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Sunday, August 16, 2015

A Lesson From Russell M. Nelson's On-the-Fly Heart Surgery Innovation: Sometimes Revelation Can Be Detailed and Technical

Russell M. Nelson examining a model of the human heart.
Last night I read an entire article from BYU Studies out loud to my wife so we could discuss and contemplate the remarkable content. The article is "Discovering a Surgical First: Russell M. Nelson and Tricuspid Valve Annuloplasty" by Austin A. Robinson and Curtis T. Hunter, BYU Studies, 54:1. A brief overview can be read on the BYU Studies website, and you can download the full PDF for $0.99 (better yet, just go ahead and subscribe to this excellent journal!).

As Austin Robinson mentions in his overview, the details of this remarkable event have not been widely appreciated. Most of what we knew came from Elder Nelson's description of the event in his April 2003 General Conference addresses, where spoke of an incident "during the early pioneering days of surgery of the heart" when a stake patriarch from southern Utah suffered much because of a failing heart.
He pleaded for help, thinking that his condition resulted from a damaged but repairable valve in his heart.

Extensive evaluation revealed that he had two faulty valves. While one could be helped surgically, the other could not. Thus, an operation was not advised. He received this news with deep disappointment.

Subsequent visits ended with the same advice. Finally, in desperation, he spoke to me with considerable emotion: "Dr. Nelson, I have prayed for help and have been directed to you. The Lord will not reveal to me how to repair that second valve, but He can reveal it to you. Your mind is so prepared. If you will operate upon me, the Lord will make it known to you what to do. Please perform the operation that I need, and pray for the help that you need."

His great faith had a profound effect upon me. How could I turn him away again? Following a fervent prayer together, I agreed to try. In preparing for that fateful day, I prayed over and over again, but still did not know what to do for his leaking tricuspid valve. Even as the operation commenced, my assistant asked, "What are you going to do for that?"

I said, "I do not know."

We began the operation. After relieving the obstruction of the first valve, we exposed the second valve. We found it to be intact but so badly dilated that it could no longer function as it should. While examining this valve, a message was distinctly impressed upon my mind: Reduce the circumference of the ring. I announced that message to my assistant. "The valve tissue will be sufficient if we can effectively reduce the ring toward its normal size."

But how? We could not apply a belt as one would use to tighten the waist of oversized trousers. We could not squeeze with a strap as one would cinch a saddle on a horse. Then a picture came vividly to my mind, showing how stitches could be placed—to make a pleat here and a tuck there—to accomplish the desired objective. I still remember that mental image—complete with dotted lines where sutures should be placed. The repair was completed as diagrammed in my mind. We tested the valve and found the leak to be reduced remarkably. My assistant said, "It's a miracle."

I responded, "It's an answer to prayer."
As with many faith-promoting stories, things are often more complicated than they seem. There are many details related to the specific procedure that Elder Nelson invented on the fly, plus details of what was revealed to him, the relationship to other heart procedures that were known, and the technical matters related to the condition he faced. When these are considered, a cool faith promoting story blossoms into an incredible, gritty, granular episode that almost overwhelms me. Please take a look at this account.

Doctor Nelson had been part of the team that developed the first successful heart-lung bypass machine at the University of Minnesota, work that was the basis of his Ph.D. dissertation. After Doctor Nelson came back from further training at Harvard's Mass. General Hospital, he brought the technique to Salt Lake City in 1955, making Utah the third state in the nation with open-heart surgery capabilities. This technique allowed surgeons to see the living heart in action and understand the many mysteries of valve function and other details of the heart, one of the most brilliantly designed organs of the human body. Yes, of course it's designed. Intricately, carefully, brilliantly--it's amazing that it's even possible. Reading the details discussed in this article should further increase your appreciation for the majesty of this vital part of the Lord's Creation.

In spite of the potential offered with new techniques, the tricuspid vale had received very little attention among surgeons by the late 1950s. Most of the problems people had were with the other side of the heart in the mitral valve, where rheumatic fever was a common factor causing valve failure. When Doctor Nelson decided to operate on what medical science then declared was an inoperable condition, he did not have the benefit of the experience of other surgeons in operating on the tricuspid valve.

As he started the surgery on May 24, 1960, he found the mitral valve had the "stenosis" he expected and he was able to treat it with known techniques. Then he turned to the right side of the heart and its tricuspid valve, where he found the kind of inoperable damage he expected to find. He could thrust all five fingers of his right hand through the greatly dilated valve into the right ventricle. As he pondered the severe damage, he had a critical impression: reduce the circumference of the ring. But how? People who had tried constricting ligatures on the mitral or aortic valves had resulted in spectacular failures and death. Purse-string sutures into the external heart tissue would eventually tear through the heart. Belt and strap approaches had also failed. It would be impossible to simple apply mitral valve techniques to this very different system. There was nothing to guide him--except God.

At this point an image was placed in Nelson's mind that gave detailed instructions about how to apply sutures to the flaps of the valve to pull them together and reduce the annulus diameter, restoring valve function. Brilliant.

What most impressed me was how technical the revelation was. As he looked at the second valve, with no idea what he could do, he was given a specific piece of information about the need to reduce the diameter of the annulus. He expressed that goal to his assistants, but neither he nor they knew how to achieve it. And then an image was placed in his mind that showed specific details, even with dotted lines indicating where sutures should go. On the fly, without years of animal testing and analysis, he invented and implemented a surprisingly clever procedure that would provide to be brilliantly correct and successful. It didn't take a series of patient deaths after the animal tests, as in other heart innovations, before it began to work. It was successful on the first try. Truly a miracle.

The article is heavy in technical detail and was a bit overwhelming at times, but well worth the exploration and learning. Enjoy!

This may also be helpful in understanding just what can happen when there is "tight control" in revelation. Certainly shows the extremes that the Lord can achieve in giving revelation. It's not all just warm fuzzies.

Update, Sept. 5, 2015: A helpful commenter observed that Dr. Nelson was recognized as one of the top 20 most innovative surgeons alive today. OK, not sure where that list really came from, but it does remind us that Dr. Nelson has earned a great deal of recognition in his profession. 

11 comments:

C T said...

Terrific post. Thank you for sharing the story.

Anonymous said...

Yes, it is a great story. If only we could all be so fortunate to have an excellent doctor.

In this day and age with great advances in technology, medical schools are not producing very many good doctors. Medical schools have forgotten to teach about using common sense and listening to the patient, and not to dismiss people's symptoms being made up and telling patients there is nothing wrong. Happened to me many times and to my husband and my children. Finally after six years my husband finally found a doctor to confirm a disease WE diagnosed two years ago from Internet sleuthing and talking to health professionals online and talking online to people who have the debilitating disease. Had to get an official doctor diagnosis to get treatment. A lot of damage has been done. A lot of misery and missed work for my husband, missed work equals no pay.

And it is bad enough U.S. medical schools can't produce good doctors. The U.S. lets foreign trained doctors come in who are worse.

Does anyone know if Dr. Nelson published his procedure in a medical journal or journals? Did he share how to do the procedure?



rkt said...

Thanks for your review of this article and your kind words about BYU Studies. We do publish a lot of very good material. All of it is peer reviewed and source checked too, so it is quite reliable.

The comment above asked if Dr. Nelson published his procedure in a medical journal. The answer is no, and the explanation is given in the article.

(Also, for your title, add another "L" to Russel. Once an editor, always an editor.)

Anonymous said...

It makes sense to reduce the diameter of the surrounding tissue to make the more plastic tissue fit the valve but how is this "revelation" different than having a hunch to brighten a soup by adding lemon juice or seal a package with hot glue instead of tape or use a 9 iron? I can see that a surgeon could use this information to repair the operation of a heart but a seamstress probably could have supplied the solution.

If you're a believer you may want to consider something as inspiration but, let's face it, most of us get through our lives every day drawing on our training and experience and being innovative when we deal with new challenges and circuumstances. Why would you say the rest of us are able to do that without relying on supernatural influence?

Orbiting Kolob said...

Inspiration is a wonderful thing, regardless of its source. Nelson's story reminds me of August Kekule's famous claim about discovering the structure of the benzene molecule when he dreamed of a snake swallowing its own tail. Might or might not have happened that way -- see here -- but either way it was a remarkable accomplishment. Same goes for Nelson.

James Anglin said...

This is a cool story. I don't doubt at all that it happened just as Dr Russell said. Things like this do happen. I wouldn't say that this kind of event is decisive evidence of anything, but I do think it's worth something as evidence. It ought to make an alert atheist at least pause and say Hmm. On the other hand, though, believers ought to realize that atheists do sometimes also have experiences comparable to Russell's. There's enough Hmm for everyone.

I've had odd moments of inspiration myself a couple of times, though no lives were ever at stake for me. One of those times seemed like an immediate answer to prayer, and that experience has done a lot to shape my life. Things like that don't happen often, however. Once or twice in a lifetime seems to be the usual ration, as far as I can judge.

I'm afraid I'm a bit reluctant to read a long article heavy on technical detail. I'd appreciate the favor if someone who has done this could briefly summarize the reason why this heart procedure was not written up in a medical journal.

I'm not suspecting any discreditable reason. I know nothing about surgery, or medical journals, so I'm quite prepared to believe there was a fine reason not to publish this. I'm just curious about what the reason was, since in fields I do know, even quite small advances are published almost invariably.

Orbiting Kolob said...

FWIW, there's a famous passage in the literature of mountaineering that might be of interest here. It was written by John Muir about his 1872 first ascent of Mount Ritter, in the Sierra Nevada of California. Near the summit, Muir had a close call he described as follows:

At length, after attaining an elevation of about 12,800 feet, I found myself at the foot of a sheer drop in the bed of the avalanche channel I was tracing, which seemed absolutely to bar further progress. It was only about forty-five or fifty feet high, and somewhat roughened by fissures and projections. The tried dangers beneath seemed even greater than that of the cliff in front; therefore, after scanning its face again and again, I began to scale it, picking my holds with intense caution. After gaining a point about halfway to the top, I was suddenly brought to a dead stop, with arms outspread, clinging close to the face of the rock, unable to move hand or foot either up or down. My doom appeared fixed. I must fall. There would be a moment of bewilderment, and then a lifeless rumble down the one general precipice to the glacier below.

When this final danger flashed upon me, I became nerve-shaken for the first time since setting foot on the mountains, and my mind seemed to fill with a stifling smoke. But this terrible eclipse lasted only a moment, when life blazed forth again with preternatural clearness. I seemed suddenly to become possessed of a new sense. The other self, bygone experiences, Instinct, or Guardian Angel,--call it what you will,--came forward and assumed control. Then my trembling muscles became firm again, every rift and flaw in the rock was seen as through a microscope, and my limbs moved with a positiveness and precision with which I seemed to have nothing at all to do. Had I been borne aloft upon wings, my deliverance could not have been more complete.


As Muir said, call it what you will. But clearly something remarkable happened here.

Anonymous said...

Do I believe that a cardiac surgeon would open up a chest without a plan of what they intended to do before they closed? No. I do not.

Anonymous said...

Of course. The surgeon knew exactly what he was going to do back in 1960 with all the technology that was available to him to plan for and execute the required procedure. It was just hyperbole when Elder Nelson described that heart surgery was in its infancy at the time. Phttt, Elder Nelson isn't going to fool me either.

Steve

Anonymous said...

My b-i-l had open heart surgery in the 50s. His truly was one of the first in which the heart was stopped. Someone before him actually was THE first but I have no doubt that the team of surgeons in that genuinely pioneering procedure discussed in great detail what they expected to happen, what they planned to do and a variety of contingencies if the unexpected happened before they undertook such a task. If nothing else ANY surgeon would have had to have such a discussion with the patient and patient's family to assure them that the risk they were taking had some outcome for success in order to get their consent. I know my in-laws were scared to death and they relied on all those professionals to be informed and prepared. There was no way they were going to let someone wing it on their 14 year old son!

A story like this makes you wonder about the credibility of the person who tells it and the regard (or lack thereof) they have for the intelligence of their audience when they engage in reckless hyperbole. Could the point not be made by an honest recounting of events? It also makes you seriously question the gullibility of the people who take it at face value.

Anonymous said...

Oh, absolutely. Every heart procedure that is ever done is already well planned out in the multitude of varieties and possibilities because they always know everything that is wrong with the heart before they ever go in. It won't be long before they just automate away the heart surgeon. 10 years (or less in this case) is clearly enough time to graduate from infancy to well documented. In fact, it makes me wonder why they waited so long to have the first human heart transplant (1967 btw). They (and by proxy, Elder Nelson) knew exactly what was wrong and exactly how they were going to fix it. No inspiration needed. No on the spot, quick decisions have to be done because every path was already decided.

In fact, him being listed as one of the 20 most inventive surgeons alive today is not deserved:

http://www.healthcare-administration-degree.net/20-most-innovative-surgeons-alive-today/

because of him telling such an outlandish story to the gullible puts his professional credentials at risk. Phhttt, I'm not buying it either. I'm too smart to fall for such a yarn.

Steve