How does a cardiothoracic surgeon differ from a cardiologist?
A paediatric Cardiologist is a Paediatrician that further specialised in cardiac diseases and abnormalities. An adult Cardiologist is a specialist physician that further specialised in adult cardiac diseases. They assess cardiac conditions and treat medically where possible and appropriate. If a disease that presents to a Cardiologist requires further corrective intervention, the Cardiologist then refers the cases to a Cardiothoracic Surgeon for surgical correction of the disorder. Cardiothoracic Surgeons not only operate on congenital and acquired diseases of the heart, but also diseases that affect the lungs.
Do you have a specific ritual before going to operate? How do you prepare for surgeries?
I pray the morning before and evening after a procedure. The morning for strength and guidance and a clear mind, and in the evening I give thanks and pray for a good outcome.
I like to over-prepare for any procedure. I make sure that I understand exactly what the problem is and what the best way to deal with the condition is. I try to anticipate any possible complication. I like to have a specific plan in place for any possible scenario that may arise. I have a backup plan for a backup plan for a backup plan. I like to do literature research when it is a unique challenge or a rare case and will often contact my mentors for some added guidance when necessary.
One of your fondest memories in the operating room?
As a Fellow during my training when we took the cross clamp off my first arterial switch procedure and the heart immediately started beating well. The patient went home five days later.
Do you find that you sometimes get attached to your patients and/or them to you?
I believe that sincere honesty and devoted interaction is the only way to build a relationship, whether a personal or professional relationship. It is easy to get attached to patients and their families. Families are in a vulnerable position and we have to respect them entrusting us with their dear child’s or family member’s life. Many of these children will have repeat surgeries in future. It is important to keep the family’s trust and maintain mutual respect through this journey.
What do you love about your job?
I love working with patients where you can see the immediate effect the procedure has had on their lives and how it positively impacts the whole family. Managing the complexity of the disease and integrating the anatomical abnormality with its effect on physiology is very stimulating.
What is the most difficult part about being a cardiothoracic surgeon?
Dealing with emotions when we are unable to help a patient have a good outcome. And spending a lot of time away from the family.
Any memories that are more prominent than others?
Every single case and its outcome is equally important. Every single family is equally important. The cases that I currently think of on a daily basis are our first transplant and first mechanical heart implantation.
Your greatest achievement practicing as a surgeon? Is there something you are most proud of?
Starting the transplant and artificial heart programme, Maboneng Heart and Lung Institute, in collaboration with the University of Alberta Stollery Children’s Hospital and Netcare Sunninghill Hospital.
Do you have a mantra/saying that keeps you going when things get tough? And is it the same when things are going well?
When things are tough, Winston Churchill, “If you are going through hell, keep going.”
When things are going well, Warren Buffet: “Someone is sitting in the shade today because someone planted a tree a long time ago”.
“None. I just pray.”
The words the incredibly unassuming and self-assured Dr Hendrick Mamorare uses to reply to a question about pre-operational rituals. The simplicity of his answer to the stressful reality that lies in committing to perform surgeries on a beating heart bares testimony to the humble nature this renowned Cardiothoracic Surgeon possesses. With 35 years of experience and practice, Dr Mamorare is fully aware of the ever-expansive field of medicine - allowing humility to serve him and his patients in the best possible way.
“You have a learning curve but even after many years in practice, you will still encounter unusual cases,” explains Mamorare, who finds the most challenge part of his job managing the high expectations from colleagues and families.
His answer echoes and whispers to me the idea that "Heroes are not created easily” (Uldus Bakhtiozina). And most certainly, the belief that heroes pertain increased longevity when created in the face of humility.
The valued member of the Cardiothoracic Surgeon trio of Maboneng Heart & Lung Institute is a Doctor of few words and one that is deeply passionate about his work, which has grown to become his way of life. “The only reason I studied medicine was to do Cardiac Surgery. If I could not have, I would probably not be involved with medicine, and do something like engineering.” His answer a subtle indication of his ability to problem solve, perhaps explaining his immense success in the OR (operating room).
Dr Mamorare fully recognises and stresses the demand for Cardiac Surgeons of a high calibre, especially in the “so called developing countries”. “Only a few paediatric cases get to be operated upon due to a shortage of surgeons and equipment.”
Love is a prevalent quality in the work Dr Mamorare has used, and allowed, to shape himself and his life. “Paediatric Cardiac Surgery is a humbling, challenging and exciting field. Just about every patient is unique and there is hardly any repetition.”
The light in which Mamorare holds his work - to be “wonderful, challenging, humbling” - is a true and genuine reflection of the great surgeon behind the scalpel.
What is a cardiothoracic surgeon?
The cardiothoracic surgeon is a surgeon who specializes in the surgical procedures of the heart, lungs and other organs in the chest. Congenital cardiothoracic surgeons subspecialize in the surgical procedures required in the correction of congenital defects in babies and young children.
How long does it take to become a cardiothoracic surgeon in South Africa?
Cardiothoracic surgeons take a minimum of 12 years to qualify. Congenital cardiothoracic surgeons require an additional 2-5 years of training.
What does a typical day involve as a cardiothoracic surgeon?
Long days, with exhilarating highs and soul destroying lows. The average day starts with ICU rounds at 7am, followed by two surgical cases on average daily. Each case averages 5 hours. In between cases new patients are consulted, or old patients are followed up, and any emergencies are attended to. Once surgeries for the day are complete ICU patients are reviewed. One surgeon remains on call for any ICU problems or emergencies during the night. Patients undergoing surgery the next day are seen and the family members or parents are counseled. If you’re not on call your day usually ends by 8pm. The surgeon on call returns to ICU during the night for routine rounds and is on call till the following morning. Weekends are similar but surgical cases are on an emergency basis only.
What do you love about your job?
I love been at the cutting edge of a physically and intellectually demanding occupation. I love being part of a team of people who each in his or her own way is putting all their effort, skill, blood, sweat and tears into saving lives and improving quality of life. The skill of each and every member of our team is a very rare commodity and it’s a privilege to stand shoulder to shoulder with them.
Congenital cardiac surgery is especially rewarding. These kids present with little or no long term survival, but in the vast majority of cases they end up having a normal quality of life and normal life expectancy following surgery. In other words spending resources on babies with congenital heart disease outstrip any other procedure in medicine due to the fact that successful procedures can add seventy or more years of life.
The diversity of surgical procedures performed is vast. From an open heart procedure on a 2.5 kg baby’s strawberry heart to a lung resection in a 75 year old smoker or a coronary artery bypass operation on a 100 kg man. This is rare in any other speciality
Anything you dislike about your job?
I hate losing. I hate the odd complication or loss. The peak of a successful operation is addictive but the valley of a loss is a dark hole with slippery walls… I feel the weight of every parent and family member on my shoulders with every skin incision. I have the utmost respect for the parent that willingly hands over his or her child to the masked stranger on the other side of the red line; handing over that child or loved one’s future into our hands. Parents and family members are the true heroes.
Surgeries are average 5 hours long? Do you take meal or tea breaks?
Ha. No time flies when you are having fun. Most of the surgeries we perform are open heart surgeries. This means the aorta is clamped and the heart isn’t receiving any nutrient or oxygen rich blood. We use the saying, “time is muscle”. The shorter the period the heart muscle is without blood flow, the better for the patient. Heart surgery is about connecting the patient to the heart lung machine, stopping the heart, repairing the defect, removing all air from the heart, restarting the heart and weaning the heart from bypass. This should all be done expeditiously and accurately. The heart can’t be rested like a broken bone or an inflamed intestine. It has to start working immediately and efficiently to sustain the blood flow required by the organs and body tissues.
Any outstanding memories?
Hundreds, some good, some bad. The first time I saw the beating heart as an intern. My first solo heart surgery. My first operation on a new born baby. My first death. Seeing babies who were blue and dying now going to school and playing sport. New memories are created every day.
Netcare Sunninghill Hospital is a cutting edge multi-disciplinary healthcare facility that has easy access from the N1 North and West highways at the Rivonia/Sunninghill off-ramp.
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