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I was there

Author: Claire Halliday
Date: 16/04/2000
Words: 949
          Publication: Sun Herald
Section: Sunday Life
Page: 35
Professor Don Harrison, 69, was an anaesthetist and director of the cardio-thoracic intensive care unit at Sydney's St Vincent's Public Hospital in 1984, when 14-year-old Fiona Coote became Australia's youngest heart transplant patient. Interview by Claire Halliday

We started about six in the morning. I went to see Fiona and administered the anaesthetic. She was unconscious. She was nearly dead. She had a tube into her lungs and she was attached to a ventilator. She had a catheter into her abdomen to support her kidneys and she had another catheter in her leg to help the heart.

In the operating theatre that day, there were three anaesthetists, two people running the heart/lung machine, three or four surgeons, three nurses and there was a technical/scientific officer as well. That's about 12 essential people to do that operation.

There were two cases of heart transplants back in the '70s that I was involved in, plus another in the '80s, so even though many people think Fiona Coote in 1984 was the first transplant recipient, she was actually the fourth. She was just the best known, perhaps because she was so young.

I was a director of cardiac anaesthetics at that time and I was on permanent call for transplants. I was at a dinner party the night when we got the call - there was this very sick young girl and there was a donor heart that was going to be available.

We were down at Palm Beach and there were about eight of us. They were members of a cooking class and we were having a gourmet dinner we'd been planning for months. My friends at the dinner party were very excited. I'd known them for several years and they took a real interest in the transplant because they knew that was what I was going back to do.

My wife and I abandoned the dinner party and I went home and got some sleep ready for the next morning. I feel very privileged, even now, to have been part of it.

It was still very early days for heart transplants. It had gone beyond the experimental but it was still a very high-risk operation.

In Fiona's case, it was even higher risk because she was so sick. Some things were in her favour because she was very young but some things went against her because of that. She was really struggling.

They didn't know what the outcome was going to be. I think everyone was very sad about it because she was a very pretty and very young girl, and it just seemed an awful thing that she had to go through this enormous procedure when she should have been a lovely, carefree country girl without any of these worries.

The anaesthetist is responsible, of course, for maintaining sleep and making sure the patient is not experiencing any pain.

We have to give gases and intravenous drugs and we also have to monitor her circulation and her heart and her respiration because they're on a ventilator. I'm right near the patient's head during a procedure. I was monitoring her and looking at what was going on.

You need to know what's going on in the surgical procedure. The moments before we went onto the bypass machine were very tense because her old heart wasn't working very well and it was very difficult to maintain blood pressure. It's always tense coming off the bypass machine but she improved quite rapidly and responded quite well. We were starting to feel a bit more relieved after about half an hour of coming off the bypass machine.

Because there were three anaesthetists, we were able to have short breaks. I went out for a cup of tea once and watched what was happening.

In the operating theatre in situations like that, you do talk about philosophical issues and we talked about what the impact would be on Fiona's life. We didn't really know her that well because she came to us unconscious from another hospital. Once she was conscious though, it was pretty obvious she was a very special sort of person.

I did have a sense of being involved with something ground-breaking at the time of the first transplants I worked on but also you are just saving someone's life. There was a great deal of excitement about this new treatment but, at the same time, concern for Fiona.

She finished in the operating theatre at about half-past one in the afternoon. It's a long time and it's very difficult for us but when you've been doing it so long, you know how to have that high concentration ability, otherwise you wouldn't be doing it.

It wasn't until one to two weeks after that we knew it was going to work. Immediately after the operation, she went back to our cardiac intensive care unit and I continued to look after her in there.

I stayed with Fiona until I thought she was stable enough for me to go home. It was about midnight. There were nurses and surgeons coming and going and her parents were there a bit, too, I think.

Fiona was the sickest one we'd done at that stage and I think she would still be one of, if not the, sickest patient we've ever had. She had more support systems than any other transplant we get these days. She was a great patient with great courage. Very co-operative and easy to look after.

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