PRINTHearts in his hands
A day in the life of Dr. Richard Mellitt
Courtesy of Boone Hospital
Richard Mellitt performs open-heart surgery alongside scrub nurse Sharon Newman. Mellitt performs more than 250 heart surgeries annually at Boone Hospital.
December 18, 2008 | 12:00 a.m. CST
Boone Hospital is quiet, with only the soft chatter among nurses and doctors filling the silence as most of their patients are still sleeping. There is a slight aroma of coffee in the air mixed with the potent smell of cleanliness. Dr. Richard Mellitt holds a cup of coffee in his hands as he stands quietly next to the nurses’ station. It is early morning, but Mellitt does not look tired. Fatigue could only lead to trouble in his career. At 7:30 a.m., Mellitt, a cardiothoracic surgeon, is now beginning his 11-hour day. After a long sip of coffee, he heads toward the stairs with a nurse to begin visiting patients.
Walking up the stairs, he asks his nurse which patients he will be visiting this morning. She reads through the list of patients, which includes a woman with stage IV lung cancer and a man who desperately wants to be discharged from the hospital that morning. They are all patients who had already been operated on and are awaiting the next step. Mellitt’s nurse tells him he doesn’t have to visit all of them now. “I want to see them all right now,” he says. His nurse nods in acceptance, and they continue to walk up the stairs.
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After reaching the top of the stairs, they walk down the hall. The man who wants to be discharged is standing outside his room waiting. The nurse smiles and tells him they will be back in a couple of minutes.
Mellitt, wearing khaki pants and a button-down shirt, walks to the end of the hall near the nurses’ station and stops in front of a computer. He looks up the lab results for each patient while Lisa Byrd, his nurse of seven years, explains details specific to each patient.
Mellitt steps in the room of the woman with stage IV lung cancer. The woman’s other doctor had previously performed some biopsies on her, and Mellitt explains what medications she will be taking when she is discharged.
He moves from room to room in just a couple of minutes. After he tells his next patient that she will also be discharged later that day, she thanks him for the good news. “You are a lifesaver, you know that?” she says to him while holding his hands in hers. He smiles shyly and walks out of the room. She sits back in her reclining chair with a content look on her face.
Following the visits, the tall doctor with graying hair heads over to the computer again and takes notes on his voice recorder. Quietly, he mentions which patients are being discharged, which ones are staying a couple more nights, what medications he prescribed and if any of the patients are scheduled for surgery soon. Every detail is an important reminder for each patient’s specific case.
Last, he visits the man who wants to leave the hospital. Unfortunately, he has to stay at least another night. After hearing the news, the patient seems disappointed but gracious about Mellitt’s care and encouragement. Leaving the last room on his route, the 47-year-old doctor is now done with his morning rounds.
Walking to the elevators to prep for surgery, he comments about the nurses who assist him. “They are the key to all of this,” he says. The doors of the elevator open, and he steps in. A few seconds later, he adds: “You can’t do all this stuff by yourself. You have to have other people.” The bell signals that he is on the right floor, and he heads to get ready for his only surgery of the day. Typically, Mellitt performs one or two surgeries a day.
Later, Mellitt explains the intensity of helping patients by performing surgery. He says that the nature of what he does is dealing with people during one of the most emotional events of their life. It can be a stressful time because he knows how important his work is, and he has to fully understand what the surgery means from his patients’ points of view.
“They have a life-threatening problem, and you’re there in the midst of their personal drama,” he explains.
The clock on the wall of the operating room reads 8:30 a.m. Mellitt scrubs in for what is expected to be a four-hour bypass heart surgery. He is alone — it is the only time during the day that he is by himself for a couple of minutes. It is his time to make a personal transition from rounds to surgery where he silently prepares himself for the bypass procedure that he is about to begin, one he has done many times before. Because he performs between 250 and 300 heart operations annually, he isn’t anxious. In fact, it’s the most gratifying part of his job. These surgeries can actually cure his patients’ diseases instead of just holding them off temporarily.
“There are certain things in the mitral valve that can be repaired, and once they’ve been repaired, the problems can’t come back,” he explains.
Mellitt didn’t always have a desire to be a cardiothoracic surgeon. When he first started medical school at St. Louis University, he wanted to be an orthopedic surgeon. “Being in ICU as a medical student and seeing the surgeries made me change my mind,” he says.
In the OR, two nurses prepare the patient for surgery while other nurses prep the room and the equipment. The patient is in his 70s and suffering from congestive heart failure, which causes fluid to back up into his lungs. Because of this, the patient has trouble breathing easily.
Mellitt walks into the OR, hands still wet from washing them vigorously. A nurse helps him put on a scrub jacket and gloves.
He watches the two nurses work to remove the saphenous vein from the patient’s leg so it can be used to create a bypass for the blocked part of the artery. The saphenous vein will restore proper blood supply to the heart. Then, when he is ready, he takes a scalpel and makes a vertical incision down the middle of the man’s chest. Next, he cauterizes the incision. The smell of burning flesh seeps through the paper face masks and burns the nostrils, yet Mellitt doesn’t seem to notice the lingering odor. Next he exposes the sternum, cracks it and holds it open with a sternal retractor, making the heart visible.
During surgeries, Mellitt says he tries not to focus on the emotional aspect and significance of his work for his patient.
“You don’t want to be thinking about the family in the waiting room,” he says. “It’s just me and the patient.”
KBXR 102.3 FM plays quietly in the background, and Mellitt takes his time as he works on the patient. Every now and then he sings along with some of the popular tunes playing over the radio such as “Personal Jesus” by Depeche Mode,
“Bubbly” by Colbie Callait and “Boulevard of Broken Dreams” by Green Day. The mood in the OR is not tense. Instead, Mellitt and the nurses often laugh and exchange stories. They discuss politics, family, even ridiculous outfits they have seen people wear while working out.
The brightly lit OR, filled with a mixture of soft chatter and music, is nothing like the drama-filled rooms seen in shows such as Grey’s Anatomy and ER. Mellitt says there are always interesting things that happen in surgeries, but they aren’t as extravagant as those shows make them out to be.
“Stories on Grey’s are far more interesting than anything I’ve ever seen,” he says.
He explains that the goal of his operations is to be as dull and routine as possible — without any excitement or surprise. “Excitement usually happens when something goes wrong,” he says.
About two hours into the surgery, Mellitt signals for the heart to be put on a heart-lung machine that maintains a steady flow of blood and oxygen content in the body. During an open-heart surgery, the machine continuously draws blood away from the veins, oxygenates the blood through the machine and then pumps it back into the arterial system. The heart is stopped from beating with an injection containing a mixture of cold blood and potassium.
Because of all this, Mellitt is able to work inside the heart on the aortic valve, another procedure the patient needs done in addition to the bypass. To many, the work of a heart-lung machine might seem amazing, but Mellitt’s demeanor suggests that this procedure is nothing out of the ordinary. And for him, it isn’t.
“There are certain moments in a surgery that are very exciting for someone who has not seen it before — the moment the pericardium is opened and the heart is seen for the first time, and the moment the heart begins to beat unaided after being stopped for an hour,” he says. Although he has seen this procedure several thousand times, he says he sometimes still has to remind himself of how amazing those events really are.
Mellitt is done with the single bypass heart surgery and aortic valve replacement by 12:30 p.m. The surgery was successful, and the prognosis looks good for the patient.
Afterward, he grabs a sandwich to eat on his way to clinics in the hospital. He is already about 20 minutes late. During clinics, which are essentially doctor appointments, he follows up with patients who are recovering from surgeries. He checks to make sure incisions are healing well and patients are on the proper medications. During this time, he also visits new patients who have been referred to him by other physicians. He is done with clinics by 4:30 and moves onto treating patients in the ICU.
The day has been busy, but he is out of the hospital by 6:30 p.m., just in time to go to Columbia Catholic School to watch his youngest son, David, at middle-school basketball practice. He tries to spend as much time as possible with his wife, Jennifer, and their three kids, Mike, Laura and David, despite the frequent interruptions that life as a surgeon might cause.
His son’s practice is over by 8 p.m., and Mellitt heads home where he eats a quick dinner. He gets to bed early so he will be fully rested for tomorrow. Just like any other middle-aged professional, he is due back at work early in the morning. The only difference is that he holds hearts in his hands, and he must keep them beating as long as possible. Instead of working in an office all day, his schedule tomorrow consists of another coronary bypass heart operation and a lung resection. And though it sounds incredible, it’s just one more demanding day in the life of a cardiothoracic surgeon. V
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