Inside Operating Room 4 at the Peter Munk Cardiac Centre, heart surgery is about to begin. The patient, 80-year-old John Gentle, lies anesthetized upon a table. His chest, stained orange with an iodine solution, is the only part of his body not covered by green sheets and towels.
Standing at Mr. Gentle's side is Dr. Jerry Bobiarski, a cardiac surgeon from Poland doing his residency in Toronto. At more than six feet tall, Dr. Bobiarski is a hulking presence in the OR.
The surgeon who will be operating on Mr. Gentle enters the room dressed in green scrubs and a pink surgical cap dotted with pink hearts. It's not a nod to Valentine's Day, but a memento from a 2006 breast-cancer fundraiser for which she had her head shaved. Dr. Stephanie Brister, a diminutive woman in her 50s who is nearly a foot shorter than Dr. Bobiarski, steps up on to a small stool to elevate herself above the patient and reaches up to the lights, directing their beam squarely on the patient's chest, a bright white spot where soon a beating heart will be revealed.
Over the next four hours, Dr. Brister, one of nine cardiac surgeons at the Peter Munk Cardiac Centre, will guide a team of two other surgeons, three anesthesiologists, a scrub nurse and a perfusionist - who operates a heart-lung machine - through a cardiac bypass and an aortic-valve replacement.The operation will be just one of more than 1,800 open-heart surgeries performed at the centre this year. Part of Toronto General Hospital, it opened in 1997 thanks to a $6-million donation from the founder and chairman of Barrick Gold Corp., for whom the centre is named. It does more heart transplants than anywhere else in the country, and, despite receiving some of the most difficult cases from around the world, boasts the lowest mortality rates in the province.
The Peter Munk Cardiac Centre is on par with the Mayo Clinic and Johns Hopkins Hospital in terms of its international reputation, says Dr. Tirone David, who has been head of cardiovascular surgery at the centre since it opened. "It is considered to be one of the best cardiac centres in the world by all objective measurements," he boasts.The stats are impressive indeed, but one aspect that the centre could improve is its gender balance. Of the nine cardiac surgeons at the centre, Dr. Brister is the only woman.
Of course, ask her whether she would like to see more women enter the field, and Dr. Brister's slightly evasive answer would do any politician proud.
"That's like asking if I want to see Hillary Clinton be president," she says, laughing. "Yes, but it's not because they're better. You want good people doing it. And yes, you want more women doing it because I think they'll be good at it, but what you want is the best people doing it."
Even though female enrolment numbers at Canadian medical schools are increasing, and even though more women are entering special areas of focus, particularly obstetrics, cardiac surgery remains a heavily male-dominated specialty.
"To be honest, I'm not sure that we ever will see a lot of women in cardiac surgery," Dr. Brister says. "It's a very tough training program in terms of time commitments, and because it's such a long training program it happens at your peak childbearing years, and that will never change."
Most cardiac surgeons go through 10 years of training after medical school and can look forward to long days that allow little room for a personal life, she says. On top of the 200 to 250 heart operations Dr. Brister performs each year, there are the long working hours to contend with. Most days, she arrives at the hospital just before 7 a.m. and will stay until 7:30 p.m. On Wednesday, she spent 13 hours in surgery, finally finishing the procedure at 10 p.m. "It can be a tough life," she says.
But Dr. Brister says having children of her own was never an issue. "It wasn't a decision not to have children per se; it was never important to me, to be honest," she says. "It wasn't a high priority for me and I recognized the kind of commitment I had to have for my job and I didn't think that would be fair to children."
A WORK LIFE WELL BALANCED
Born in the small prairie town of Rivers, Man., to a father in the military and a mother who taught elementary school, Dr. Brister and her two brothers and three sisters were encouraged to think of themselves as having no limitations."I owe my family a lot because they raised us with the attitude that we could ... do anything that we wanted to do," she says.
In fact, it was only after she was established in her career that she discovered that her mother had had reservations about her chosen field. "For many, many years, I always thought that my parents wanted me to be a doctor. I knew my dad did and I thought my mother did too until one day we were having one of those heart-to-heart talks," Dr. Brister says. "My mother said, 'I never really wanted you to be a doctor. I thought it would be too hard and that you would have to give up too much.' "
After earning her MD from the University of Calgary in 1979, Dr. Brister spent the next seven years at McGill University, doing internal medicine and general surgery training, eventually serving as chief resident of general surgery at Montreal General Hospital. In 1986, she moved to Kingston, where she spent two years doing cardiovascular and thoracic residency training at Queen's University. Then it was on to a fellowship in cardiac surgery at the University of Toronto, where she was mentored by Linda Mickleborough, the first female cardiac surgeon in Canada, who retired in 2003.
After completing her fellowship in 1989, Dr. Brister became a staff cardiac surgeon at Hamilton General Hospital and an assistant professor in the department of surgery at McMaster University, where she met her husband, Michael Buchanan, a professor of pathology and molecular medicine.
It has helped immensely to have a partner who understands the nature of her job, Dr. Brister says. "The people that you choose to be with, or who choose to be with you, in terms of your significant other, have to be very unique," she says. "I have my own unique person."
The two have two children from Prof. Buchanan's previous marriage, and live in Toronto in a condominium on the lakeshore.
And as demanding as her job is, Dr. Brister does, as some might doubt, have a personal life. "I love going to movies. Generally, I go at least once a week - if we can, twice a week," she says. "I was a Terminator fan long before it was popular."
She also likes to read "trashy murder mysteries," which she admits is seriously light fare. "I get enough drama in real life," she says.
Some weekends, she goes golfing, a sport she took up about 12 years. "My husband and I took it up because we thought it could be time we could spend together," Dr. Brister says. "I'm a whole lot better at cardiac surgery than I am at golf."
The couple also go antiquing when they can. "I collect carousel horses and I work on restoring them," she says. The restoration work can take months, a job she undertakes on most weekends at the farm she and her husband bought five years ago in Erin, Ont., about an hour's drive from their home.
PASSING DOWN KNOWLEDGE
When she is not duffing on the golf course or performing surgeries in the OR, Dr. Brister's time is divided between seeing patients, doing research and teaching.
Each year, the Peter Munk centre takes on six international fellowships from a list of more than 100 applicants. Cardiac surgeons from Italy, Greece, England, Poland, Australia, Singapore and France, among many other countries, have come to the centre to hone their surgical skills. Dr. Brister says she enjoys teaching. It's one of the reasons, in fact, that she was hired.
"Predominantly, she was brought here to provide excellent care to our patients because she's a superb surgeon and an excellent doctor," says Dr. Robert Bell, president and chief executive officer of the University Health Network. "But she's also a superb teacher."
Every year, Dr. Brister will have a hand in teaching eight fellows, two cardiac-surgery residents and 10 to 15 medical students. "You want to be able to share your skill. You want other people to be able to do this as well as you can," she says.
Teaching, however, is not the main reason she pursued her specialty. "The biggest reason I chose it is because, of all specialties, this is the one that gives you the most direct impact on people's quality of life. It's really an amazing thing to be able to do," she says. "It's always fun to be in the operating room doing a technically difficult operation and feel good about it, but the best part is the next day when you walk into the intensive-care unit and your patient is awake and talking to you and you know they're going to be okay."
There were plenty of those moments at Hamilton General Hospital, but after nine years there her career, she says, had "plateaued."
"I was looking at what was going to happen for the next 10 to 20 years in my career and I couldn't see a lot of change that was going to occur," Dr. Brister says. "We didn't have a formal training program in cardiac surgery so my exposure to residents in terms of teaching was limited, we didn't have a strong fellowship program there, and this opportunity came up at Toronto General. I thought, well, given that I'm going to be in practice another 20 years, I'd like to make a move to something that's a bit more challenging."
Yet there are some constants in her career. For more than a decade, Dr. Brister has been a vocal proponent of bringing attention to the prevalence of heart disease among women.
"Heart disease is the leading cause of death for men and women, and the level of awareness of the significance of the disease in the community is just not there. Many women think breast cancer is the leading cause of death in women, and it's not," she says.
BACK AT THE OPERATING TABLE
In OR 4, it is still hours before Dr. Brister will know if her patient is okay. She begins by making an incision down the centre of Mr. Gentle's chest. Then, using an electric saw, she cuts down into the sternum. Taking a heavy metal retractor, she opens a gap in the patient's chest about 10 centimetres wide.
After blood from Mr. Gentle's chest cavity has been suctioned away, his heart can be seen beating somewhat wildly.
"I'm going to wait for the pressure to go down," she says.
A short while later, Mr. Gentle's heartbeat slowly subsides. She reaches in and places a hand on the heart for a moment and then begins the surgery, a relatively routine procedure with a mortality risk of just 1 to 2 per cent. Calmly calling for sutures that are handed to her by Dr. Bobiarski, Dr. Brister leads the surgical team through the procedure, asking for updates from the perfusionist and anesthesiologists every few minutes.
"It's really not one person who makes it happen," she says. "It's a highly trained team in there and you're reliant on everyone doing their job."
When the surgery is done, Dr. Brister will do what she always does after performing surgery. She will take a seat in a corner of the OR and wait to make absolutely sure the patient is stable.
"I'll just sit there and get myself together before I go out and talk to the family," she says. "I never, ever speak to the family until the patient is leaving the operating room."
Sitting there in the operating room, she will fill out paperwork for about 10 minutes. After that, she will wait as long as it takes until she is sure she can deliver good news to whoever is waiting outside.
"Sometimes I will have brought something down to read, generally journals," Dr. Brister says. "It's all medical-related."
Giving the doc a hand
Although Dr. Brister is the only female cardiac surgeon on the team at the Peter Munk Cardiac Centre, there are women in other positions who work alongside her, a couple of whom have helped patients climb mountains - literally.
In 2006, Dr. Heather Ross, medical director of the Heart Failure and Cardiac Transplant Program at the Peter Munk Cardiac Centre, cardiovascular anesthesiologist Dr. Patricia Murphy, and a heart transplant recipient flew to Antarctica to scale Vinson Massif, the highest mountain on the continent.
Reaching the summit was no easy task. Dr. Ross, exhausted, found herself unable to finish the last leg of the climb. It was the heart-transplant recipient, Dale Shippam, a firefighter from Thunder Bay, Ont., who had to help Dr. Ross reach the summit.
The trip to raise awareness about the dangers of heart disease, sponsored by the Peter Munk centre, raised more than $1.4-million. The "Test Your Limits" campaign is still receiving donations, says Dr. Ross.
This was not the first time Dr. Ross, an avid climber, had scaled a peak with a transplant recipient. In 2004, she took two transplant survivors to scale a peak in Bolivia.
In May, Dr. Ross, Michelle White, a cardiologist from Montreal, Dave Smith, a kidney transplant patient and Mr. Shippam are heading to Nepal to climb the 6,200-metre-high Mera Peak.
"If we're successful, we will shatter the world record for transplant patients," says Dr. Ross.
By the numbers
1997 Year that the Peter Munk Cardiac Centre opened, thanks to a $6-million donation from the founder and chairman of Barrick Gold Corp. and his wife, Melanie.
30, 9, 5, 20 Number of cardiologists, cardiovascular surgeons, vascular surgeons and advanced practice nurses, respectively, at the Peter Munk Cardiac Centre.
17,000 Approximate number of patients who receive care at the centre each year.
1996 Year that Dr. Tirone David, head of cardiovascular surgery at the centre, was awarded the Order of Canada.
2008 This year, some time in the summer, the new I3 Centre is scheduled to open. The centre's name represents cardiac imaging, intervention and innovation. Under the guidance of development director Dr. Harry Rakowski, the I3 Centre, part of the Peter Munk Cardiac Centre, will establish a single space for cardiologists, radiologists and cardiac and vascular surgeons, who are currently dispersed throughout Toronto General Hospital.
37 Amount, in millions, donated by Peter Munk in 2006 to help build the I3 Centre.
7 Amount, in millions, contributed by the provincial government.
50,000 Average number of Canadians who develop heart failure each year.
1.7 The average number of years a man will live following the diagnosis of heart failure.
3.2 The average number of years a woman will live following the diagnosis of heart failure.
The I3 Centre, part of the Peter Munk Cardiac Centre, will open in spring 2011. An incorrect date appeared last week.