April 28, 2002 Surgeon with a heart Pediatric specialist make an art form of a science
Author: TIM JANICKE; The Star Edition: METROPOLITAN
Section: STAR MAGAZINE
Article Text:Two-month-old Gesserine Sevedge lies spread-eagle across the operating table - a wee bulge covered with a blue surgical drape and surrounded by towering adults in sterile garb: nurses, technicians and an anesthesiologist.And a surgeon with a pneumatic jigsaw. With several quick buzzes, Gary K. Lofland unzips her chest through a window in the blue fabric and inserts a stainless-steel frame to pry apart her sternum. Inside pulses a heart the size of an infant's fist. Within minutes 13 plastic tubes radiate from Gesserine's chest cavity. Each tube, connected to a vein or artery or to the heart itself, begins carrying blood pumped from a heart-lung device, called a perfusion machine. A line on the computer monitor dips, then goes flat. Her heart has stopped. Time for Gary Lofland to go to work.An elite group Lofland, 51, is the chief of thoracic and cardiovascular surgery at Children's Mercy Hospital. Since his arrival in 1997, the number of heart surgeries here has more than doubled, to about 500 per year. Mortality rates have dropped to between 1 percent and 2 percent - the national rate is about 3.5 percent. Lofland specializes in pediatric cardiac surgery. The maladies he fixes are almost all birth defects: holes inside the heart, deformities, transposed arteries and other things with long medical names that seem hard to explain - and repair. "There's 12 to 15 pediatric heart surgeons among the elite in the nation, and Gary's one of them. It's a very small group," says James St. Louis, an assistant professor of pediatric surgery at Brown University in Providence, R.I. He spent six months at Children's Mercy last year in what Lofland calls "finishing school." "The reason I went to Kansas City was because of the volume of congenital cardiac cases," St. Louis says, "and because of the national reputation of Gary Lofland among heart surgeons."A must-stop-destination Next year Children's Mercy will unveil the Center for Congenital Heart Disease, a hub for all of the hospital's cardiac resources. Surgeons, cardiologists, nurses, perfusionists and database employees will occupy the new department. Four new operating rooms are also under construction. Lofland's group moved into the new fourth-floor headquarters earlier this year. He plans to hire a biologist to do basic cell research, too, in hopes of finding new ways to heal hearts. "We're on the cutting edge now in terms of practice," he says. "I want this place to be a must-stop destination for anyone from around the world involved in pediatric cardiovascular services. When cardiac surgeons come to a meeting in this country, I want them to have to visit Kansas City to make their visit complete." Lofland's reputation has been boosted by his academic credentials, too. The author and co-author of scholarly research, he took over in January as editor of Progress in Pediatric Cardiology, an international medical journal published in Amsterdam.Days and nights Lofland doesn't sleep much or eat often. He's up at 5 every morning, unless he exercises. Then he hops out of bed at 4 to run or use his treadmill. (He's 6 foot 3 and 195 pounds, though he vowed to drop to 185 by the time this story was printed.) Breakfast consists of juice and some vitamins while taking a quick peek at the Weather Channel or checking sports scores. By 6 or 6:15 he's at the hospital, prowling the intensive care unit, checking on the children he operated on the day before. At 6:45 he'll meet his surgical team for official rounds, checking on all of their patients. He usually leads, striding ahead of the pack to the next patient. On most Mondays through Thursdays, he's in surgery for the rest of the day, each procedure lasting two or three hours, each day bringing two or three surgeries - and sometimes four or five. He'll do rounds in the afternoon and catch up on paperwork, usually going home between 6 and 8 p.m. Then he eats, often for the first time that day. Bedtime is 9:30 or 10, unless he's worried about an unstable patient. He says he'd rather stay up until midnight or so if he has to take a call or go back to the hospital; if he gets awakened, it's hard to go back to sleep. Of course this doesn't leave much time for hobbies or relaxation. But Lofland says he's used to work. He began working summers full time when he was 12 or 13 and also worked 40 hours a week while in medical school. "Why do you need a hobby when you can be an artist and a scientist and a clinician all at the same time? It's fun and it's challenging," says Richard Hopkins, chief of cardiothoracic surgery at Brown University and Hasbro Children's Hospital in Providence. Hopkins went to med school with Lofland, was later a colleague at Georgetown University and is now a peer and friend. Lofland's schedule doesn't really leave him time to hobnob in Kansas City society, and his name rarely appears in the newspaper, though he says he contributes to local charities. His administrative assistant, Arta Williams, says Lofland is intensely organized and demanding - but unfailingly pleasant and polite. "He always thanks you for everything," Williams says. "Before he leaves for the night, he always tells me thank you for the things I did that day. He's always been nice to me - very, very kind."Meeting of the minds It's 7:20 a.m. on a Friday, a day reserved for meetings with peers as well as patients; usually no surgeries are scheduled. Twenty-three medical experts pack a darkened, narrow conference room in the interior of Children's Mercy. There's an informal pecking order here. Lofland sits at the front table in chair No. 1. His team of nurses and a surgeon occupy the table behind him. Cardiologists and nurses fill the seats around them. Standing on a platform, surrounded by computer gear, a cardiologist narrates as the group studies big-screen monitors on the front wall. Red and blue splotches, depicting blood flow, pulse across the monitors. There's sound here, too, whooshes of blood coursing through arteries, veins and heart chambers. The group studies the EKGs, echocardiograms, angiograms - even old-fashionedX-rays. Every Friday morning after rounds, the cardiologists describe the symptoms and diagnoses for their patients, and Gary Lofland decides whether his surgery will fix the problem. Today's subjects: seven children, from 2 months old to 10 years, with congenital heart defects. It's easy for a layperson to drown in medical jargon during this conference: Cyanosis. Stenosis. Resection. Fenestration. Aortic regurgitation. Afterward, Lofland strides purposefully down the hall. Inside the examining rooms the jargon takes on faces: patients he'll meet later in the operating room.He'll fix it Lofland politely knocks on the door of an examining room and steps inside. The room is beige, but it's set off with a colorful, geometric border. Institutional but cheerful. Inside sits Bryce Huffmaster, 18, chin in hand. He's had a heart valve replaced twice, but his body is rejecting the valve, again. Lofland sympathizes but quickly explains that the problem can be corrected by using a different kind of valve. He says the new proceduredure has been proven to be more successful. The mood is glum, but Lofland promises to repair the problem. Inside door No. 2 sits Lori Sevedge, holding her 2-month-old baby, Gesserine. Born with Down syndrome, Gesserine has a hole in her heart. Lofland, in low, dulcet tones, explains that he'll fix it. Lori smiles as Lofland gives Gesserine a perfunctory chuck under the chin. Behind the third door sits Michelle Dulle and her husband, Michael. She's pregnant, and cardiologists have already figured out that her baby needs a heart operation. Michelle and Michael anxiously lean forward, holding hands, fingers intertwined, listening intently to Lofland. By the time he finishes explaining how the operation will work, the pair are grinning and then laughing. Lofland's manner soothes. "He made me feel like everything was under control - he seems to know his job," Sevedge says. "He's to the point. He was focused on what he was doing, and he was focused on her."'Don't worry about it' Lofland's soothing approach impresses doctors, too. Laura Fitzmaurice is division chief of emergency medical services for Children's Mercy. An emergency room doctor who still pulls regular shifts, she's seen the gamut of medical problems. She'd also known her whole life that she had a congenital heart defect, nothing that had ever been a problem. Until she began to get short of breath and to wheeze. Her cardiologist said she needed surgery and suggested the Mayo Clinic. More than anyone, Fitzmaurice knew this would be a serious operation - her chest would be opened and her heart stopped while a hole was closed and a muscle removed. She wanted to know for sure that surgery was necessary. So she asked Lofland if she should go. "The first thing he said was, 'I can do that. Don't worry about it. I can fixthat,' " Fitzmaurice says. "He has a persona that is very calming - it makes you relax. He does instill confidence; he lets you know that he can handle it." So rather than leave town for surgery, Fitzmaurice opted to stay in Kansas City and have her surgery at Children's Mercy. Lofland's unflappable and unpretentious style convinced her. "He's also very humble," she says. "He doesn't come across as somebody that has a big ego. He makes it seem like he's sewing up a cut - almost like an everyday thing. He doesn't make it seem like he's God or anything."His Virginia home It's 5 a.m. on a glorious spring Saturday. Gary Lofland eases out of bed, dresses and heads out the door to his white Dodge four-wheel-drive pickup. He rattles down a winding lane, stopping a few miles away at the country store. He drinks a cup of coffee and drives back. By the time he gets home, Jan, his wife of 23 years; son Kiernan, 14; and daughter Glennis, 12, will be awake. Or maybe not. At least, he says, he "won't feel as guilty about starting the tractor" and getting to work. Jan's a master gardener, so he'll spend the day moving dirt or turning ground for her. He'll says he'll stop sometimes to toss the football with Kiernan. Or go down the lane with Glennis to pick up the trash that's accumulated in the ditches. Maybe chop firewood for winter. The Loflands live in a Colonial brick house perched on a bluff above the river. The James River. In Virginia. Oh, sure, during the week, he's settled in an apartment near Crown Center. But he and Jan, a registered nurse, decided in 1997 that he'd work in Kansas City and that the family would stay in rural Crozier, Va., outside of Richmond, where he last practiced. They thought their children would benefit from the stability of staying in their schools. And the arrangement lets Lofland pull the long hours he thinks are necessary for his job. "It has let me focus entirely on the development of this program," Lofland says. He often flies home on weekends, or the family comes to Kansas City. Lofland says he finds time to talk to Jan "eight or nine times a day on the phone." He calls often enough that Glennis simply answers, "Hi, Daddy!" when the phone rings. Last year Children's Mercy hired a second heart surgeon, James E. O'Brien Jr. Until then, Lofland says, he was always tethered to the hospital. It was hard to relax when he went home to Virginia. "Now, when I'm there," he says,"I try to focus on being there. Because I know that things are under control and well-managed here."Fascination with anatomy Lofland was born in Sussex County, Del., a shipbuilding community, but he traces his Irish lineage back to 1690 in Virginia. His father was an undertaker, though he says his parents shielded him from the technical aspects of the funeral business - embalming, for instance. His father's anatomy books got him interested in medicine. By the time he was 12 he had a "fascination with anatomy" and decided to become a doctor. He got his medical degree from Boston University, then hopped around the country and the world, working for the public health service in Montana, as a resident at Duke University, for a year at the Hospital for Sick Children in London, and back at colleges in the United States. At the Medical College of Virginia, he performed "50 or so" heart transplants, an operation that Lofland describes as "really not all that exciting or challenging" compared to what he's doing now. His current work, he says, is "like starting out with a heart kit and trying to make something that actually works." Before he came to Kansas City he was the sole surgeon for the Center for Congenital Heart Disease in Richmond, Va., and a professor at Georgetown University. In Virginia he operated on children and adults. "I did the adult practice for relaxation," he says half-jokingly.Hitting the ground running Keith Ashcraft says he pursued Gary Lofland. Ashcraft, who retired from Children's Mercy in 1999, was surgeon in chief. He wanted the hospital to have a full-time cardiac surgeon - and he wanted it to be Gary Lofland. Until then Lofland had seen Kansas City only as he passed by on the interstate. After Ashcraft finally lured him for a visit, Lofland says he saw "unlimited potential." "I saw a hospital that was bound and determined to be the nicest children's hospital in the country. I found an extraordinarily competent group of people that accomplished things without any pomp." So he loaded up and moved. With his father, Joseph, driving one car and he and Jan driving another, they left Virginia at 4 a.m. on a Sunday and drove straight through to Kansas City, arriving about midnight. The next morning he went to work, performing heart surgery on two priority cases that had been waiting for his arrival. "It's called hitting the ground running, and we've been running ever since," Lofland says. Fred Burry, executive medical director and senior vice president of Children's Mercy, says, "Gary brought to the program an intensity and vision. He wanted to build a program that would not be outshone by any program in the United States." As to how much that costs the hospital, Burry will only say "a lot." Lofland says he made his financial arrangements confidential as a term of employment. Other surgeons and experts in the field say that a top, nationally regarded surgeon such as Lofland would make $750,000 to$1 million a year, or more. "One of the keys about compensation is that very high-performing people who have considerable expertise can command considerable compensation," Burry says.Legendary concentration Lofland deftly slices open the heart of Gesserine Sevedge, gingerly probing the inside until he can find the hole in parts of the top and bottom, left and right of her heart - all four chambers. Scientifically it's called atrioventricular septal defect. It's quiet in the operating room. Blood pulses through the perfusion machine; the ventilator whispers, pumping air. Lofland murmurs orders to the nurses, perfusionists, anesthesiologist and assisting surgeon. His concentration is legendary. "He is the most focused surgeon I know," says St. Louis, the Brown University professor. St. Louis says that in other operating rooms, the surgeon sometimes plays music; sometimes voices are raised. Sometimes the noise distracts. But not in Gary Lofland's OR. "If you notice, in his operating room, it's quiet; there's no music blasting," St. Louis says. "People are focused on their jobs." Before he begins cutting on any patient, Lofland says he's considered all the options, considered all possible outcomes. "I go step by step through many of these operations the night before," Lofland says, "before I go to sleep." Under the snarl of plastic tubes tethered to the heart, Lofland performs an intricate ballet of incisions and suturing to repair young Gesserine's heart. He describes it as "rearranging the three-dimensional geometry of the heart." Then he checks for leaks. As he begins removing the tubes from the perfusion machine, blood begins to flow naturally, allowing little Gesserine's heart to start beating again. He's in and out in about two hours. Lofland uses wire sutures to pull the baby's sternum back together. Pam Dennis, Lofland's first assistant, sews up the chest while Lofland marches off to the intensive care unit to brief personnel on Gesserine. As he walks, he talks. "That," he says matter-of-factly, "is infinitely more difficult than a heart transplant."Art and science "I pride myself on being a surgeon," Lofland says, explaining that there's something else that takes over beyond brains and dexterity. "What we do is an art form as much as a science. I can't draw. I can't paint. But I understand the three dimensions of the heart. It's important to me to take something that's difficult and make it look routine." In a rare moment, Lofland sheds a little of his characteristic humility: "Sometimes I come out of surgery and think: There's only a handful of guys that could do that." Tim Janicke is the photo editor for Star Magazine. To reach him, call (816) 234-4791 or e-mail firstname.lastname@example.org.For more information To find out more about the Center for Congenital Heart Disease or about Children's Mercy Hospital, call the hospital's community relations department at (816) 346-1370 or consult your pediatrician. Caption:
On the cover: Gary K. Lofland wears special headgear with a light and a television camera when he performs heart surgery at Children's Mercy Hospital. A magnifier is attached to each lens of his eyeglasses.Gary K. Lofland listens as cardiologists describe the symptoms of their patients. In this weekly conference, Lofland decides which patients will benefit from open-heart surgery.During this operation, 2-month-old Gesserine Sevedge's heart has been stopped. Lofland (right) gingerly reconstructs the tiny heart with the assistance of Eric Sandwith (left), a cardiac surgery resident at Mid-America Heart Institute at St. Luke's Hospital.Bryce Huffmaster (center) underwent heart valve replacement when he was 14 and 16. Now he is 18, and the valve is failing again. Lofland explains how he will replace it with a new one that should be permanent. At right are Huffmaster's father, Leon, and mother, Jeanie.Lori Sevedge holds 2-month-old Gesserin! e during a consultation with Lofland. Gesserine's surgery was successful. She had been lethargicnow, her mom says, she's energetic and makes baby sounds, "laughing and cooing."Michelle and Michael Dulle talk about their unborn child's heart problem. After the baby, Jonathan, was born Feb. 20, doctors decided he could get by without open-heart surgerythey snaked a catheter into his heart to repair a closed valve.Above: Unlike personnel on the periphery of the operating room, Lofland must scrub carefully and wear sterile gloves before he operates. Below: The myriad tubes that reach out of Gesserine's chest are routed to a machine that circulates and adds oxygen to her blood.Because he lives in an apartment nearby, Lofland can walk to and from work. He also has a home in Virginia, where his wife and children live.Photos (9, color)TIM JANICKE/The Kansas City Star Copyright 2002 The Kansas City Star Co.
Record Number: 10176872