Guardian an­gel

Renowned heart sur­geon Alan Kerr saved Donna Lan­der’s life in 1987. This year – thanks to a Lis­tener story – he saved her again.

New Zealand Listener - - CONTENTS - by Donna Chisholm

Renowned heart sur­geon Alan Kerr saved Donna Lan­der’s life in 1987. This year – thanks to a Lis­tener story – he saved her again.

July, 1987. David Lange’s Labour Gov­ern­ment is on the cusp of its sec­ond term, the in­ter­na­tional stock mar­ket is three months away from the Black Tues­day col­lapse, and in Auck­land’s Green Lane Hospi­tal, 38-weeks preg­nant Donna Lan­der is close

to death.

She had been ad­mit­ted to the heart unit with ch­est pain af­ter an emer­gency flight from her New Ply­mouth home. A 6cm aneurysm in her aorta was rup­tur­ing and only ur­gent surgery could save her life, but it was fraught with risk, both for her and her un­born child. Do doc­tors de­liver the baby first, or try to save Lan­der’s life and let the baby take its chances?

Usu­ally dur­ing open-heart op­er­a­tions, the pa­tient’s body tem­per­a­ture is cooled to re­duce its de­mand for oxy­gen, but that car­ried an un­ac­cept­able risk to the baby. In a finely judged med­i­cal bal­anc­ing act, the theatre team, led by car­diac sur­geon Alan Kerr, de­cided to keep Lan­der warmer than usual dur­ing the five-hour op­er­a­tion – it would pro­tect the baby but in­crease her risk of brain dam­age.

It was “touch and go”, he says – an ob­stet­ric team was on standby in case the baby needed to be ur­gently de­liv­ered by cae­sarean sec­tion. “It was a very ma­jor op­er­a­tion at the best of times, even in non-preg­nant pa­tients. We caught it just at the time of rup­ture.”

Kerr re­paired Lan­der’s aneurysm with a dacron graft, and re­placed her fail­ing aor­tic valve with a pros­the­sis. Twelve hours later, baby Jeremy was de­liv­ered in a planned cae­sarean. The op­er­a­tion made news­pa­per head­lines at the time, but Kerr says the drama con­tin­ued be­hind the scenes when Lan­der de­vel­oped sep­ti­caemia and both the graft and pros­thetic valve had to be re­placed. The new valve was this time a ho­mo­graft – a valve from a hu­man donor that was ex­pected to give her 10-15 years of good func­tion be­fore it de­te­ri­o­rated.

Lan­der was in hospi­tal for about three months, but her recovery was ul­ti­mately suc­cess­ful. She raised Jeremy – now a chef in Perth – and worked as a care­giver, gar­dener and house­keeper. By March this year, how­ever, Lan­der was again gravely ill, and was ad­mit­ted to Taranaki Base Hospi­tal in se­ri­ous heart fail­ure. Her clin­i­cal notes recorded that she was so short of breath she could

walk only three steps, had gained 15kg of fluid in two months, and had to sleep propped up by pil­lows. Her 1987 ho­mo­graft re­pair was men­tioned in her notes, but there was no sug­ges­tion that the now 30-year-old valve must have al­most com­pletely dis­in­te­grated. Lan­der was treated with drugs for her heart fail­ure, ini­tially re­sponded well and was dis­charged. The re­al­ity was, though, that with­out surgery, Lan­der could not re­cover. Within weeks, her con­di­tion be­gan to de­te­ri­o­rate once more as her heart fail­ure wors­ened and she de­vel­oped cel­luli­tis in one leg. For Hez Lan­der, the de­cline of her younger adopted sis­ter was cruel to see. “It was al­most like she was drown­ing in fluid. She was turn­ing blue from lack of oxy­gen and she could hardly breathe. She was so sick I thought she was go­ing to die.”

CRU­CIAL EMAIL

Months ear­lier, Donna and Hez had be­come aware of a Lis­tener story from Septem­ber 2017, in which we’d writ­ten about Alan Kerr and his car­di­ol­o­gist son An­drew, who’d both de­voted their ca­reers to the pub­lic health sys­tem and had never worked in pri­vate. The story marked the open­ing of an ex­hi­bi­tion, Brave Hearts, to hon­our the coun­try’s trail­blaz­ing history in car­diac care.

On April 12, Hez emailed the Lis­tener: “Is there a way I can con­tact Alan Kerr, the now re­tired sur­geon about whom Donna Chisholm wrote in 2017? He saved my sis­ter and her son’s lives in 1987, her sur­vival mak­ing the NZ Her­ald, and I’d like to thank him. My sis­ter (also named Donna) is pretty sick right now but that served to re­mind me how grate­ful we all are … 30 healthy years be­cause of Alan’s skill.”

Hez says she wasn’t writ­ing to ask for Kerr’s help – she thought it was way too late for that. Donna had sent her a copy of the story in Novem­ber 2017, but in April, when she saw that her sis­ter was dy­ing, Hez says she felt the urge to let Kerr know how thank­ful they were for the ex­tra time she’d had, be­cause of his skill. That three-sen­tence email was to save her sis­ter’s life for a sec­ond time.

Af­ter the Lis­tener for­warded the mes­sage to Kerr, now 83 and re­tired for a num­ber of years, he sought more de­tails of Donna Lan­der’s case from Hez, then asked for her med­i­cal notes from Green Lane’s com­put­erised data­base – ini­tially, he didn’t recog­nise the name. In July 1987, Lan­der had been ad­mit­ted un­der her mar­ried name, Hogg. She re­verted to her maiden name af­ter her mar­riage broke up when Jeremy was a teenager.

She was so short of breath she could walk only three steps, had gained 15kg of fluid in two months and had to sleep propped up by pil­lows.

“When peo­ple do write to thank me, I quite like to have some mem­ory of what they are thank­ing me for,” says Kerr. “When I first got her email, I was tempted to just write back and say, ‘Thank you very much, it’s very nice to hear these things and I hope she re­cov­ers.’” But he says he had a sus­pi­cion “there was some­thing else go­ing on”.

When Kerr read her 30-year-old hospi­tal notes the fol­low­ing week­end, he re­alised in­stantly that it was likely her ho­mo­graft was the cause of her heart fail­ure. “I was just glad I had this sus­pi­cion.”

Renowned New Zealand heart sur­geon Sir Brian Bar­ratt-Boyes pi­o­neered the use of ho­mo­grafts in 1962, but they fell out of favour in later years be­cause of the dif­fi­culty in re­plac­ing them, and fi­nally be­came ob­so­lete as im­proved ver­sions of ar­ti­fi­cial valves be­came avail­able. Very few have lasted for as long as 30 years. Kerr says it also be­came ap­par­ent that the Taranaki doc­tors did not have Lan­der’s full med­i­cal history, be­cause they didn’t have ac­cess to the Green Lane records.

On April 21, he emailed New Ply­mouth car­di­ol­o­gist Ian Ternouth – who hadn’t treated Lan­der dur­ing her March ad­mis­sion be­cause she’d been in a gen­eral med­i­cal ward – and told him he strongly sus­pected her con­di­tion was not the re­sult of a “slight nar­row­ing” in the valve that was di­ag­nosed af­ter an echocar­dio­gram test, but of a sig­nif­i­cant leak in the ho­mo­graft that was prob­a­bly no longer func­tion­ing at all.

Kerr said Lan­der could be a can­di­date for a pro­ce­dure known as tran­scatheter aor­tic valve im­plan­ta­tion (TAVI), in which a new ar­ti­fi­cial valve is in­serted through a catheter fed into the heart from the femoral artery. “I just sug­gested it’d be great if he could have a look at her and see what the heck was go­ing on. He latched on to it straight away.”

Within two days, Ternouth had Lan­der read­mit­ted. “Alan said the lady is in trou­ble, so we got the lady in. We got her well enough to lie flat for an an­giogram, and then sent the im­ages to Waikato Hospi­tal.” Scans showed a “mass of fi­brous tis­sue around the valve”, with “chronic re­jec­tion”.

Lan­der’s was such a high-risk case, Waikato re­ferred her to Auck­land City Hospi­tal, where doc­tors had more ex­pe­ri­ence in us­ing the pro­ce­dure on ho­mo­grafts. “Nor­mally the pro­ce­dure is done only if the valve is nar­rowed but isn’t leak­ing, but hers was sig­nif­i­cantly leaky,” Ternouth says.

He told Lan­der the op­er­a­tion was her only hope. “She hates hos­pi­tals, and you don’t blame her. Mul­ti­ple times she said she didn’t want any­thing else done – un­der­stand­ably, she was ter­ri­fied. We don’t like per­suad­ing pa­tients to have a pro­ce­dure, be­cause that’ll be the one that goes hor­ri­bly wrong, but we didn’t have a choice.”

He says if Kerr hadn’t be­come in­volved, Lan­der would prob­a­bly have stayed at home un­til she died.

When the air am­bu­lance ar­rived and Lan­der was be­ing wheeled to the tar­mac, she said she didn’t want to go. Hez says Donna had made her will the day be­fore, and had given up hope. “She was so anoxic [oxy­gen-de­prived] … she said, ‘I’m not go­ing to go, it’s no use, noth­ing can be done.’ I told her if we didn’t get this pro­ce­dure, she would be dead.” On May 14, Donna and Hez Lan­der flew to Auck­land, where Donna had the hour-long pro­ce­dure about a fort­night later, just af­ter her 58th birthday.

Donna Lan­der says she was ini­tially re­luc­tant to have an­other op­er­a­tion be­cause “the first one was so hor­rific”, but the TAVI was “much eas­ier”. How­ever, the op­er­a­tion trig­gered a tem­po­rary toxic delir­ium and she was ad­mit­ted to a men­tal-health unit in Hamil­ton, be­fore re­turn­ing home in late July to live with a birth sis­ter, Sallyann, with whom she was re­united only two years ago. “The op was a suc­cess but the trauma of an­other near-death ex­pe­ri­ence played up with my men­tal state,” she says. A few months on, those mem­o­ries have faded. Af­ter be­ing too ill to walk just a few months ago, Lan­der told the Lis­tener she’s dis­pensed with her walk­ing stick and is now gar­den­ing and cy­cling and has taken up yoga. She hopes to start work again soon. “It’s bet­ter than be­fore – it’s amaz­ing. Mr Kerr is my guardian an­gel.”

Hez Lan­der tries not to dwell on what might have been had she not sent that email, but says if any­one de­served the lucky stars to align, it’s Donna. “If any­one needed it, she did. I doubt many peo­ple would have sur­vived what she has sur­vived. Many peo­ple would have caved in but she is strong and al­ways has been. I have the ut­most ad­mi­ra­tion for her.”

She keeps the fi­nal word for Alan Kerr. “He is the most amaz­ing per­son I’ve ever met – he is not just skilled, but he has in­cred­i­ble com­pas­sion. To me, he is God.”

Kerr laughs off the praise. “I’m just very glad I fol­lowed it up.”

She’s dis­pensed with her walk­ing stick, is now gar­den­ing and cy­cling and has taken up yoga. “It’s bet­ter than be­fore – it’s amaz­ing. Mr Kerr is my guardian an­gel.”

Donna Lan­der, above, and with her sis­ter, Hez, right, pho­tographed by Taranaki free­lancer Glenn Jef­frey, who also took the 1987 pic­ture of Donna, hus­band and baby in Green Lane Hospi­tal for the New Zealand Her­ald. “It was lovely to see her so full of life,” he says.

Alan Kerr, above, and New Ply­mouth car­di­ol­o­gist Ian Ternouth.

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