How heart surgeon Alan Kerr saved a woman's life twice in three decadesby Donna Chisholm
Renowned heart surgeon Alan Kerr saved Donna Lander’s life in 1987. This year – thanks to a Listener story and a three-line email – he saved her again.
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.”
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.
“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.”
In March 2019, Donna Lander’s son Jeremy Hogg is taking part in a nine-day cycle through Cambodia to raise money for Kiwi heart patients. Details of how to donate to the effort can be found here.
This article was first published in the September 15, 2018 issue of the New Zealand Listener.
The National Party is calling the u-turn on a capital gains tax a massive failure for the Prime Minister.Read more
The TV network is switching things up - again.Read more
The Wall may be speculative fiction, but it feel like it's just round the corner.Read more
If we find that up to 10% of people report insomnia after taking Panadol, does that mean it was a side effect of the drug?Read more
Talk of a capital gains tax hits a particular nerve, but changing the tax system doesn’t always have to be like pulling teeth.Read more
Money worries have set off a wave of populist politics in most Western democracies, but not here. Pattrick Smellie investigates why.Read more