In Good Hands 

When the smallest patients go under the knife

Dr. Scott Bradley's patients never call the hospital to arrange an appointment, and they often arrive unexpectedly. They never say a word, they turn their noses up at hospital food, and the only time they yell for a nurse is when they crave warm milk. His specialty is pediatric cardiac surgery, and his smallest patients weigh 500 grams.

When Bradley, cardiothoracic surgeon at MUSC, first encountered pediatric heart surgery at Harvard Medical School, he was hooked by the field's challenging complexity and the variety of heart defects. "I saw the opportunity to do some good, help people born with things wrong with them," he recalls. "It seemed really fascinating."

Bradley performed his first infant heart surgery in Ann Arbor, Mich., in the early '90s. "It was intimidating, because everything's so small," he says. The surgeon had done most of his training with adults, so to get used to dealing with smaller hearts, Bradley practiced on lambs. And on top of all that, he had to deal with puzzling defects.

"There's such a wide range of problems," says Bradley. "We really don't know what causes heart defects. Some are genetically linked. A lot that we do involves rearranging the heart from the way it was to how it's supposed to be."

During the precarious procedure, Bradley wears glasses that magnify the membranes of his fragile patients. It's a process that can take up to 12 hours, although the surgery can be broken up into two to three hour stints for smaller premature babies.

"Some of them are in intensive care on a ventilator when I first see them," he says. "They can't even go home. They can't eat, or they don't grow. It's remarkable to see them afterwards. The parents tell me that their baby eats like a champ, can't get enough. It's exciting to see how they do and rewarding to completely change someone's life."

Some operations are more successful than others. "I always hope for the best and try to do my best. But there are difficult days that can be pretty discouraging," he says. "I have to talk to the parents about it afterwards, but it's impossible to put yourself in the position of somebody who loses a child."

Bradley knows that if he dwelt on the tragedy of an unsuccessful surgery, it would stop him from working for a month or two. But each day brings another family and a brand new patient. "I try to live in the present. And although it's difficult sometimes, I'm fortunate that I work in this time and this field. The operations usually work well. Twenty years ago, a baby might have had a 50/50 chance of surviving. Techniques were not as advanced as they are now."

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