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The Virginian-Pilot
© February 6, 2006

By NICOLE MORGAN, The Virginian-Pilot

Dr. Joseph S. Auteri operates on John Centko, 84, of Chesapeake, who had a heart attack. Auteri said his goal is to treat every patient like he would his own mother. Vicki Cronis / The Virginian-Pilot

PORTSMOUTH — Eleven-year-old Peter Auteri lay still on the operating table, the heart surgeon hovering over him.

The doctor and staff made sure the instruments were ready. They monitored the machines that kept track of the boy’s vital signs. They paid meticulous attention to every aspect of the procedure.

But when Peter left the operating room , he hadn’t undergone a single cut. That’s because his father, Dr. Joseph S. Auteri, was the surgeon, and the procedure was only a drill. Auteri wanted staff at the new Bon Secours Heart Institute ready to handle every detail of a patient’s stay – from arrival to discharge.

Before the Heart Institute opened last fall, they ran through the routine at least nine times before it met the surgeon’s approval.

“Some people have room for error – more wiggle room,” Dr. Auteri said. “Cardiac surgery is unforgiving. You need to do it right, and you need to do it perfectly.”

Auteri, 45, is the medical director of the Heart Institute at Maryview Medical Center. He came here from Arizona to take on the challenge of building a cardiac care program from scratch.

The Heart Institute targets Portsmouth, Suffolk and western Tidewater, all of which have high death rates from cardiovascular disease, according to hospital data. It is a partnership with the Columbia University College of Physicians and Surgeons – a heart program ranked seventh in the nation by U.S. News & World Report.

Nevertheless, Auteri has his work cut out for him. His program has entered the turf of Sentara Healthcare, a hospital system with deep pockets that has one of the leading heart care programs in the nation.

The Sentara system has six hospitals in the region and recently opened a new $29 million , four-story wing at Sentara Virginia Beach General Hospital that houses the Sentara Heart Center , with 46 rooms for cardiac patients. Plans also are on track for Sentara, on Feb. 25 , to open a separate, 324,000 -square-foot building dedicated to cardiac services. The Sentara Heart Hospital will be next to the downtown Sentara Norfolk General Hospital, which offers the region’s only heart transplant program. Sentara also is in the process of buying Obici Hospital in Suffolk.

About three years ago, Sentara opposed Bon Secours’ state application to build a new heart center. Sentara argued that an additional program could draw patients away from its hospitals. Research has shown that patients who undergo operations at hospitals that perform higher numbers of surgeries are more likely to survive .

Bon Secours is an international health care system and has three hospitals in Hampton Roads. Its $16.3 million Heart Institute is about 36,000 square feet , has 17 beds and is loaded with equipment and laboratories.

The space and new equipment are a great start, but that’s not what will lead patients to choose Bon Secours over Sentara, Auteri said. “Bon Secours cannot compete with their checkbook, their ability to buy things.”

The only way to make the venture a success is to strive for nothing less than perfection and to treat patients like family, he said.

Auteri describes himself as “ focused, determined, unwavering.”

“Sometimes that can include being a pain in the neck to deal with,” he said.

He’s on edge because the garage of his home in Suffolk isn’t yet set up like an operating room – every tool in its place and ready to be put in his hand at a moment’s notice.

The Heart Institute is held to no lesser a standard.

It is 8:07 a.m., and Auteri is headed toward the operating room to perform a double bypass.

He pushes through the doors. An assistant helps him out of his coat, embroidered with his name. His well-worn, highly polished white shoes don’t show the slightest scuff.

Warren R. Parker , a 61-year-old Portsmouth resident , lies sedated on the table.

Auteri makes an incision about 2 inches long on Parker’s left thigh and removes a portion of a vein that he’ll later use to help bypass the blocked artery.

Once he is inside Parker’s chest, Auteri moves the light fixture closer and bends his knees for a better view.

He snips the end of the left internal mammary artery, which helps supply the breastbone with blood, then tucks it away in what he calls “a sleeping bag.” The artery will be safely out of the way until Auteri is ready to reroute and connect it to another artery supplying Parker’s heart.

The patient is attached to a machine that keeps his blood oxygenated. “This will become this gentleman’s lifeline,” Auteri says.

To finish the operation, the surgeon must temporarily stop Parker’s heart. There are lots of ways to do that, he says. “But there aren’t many ways to stop it so it wants to start again.”

“Number one, we make it really cold. Number two, we give it lots of potassium.” Soon, Auteri uncovers the heart, a mass of purplish red tissue rocking back and forth.

He measures the artery to determine how much blood can pass through, and he makes sure it doesn’t have any punctures. If a vein is not good enough, Auteri has to go back for a better one. But the one taken from the left thigh is fine.

Several saline ice cubes are poured inside the chest.

“A cold heart is good in the operating room,” Auteri says. The high-pitched beeping from the heart monitor stops. “And there you go,” he says. “A flat line.”

He removes the ice, holds Parker’s flattened heart in his hands and refers to a diagram to remind him where the patient’s blockage is.

By 10:16 , he’s attaching the artery and vein to the heart with a thread that is about the diameter of a strand of hair.

“You’re going to like that, alrighty, Mr. Parker,” Auteri says.

The goal of the surgery is to allow blood to travel freely along a new path, like a car taking a detour to avoid a traffic jam.

Parker should feel a big difference, Auteri says. The blockage was in a large blood vessel – 2 mm in diameter.

By 10:50, blood is allowed to fill Parker’s heart again. He’s off the machine and has a pulse.

Ten minutes later, Auteri closes Parker’s rib cage, and the patient is soon off to the recovery room.

Several days after his surgery, Parker was feeling pain in his chest as he healed. There was some scabbing. But none of that came as a surprise because Auteri had told him exactly what to expect.

“Every little detail, he explained it to me,” Parker said. But beyond medicine, the two just chatted. They talked a lot about football. Auteri knows the game well. He played quarterback for Harvard as an undergraduate.

“He told me he was a New York Jets fan,” Parker said.

It was Parker’s first conversation like that with a doctor. Auteri put him at ease.

Dr. Mehmet Oz , a vice chairman of cardiovascular surgery at Columbia University Medical Center, said communication is Auteri’s forte.

Oz and Auteri lived in the same dorm and played football together at Harvard. Auteri never couched his comments. He identified the problems, did an examination, made a diagnosis and decided what to do, Oz said.

“That’s good for a heart surgeon,” he said. “You need some guys who can get in the trenches and start making some decisions.”

Bon Secours administrators cho se Auteri from a pool of about 50 candidates because he knew how to make people feel comfortable, informed and secure, said Jennifer Boynton Smith , executive director of cardiac and vascular services at the Heart Institute .

Auteri has spent more than a dozen years as a heart surgeon and has done more than 3,000 open-heart surgeries, including 18 at the Bon Secours Heart Institute.

Bon Secours Maryview used to send about 450 patients a year to other facilities for cardiac surgery procedures, Smith said. Now that Auteri has brought his special ties – surgery and top-notch customer care – to Bon Secours, Smith said, the Heart Institute hopes to see 350 cardiac surgery patients a year.

John Centko , 84 , is among the new patients.

From his recovery room, the Chesapeake resident recalled his heart attack. “I went and took the garbage out, and it hit me.”

At first he felt a cold sensation. “It’s like drinking ice water,” he said. That feeling quickly changed. “It was like my whole chest was on fire.”

Centko ended up in Auteri’s office.

“When he grabbed my hand, I knew he was a guy to trust,” Centko said.

Providing that type of service and building relationships is something Auteri learned over time.

He remembers being called to operate on a patient in Arizona who had gone into cardiac arrest. His prognosis was “terrible,” but five days later he went home.

At a follow-up visit, the patient said he felt great. But he had a “funny look on his face,” Auteri said. The man pointed to bruises on his arm and said a nurse had stuck him five times with a needle.

Auteri said he was thinking, “Mister, you have no idea how dead you were.” But that’s not what he said. Instead, he simply apologized for the patient’s discomfort and walked away with a lesson learned.

Patients care about more than just life or death, Auteri said. They want to be treated like human beings. His goal is to treat every patient like he would his own mother.

That matters to patients, he said. “Therefore, we’re going to make it matter to us, too.”

Reach Nicole Morgan at (757) 446-2443 or nicole.morgan@pilotonline.com.

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Bon Secours Hampton Roads Health System is a leading health care organization known for providing care for the whole person with grace and clinical distinction. Bon Secours brings together a network of hospitals, primary care practices, ambulatory care sites and continuing care facilities to provide quality health care services to the residents of Hampton Roads. Bon Secours, which employs more than 4,500, includes: Bon Secours DePaul Medical Center, Bon Secours Maryview Medical Center, Mary Immaculate Hospital, Bon Secours Health Center at Harbour View, Bon Secours Maryview Nursing Care Center and St. Francis Nursing Center.

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