Review: Open Heart

Cardiac surgeons are rock stars of the medical world. They're able to save patients given up for dead, literally grasping life and death in the palm of their hand. British surgeon and artificial heart pioneer Stephen Westaby's Open Heart is a thrilling memoir of some of his most challenging cases--both extraordinary successes and tragic failures. He passionately advocates for advances in technology that will extend the lives of many patients, short of a heart transplant.

Each case is more astonishing than the next. He describes high-risk surgery for an aortic stenosis that threatened to cost a pregnant woman both her life and that of her unborn child. He also recounts how pure chance allowed him to save a heart attack victim in cardiogenic shock from certain death. But for all the compassion Westaby demonstrates for desperate adults in the end stage of heart failure or struggling infants in surgery for complex congenital anomalies, he understands the need to maintain the "psychology of detachment" that enables him to keep a cool head and a steady hand in the operating theater.

Westaby is proud of his role in advancing cardiac surgery technology in the United Kingdom. A trachea replacement stent bears his name, and he was the first surgeon to use the Jarvik 2000 heart pump in Great Britain. In detailing these efforts, he spares no criticism of Britain's National Health Service. He accuses the NHS of placing its desire to maintain a monopoly over the field of conventional heart transplants ahead of progress in pursuing lifesaving technology, which forces him to pursue most of the funding for his research from private charities. "What matters in the NHS is keeping down costs," he writes. "Death is cheap."

Westaby's prose is clipped and direct, as if he dictated these reminiscences with the adrenaline rush of a challenging surgery still pulsing through him. Although the book contains an informative glossary, only readers conversant with the anatomy of the cardiovascular system will be able to visualize the accounts of his surgical exploits with ease. That complexity doesn't detract from the propulsive quality of these stories, all of which include an intensely human dimension and occasional feats--like late-night international flights of essential medical equipment--that lift them into the thriller category.

As Westaby approaches age 70, the physically and emotionally demanding surgical career that took him "everywhere from Tehran to Toronto" has ended, not because of any loss of nerve, but instead by impairment from overuse of his ability to grasp surgical instruments. In his long surgical tenure, he's left behind an impressive legacy, one that transcends the gratitude of the patients whose lives were saved by his talent. --Harvey Freedenberg, attorney and freelance reviewer

Shelf Talker: British cardiac surgeon Stephen Westaby delivers dramatic stories from a long career at the leading edge of his demanding profession.

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