country about one baby in five is born by caesarean section. Jane found herself needing the operation when something, six weeks before the babies were due, began to go wrong in her pregnancy. For some unknown reason, she became toxemic — poisoned — with high blood pressure and swelling. An overnight stay in the hospital had done no good, the babies were in stress, according to fetal monitoring; the caesarean was the only resort.

So far in the labor room the preparations were just as they had been described in class. Jane had been cleaned and dressed. Her legs and trunk were gradually being numbed by an anesthetic that dripped through a tendril thin tube into her spine a few inches above the small of her back. She was awake and outwardly calm when the nurses wheeled her across the ward to the operating room.

As expected, the operation was a routine success, and as promised, I was allowed to watch. The room was rectangular, roughly the size of a ranch kitchen, with a counter at one end near the foot of the table. Outside by the open door was a utility room with laundry-size tubs at which the surgical team scrubbed up. When I arrived in my sterile garb and plastic-capped shoes, someone indicated my seat — a black swivel stool at the head of the table where Jane lay with outstretched arms. Once seated it was difficult to move, as the floor around the anesthesiologist’s station was strewn with cables, and as the room itself was fairly crowded. There were Jane, myself, and the anesthesiologist at the head of the table, then a low drape at Jane’s bosom, and beyond that the obstetrician, Richard Porreco, and a nurse on one side of the table and the assistant surgeon and a nurse on the other side, and at the counter, two pediatricians and their assistants.

It was odd to see a part of Jane awake, to feel her grip, while most of her lay inert under the dazzling lamplight and the activity of instruments, voices, and gloved hands. The incisions were low on her abdomen, on the so-called bikini line. “We’re going to break the sac,” said Porreco, after opening the uterus and finding the waters intact. He glanced in my direction with lifted eyebrow. Jane, who only heard him, licked her lips and nodded.

“We’re going to try to break the sac,” he said, nipping it for a second or third time. “Darn thing doesn’t want to go. Oops. There.” The liquid sluiced into a pan. At the same time one of the pediatricians turned from the counter and faced us with a blanket bowed between his hands.

“Just a sec,” said Porreco, reaching inward. “Here comes.” And then our daughter A was born, A was the temporary designation recorded by one of the nurses, who also noted the time and date (11:01, 7-18-81) on the surgical record. B was born a minute after her sister. Jane and I hadn’t settled on names before the births, because we wanted to wait to see which names would suit their individuality.

The births required some tugging, which made Jane nauseous for a moment. Though she was conscious, she was not, in a mental sense, fully alive. Her face held a stunned, wooden look, and held it even when A was lowered into view for five or ten seconds before the pediatrician rushed her to the intensive care nursery. The second birth was more physical than the first; it was then that Jane began to have had enough.

For me, of course, the births were thrilling. They reminded me of watching strange fish being landed from the sea — the triumph of drawing them into our world, and of being there to see the perfect newness of the arrival; and beyond that was their color, for which I was totally unprepared — a waxy, agate blue. Alien.

Unearthly too was the feeling that roused itself in Jane and me when the first child was lowered close for us to view, swaddled in the arms of the pediatrician. She wasn’t pretty, not at least as I’d envisioned the infant to be. Her face was distorted around her crying mouth, her eyes merely slits. Yet one could sense that she was complete, in just the way our affection was. Our devotion to her was born at the same moment she was, and what seemed strange, at first, was that the devotion was complete, full blown and ready to live — just like her. Our love for the child was a part of her, as much a part as anything physical, her hand or her hair, and its presence was as sudden and as real as though someone had come up behind me and touched the back of my neck. Tears came to our eyes in the seconds that she was there. As short as that time was, it was enough.

Then while the newborns were being examined and treated for the troubles of immature birth, the longer part of the operation ensued. Porreco restored the uterus and adjacent organs to their places, and closed layer upon layer of integument, muscle, and skin. It seemed to take about forty minutes. There was one slight delay when he pricked his finger on the hook-shaped needle (“Guess I can’t blame anybody but myself for that one”) and stopped to have a nurse help him into a fresh glove. The other nurse accounted for the original number of instruments and towels, calling out numbers aloud as she did. Soon Jane was wheeled into the recovery room to rest, attended by me and the nurse with the cast.

Word came back frequently on the babies. Their limbs and features were normal; the girls appeared to be identical, though small. Each weighed only 1480 grams, a little more than three pounds. From the beginning, much ado was made about the age of the infants; what is, how long they had been in the womb. I was not aware at the time that the gestational age is one of the baselines by which the pediatrician charts the newborn’s condition or progress. Our A, for example, was born with a lusty cry and active limbs. Soon, however, her movement and breathing ceased almost entirely, and her pediatrician was obliged to cup a small, oxygen-filled bag over her face and puff the pure oxygen into her mouth and nostrils. A moment later he slipped a tube down her windpipe and attached it to a machine that would help her to breathe oxygen-enriched air as long as she needed it.

A while later he gave her a physical examination; he found her temperature and blood pressure normal, weighed her, measured her length and head circumference, listened to her heart, and finally gave her a series of tests involving the flexing actions of the arms and legs. Her score on these tests gave an estimate of her gestational age — thirty-four weeks — which, together with other external evidence, such as the development of her ear flaps and the creases on her soles, confirmed the supposition that she was six to seven weeks premature. Infants of this age are more likely than not to incur respiratory distress syndrome — to have trouble breathing because their lungs are not completely developed.

Thus with a fix on the infant’s age, the pediatrician had a clue as to why A was unable to breathe on her own. B likewise was put on a respirator, the mouthpiece taped to her cheeks, and was laid under a heater to rest and keep warm while the staff watched over her. When I went in to see them, they looked like fresh-hatched birds in electronic nests.

Jane meanwhile managed to fall asleep, and was returned to her room for greatly needed rest. As soon as she was able she would see the children, but that wouldn’t be for a few hours, so I made several phone calls and then went home for some rest of my own.

I think I left in the midafternoon; I know it had taken several hours to watch over Jane, who’d had fever and chills in the recovery room. In any case, I remember one of the pediatricians telling me that A was having some particular problems, but I didn’t pay too much attention, thinking that they were the normal problems of prematurity. It was about the time I left, however, that her condition began to draw unusual concern.

At two in the afternoon she was being sustained on air with four times the normal amount of oxygen. Yet the amount of oxygen that reached her blood, as measured through blood-gas analysis, was far below normal, even when she was given pure oxygen to breathe. X rays showed nothing apparently wrong with her lungs and the outline of her heard, though it was difficult to see if the blood flow through the lungs was diminished.

Around ten o’clock that night the chief neonatologist, Brian Saunders, telephoned a friend, Luke C. Yu, who is a pediatric cardiologist at University Hospital, and asked him to come and look at A’s case. Presented with an array of findings, the electrocardiogram, X rays, the oxygen content of the blood, Yu and the other pediatricians thought she might be suffering from pulmonary atresia.

This is a heart defect in which the passage from right ventricle to the pulmonary artery is blocked. It is, essentially, a closed valve in the pump. Without the valve, blood has no way to get to the lungs, except through two passages in the immature heart: the foramen ovale and the ductus arteriosus. The first of these is a hole between the upper two chambers of the heart, the right atrium and the left atrium. It is something like a flap between two rooms of a tent. In the fetal heart, blood flows from the right atrium into the left. In the newborn heart, this flow stops because of changes in pressure between the two chambers, which press the flap closed. The ductus is like a switching rail between two main tracks. In the fetal heart, it switches blood from the pulmonary artery to the aorta, at a point where the two great vessels cross above the heart. The purpose of these two passages is to keep the fetus from sending too much blood to its lungs. The fetus, after all, doesn’t need to breathe; its blood is oxygenated by the mother. And so the blood bypasses the lungs until the moment of birth.

From that moment on, the heart assumes the mature pattern of function. Blood fills the right atrium, enters the right ventricle, squirts into the pulmonary artery, suffuses the lungs; it then returns from the lungs, fills the left atrium, enters the left ventricle, lunges into the aorta, and carries oxygen to the rest of the body.

With pulmonary atresia, this pattern cannot exist. The flow of least resistance takes blood on a mixing, turbulent route that succeeds in sending some blood to the lungs, but only through the two passages that were destined to close. The ductus especially, in all but the rarest cases, closes hours or days after birth, whether or not the body needs it to survive.

At 11:45 p.m., A had what her medical report calls her first hypoxic spell. In the slang of cardiologists, she crashed. The ductus passage began to narrow, pinching what little blood had been able to get to her lungs, and her color quickly faded from pink to blue.

There was nothing the doctors could do except puff more oxygen into her lungs. What saved her apparently was her own involuntary reaction to the crisis. The ductus sometimes opens spontaneously when blood acids reach unnaturally high levels, and this is what probably happened in A’s case. Her pinkness slowly returned.

Yu meanwhile had sent back to University Hospital for an experimental drug that was applicable to the case. It is a hormone commonly known as PGE (shorthand for prostaglandin-E), which dilates blood vessels, and might be counted on to keep A’s ductus passage open a while longer, giving the pediatricians time to act.

At about this hour I was at my office and had an urge to pay a midnight visit to my daughters in the hospital. I had no idea how ill A was until I arrived at the nursery, and saw, through the window, the commotion around her crib. Still puzzled, I went to the back of the nursery and stood outside the open door. I caught someone’s attention and told him who I was. A moment later Yu came out to speak with me. He was wearing a gown over a shortsleeve sport shirt, Levi cords, and Wallabies.

He told me kindly that he suspected — and only suspected — that the baby had a heart defect, and that he wanted to transport her from Kaiser to University Hospital for several reasons. First, he had available to him there an experimental drug that would be useful in her treatment. Second, he wanted to examine her through University’s echocardiogram machine (a sound wave device that pictures the inside of the heart) since he couldn’t get a clear picture on Kaiser’s machine. Third, she might need a kind of testing called a cardiac catheterization, for which he would need his own tools and technicians.

I nodded as though I were following every word, while most of my attention was grappling with the idea of a heart defect. It was as though someone had handed me an armload of wood in disarray, and I knew I was holding it, I felt its weight, but I couldn’t make sense of it yet — the pieces were sticking out every which way and the awkwardness of it had paralyzed me.

Several minutes went by while Yu and I stood talking in the hall. I signed some papers authorizing the transfer. I remember someone saying that the transfer team was late because it had taken a wrong elevator. They arrived — two paramedics, a nurse, and a doctor — with an incubator mounted on a cart, a “crash cart” one of them called it. It was equipped with a green oxygen bottle and a car battery — self-contained. They lowered my daughter into it and wheeled her through the door for the trip to Jane’s room, to say goodbye, before we left for University.

We formed a procession as we walked along the hallway. I walked beside the cart, close enough to touch it while looking ahead to the uniforms of the paramedics before me. I was reminded of a funeral, and then it occurred to me, with some wonder, that I had never been to one, had never been close to a human death. I asked myself if I were capable of the task that presented itself, not just that of carrying some mental stress, but of deciding or of helping to decide on the questions that were to be answered about her care and treatment. I had never been responsible for anyone’s medical care, not even my own. Personal reasons, having to do with religion, had to this point removed me from all but the most routine contact with medicines and physicians. There was no question of my refusing to have my daughter treated. But neither did I wish to be passive, to nod at every opinion I might encounter, just because I didn’t know any better, or because I felt powerless in the presence of disease.

And then I remembered, or rather I felt, that devotion which I have already mentioned. An idea occurred, very clearly, that it wasn’t my former self that faced this responsibility, not a son, or a student, or a bachelor, or a medical neophyte, but a father. She, after all, had acquitted herself well to this point; her father could do the same.

Not right away, but beginning at this point, it was easier to concentrate on the details at hand.

I walked ahead and had a moment with Jane before the rest of the train arrived. She was sitting in bed, heavy-lidded with medicine and fatigue, listening to me try to explain what seemed to be the matter. She’d been told about the infant’s condition and apparently the trip to the other hospital was not a surprise to her.

Then came the cart and its attendants. Jane talked to our baby while we watched. She asked some questions of Yu and the nurse. And then it was time to go. I expected to be the last to leave but Yu stayed a moment behind me to inquire about Jane’s pregnancy, and to assure her that nothing was known to cause the baby’s condition.

The Infant Special Care Center on the second floor of University Hospital receives patients from all over the country. It is probably larger than the suite of rooms that comprises the Kaiser nursery, but it looks smaller because it is so crowded with equipment. As at Kaiser, the typical infant rests on a bed that is heated by an overhead shelf. The shelf also holds equipment for monitoring the infant’s temperature and its breathing and heart rates. Alongside the platform may be an apparatus to assist in breathing, or a drip device for regulating the infusion of fluids. Ten beds are contained in the room, together with twenty cribs and “isolettes,” or incubators. In rows from the ceiling dangle black electrical cords, outlet cords for oxygen, and other utilities in service to the equipment. The cords overhead made the room look strangely like a garage.

A was resting tranquilly when I arrived. Her vital signs were good. Her heart-shaped face, with raised eyebrows, had settled into a questioning frown. She slowly opened and closed one hand.

I sat close by on a stool while Yu rolled up a blue-and-white machine and proceeded to take an echocardiogram. He held a blunt wand gently against a smear of jelly on her chest and examined a blotchy image that appeared on a small television screen. He said nothing while he worked. Then a nurse came up with a form for me to sign, and Yu paused to explain that the special hormone — PGE — had been used for years in cases like this, but was still experimental; therefore my signature was required for its use, and for permission to release information on the case for a national study of the drug’s effects. I signed.

He then said that he still suspected pulmonary atresia, but would not know for certain until he’d performed one more test — a cardiac catheterization. It involved opening a vein in her navel or leg and sliding a small tube through it to the chambers of the heart. He said the procedure would be difficult because of her size. I asked a few questions and then agreed. He said it would take a couple of hours to arrange a team for the procedure, and as it was nearly 2:00 a.m., it might be best for me to go home and try to sleep.

I remember thinking as I drove, “It is Sunday morning,” and then I remembered the lines from Louis MacNeice: —¦Man’s heart expands to tinker with his car/ For this is Sunday morning/ Fate’s great bazaar.” I had the impression that I was wide awake and thinking very clearly, but of course I was not.

I woke, still dressed, to the ringing of a call from Jane. It was seven o’clock. She had called University and had learned that the baby was doing fine, was showing a great will to live. She said her parents and sister would arrive from L.A. in the afternoon. The other girl was doing fine. She kept pulling out the breathing tube that the nurses coaxed into her, and to hear Jane tell it, had the nursery in a constant uproar.

I recounted what I could of the catheterization that Yu had performed sometime during the night, though Jane, who had done some reporting by phone, knew more about it than I. she suggested I return to University and find out what more I could, then give her a call.

Cardiac catheterization, I learned much later, was invented in 1929 by a 25-year-old medical student in Berlin named Werner Forssmann, who performed the first procedure on himself. Much had been learned about pressures in various areas of the heart through animal experiments, but Forssmann, after practicing on cadavers, wanted to see if firsthand information could be taken on a human being. He opened the vein in his arm and inserted a small catheter, then, following its progress in a mirror held in front of a fluoroscopic screen, he guided the catheter into the right side of his heart, feeling no discomfort, and experiencing no harmful reaction. His colleagues at the hospital were not impressed with the feat. As reported in Two Centuries of American Medicine, they considered it foolhardy and impractical. Forssmann must have thought little of it, too, for after publishing a paper, he dropped the work entirely.

Twelve years later two clinical investigators in New York, Dickinson W. Richards Jr. and Andre Cournand, improved on Forssmann’s technique, and realizing its potential, began a course of development that made catheterization indispensable to cardiology. In 1965 Richards, Cournand, and Forssmann shared the award of a Nobel Prize for their work.

In the case of A, Yu determined through the catheter the pressures in three of the four chambers of her heart, as well as the levels of oxygenation, and by injecting a dye, was able to produce images that indicated where and how the blood was flowing. When I arrived at the hospital, around eight o’clock, he said the catheterization had made him ninety percent certain that his diagnosis was correct, which provided a firm basis for the next step.

That step, Yu said, was an operation, but he could not be sure that an operation was feasible until he’d discussed the catheterization results with some of his colleagues. It might take a few hours to assemble them at the hospital, he said, and asked me to call him again at eleven.

I called Jane with the news, then looked in on the baby, whose leg was bruised from the entry of the catheter, and decided I needed to get out and walk. I drove down Fourth Avenue to Laurel Street, parked the car, and walked to the main west entrance of Balboa Park. I’d lived in the neighborhood and knew the park well. By the entrance are two grand fig trees, with limbs spreading low and upward to form crowns like huge inverted chandeliers. Tree surgeons had strung cables between the greater and lesser limbs, to keep the greater from falling under their own weight. I felt as I had done the night before, calm but muddle-headed — like the weather, which was clear but a little humid. I kept thinking of the line from Whitman, “The smallest sprout shows there really is no death,” as I walked southeast down the grassy slope, past the Buna-buna trees, to the grove of live oaks with its floor of twigs and brindle leaves. I stood there and looked around at the trees.

What had she done to deserve this?

Nothing.

What was the reason behind it?

No reason.

And what’s the cause?

None.

None?

No cause was known.

Can there be an effect without a cause?

Logically, no.

This sort of reasoning put me in mind of my parents, who are Christian Scientists and who in such a time would argue for the supremacy and self-sustaining nature of good. I myself had never had any medical problems, hence no medical care (and vice versa), apart from some dental work. That had been their choice for me. My choices for my daughter, without hesitation, had been to see that she was given whatever she needed at the time. Yet none of the tests and palliatives she had received so far had answered the fundamental question of whether she would live, and for that I needed an answer, or at least a hint of knowledge, to go on. And what did I know? The thought formed slowly; I know from experience that goodness endures, that what is good is so because it has some quality that carries it through time, and insofar as my daughter’s life was good, it too would endure somehow, if only, as all lives must eventually, endure as a memory.

With that small comfort I left the grove and walked back to my car, stopping on the way at the Huntress, a bar on the corner of Fifth and Laurel, where I telephoned Yu, who said he was getting a surgical team together and that I should come in soon for a briefing. He added that the surgery would be dangerous, but that we had no choice since the hormone drug would not hold the tiny ductus passage open indefinitely.

Before getting in the car, I decided to walk a few blocks west to the Christian Science church, where a service was about to begin. I passed the front of the church and headed toward a side door, which stood by a low brick wall and a flowerless jacaranda. At the door was an usher — a middle-aged man in a suit and sunglasses. I approached him and began, as best my voice would allow, to explain about my daughter and her impending danger. I sensed a few people standing off at a polite distance. He asked if I wished to speak with someone in particular — a practitioner, perhaps — but I said I only wanted to talk with him, and I looked up at him, at his troubled face behind the dark sunglasses, and I thought, absurdly, that he looked like a general out of uniform. He had some kind of service club insignia on his tie bar. But his hand, which I held with both of mine, was solid. When I could speak again, I thanked him and turned and left.

I ran down the street toward my car, and then ran diagonally across the street toward the Temple Beth Israel, which was only about a hundred steps away. As Jane was Jewish, so were our children by birthright. I thought I should speak with someone in the temple — the rabbi? — and then wondered if it would even be open on a Sunday.

It was. I mounted the steep porch steps and stopped in the dark foyer. The carpet was tinted blue by the stained glass above the lintel. To the right was a group of people my age and younger, wearing what looked like wedding attire. I rushed to them and asked if they knew where the rabbi was. “That’s what we want to know,” said one of the guys, and laughed.

“What is it, dear?” said an older woman, approaching me.

I said I needed to see the rabbi for a moment, right away.

“Well, I don’t know,” she said. “He’s — well, come this way, dear, I’ll show you where you can find him.”

She led me down a corridor toward a group of men. They all took their hands out of their pockets as we approached. One of them said, “What is it?”

As I was explaining again what I wanted, a Japanese man who was dressed like a custodian said, “Got to have an appointment, maybe next week, to see the rabbi. He’s not here now anyway.”

“But what’s the matter?” the first man repeated. He was tall and elderly, with glasses and a small moustache.

I explained to him about the baby and the operation, as fast as I could, distraught and embarrassed by it all, and then said I had to leave, and turned to go.

“Couldn’t you wait five minutes?” he said. “He’ll be here in five minutes.”

But I said that I had to go, and thanked them, and made for the door, slowly breaking into a run. As I was reaching the door I heard the man call from behind, “Come back and tell us what happened,” to which I made no reply.

One hour later, Yu led me into a conference room for a briefing with the surgeon, Joe Utley, and his assistant and the anesthesiologist. The assistant had some papers for me to sign, but before I did, Utley explained that to his knowledge no operation of this type had been performed on an infant as small as this. Three thousand grams, or twice her size, was the minimum in his experience. Not only were the vessels above her heart extremely small, but the tiny pressures required to pump blood to her body would make it difficult, if not impossible, for the team to resort to a heart-lung machine. In other circumstances, it would be wise to operate later, when she had grown, but her condition demanded an operation now. He concluded by saying that the chances of success were slim indeed. I said that was all right, because I was lucky.

The meeting broke up and the assistant surgeon stayed to have me sign the authorization and to explain once more the operation’s objective. He said they would try to create a new passage between the aorta and an artery. This new passage, or shunt, would allow blood to enter the artery, and thereby gain access to the lungs, without having first to pass through the right ventricle, which was blocked. He sketched a procedure that he said was invented by a Baltimore surgeon named Blalock. “A lot of blue babies have been saved this way,” he said, when my attention was diverted to the phone.

It was Jane. She’d spoken to a rabbi and had decided on a name for the child — Lavia, which in Hebrew means young lioness. That sounded fine, I said. Then we chose a second, everyday, name, Julie, since she had been born in Caesar’s month of July. I told Jane I’d be joining her soon, and hung up.

Now, then, Julie had a name — two of them, really. She had a signature and an identity. These thoughts were comforting for a moment, but then sadness overwhelmed me and I cried for a long while, there in the conference room. Someone held me, I believe it was Yu, and then I heard someone say that as soon as I could drive, I should be with my wife.

A little after that, I said goodbye to Julie and left. It was early afternoon and the operation was scheduled for two or three o’clock — I hadn’t really noted the time. I went to Jane’s room at Kaiser and waited with her and her family. I had already called my parents. There was not much more to be said. I sat with Jane for a while, then lay on the empty bed in the room and slept.

Alfred Blalock, I came to learn, was a professor of surgery at Vanderbilt Medical College who in 1942 joined the staff at Johns Hopkins Hospital, where he had taken his medical training twenty years earlier. He was known as a master of technique. It was his good fortune that some years prior to his arrival Helen Taussig, then only thirty-two years old, had been appointed director of pediatric cardiology at Johns Hopkins. She noticed that children born with a severe combination of heart defects, including pulmonary atresia, fared better in those rare cases in which the ductus passage remained open for life. She wondered if other children might be helped by an operation that created a new passage between the aorta and a large artery. Blalock liked the idea. For two years he experimented with dogs until he felt he’d mastered a procedure. In 1944 he attempted it on a ten-pound baby. She survived, and her condition improved. Between 1945 and 1950, about 1000 babies underwent the Blalock-Taussig operation with a mortality rate, in 1950, of 4.7 percent. A Chicago surgeon named Willis J. Potts subsequently devised a method that is used when the structure of the vessels does not permit the classic Blalock-Taussig. It was a variant of the Potts procedure that Utley performed on Julie. “Actually,” he said after the operation, “this case was unique. It didn’t fit any of the classic models.”

He opened the chest with a long vertical incision through the soft breastbone. The incision exposed a beating heart that was hardly larger around than a quarter. He and his assistant wore four-power eyeglasses called loupes — the same as worn by jewelers and watchmakers. He also used a jeweler’s forceps; they are better for microsurgery than anything obtainable through a medical supply store. He clamped the aorta, just where it emerges from the heart, in such a way that an edge of it was pinched dry, while blood continued to flow through the rest of the vessel. He waited five minutes with the clamp in place, monitoring the heart pressure, to be certain that blood was flowing freely. Meanwhile he moved an edge of the main pulmonary artery, just where it emerges from the heart, side to side with the edge of the aorta. He made a tiny slit in the edge of the aorta and a matching slit in the edge of the pulmonary artery, and with a half-moon needle and a strand of thin blue nylon, sewed the two holes together. A moment later he slowly released the clamp.

He left his assistant to close the chest while he telephoned our room. Jane answered and handed the phone to me. “You really are lucky,” said Utley. The arrangement of the vessels especially the way that the pulmonary artery was well developed despite the fact that little blood had ever flowed through it made it possible to create an artificial passage with minimal disruption to the heart and other vessels.

A few days after the operation Julie joined her sister Jeanne at the Kaiser nursery where under the excellent care of the nurses they gained weight steadily until at last we took them home."