To the Editor:
Congratulations to Madhuri Mukhopadhyay, MPH, on a superb biographical sketch of Lewis Dexter, MD (Tex Heart Inst J 2001;28:133-6). Dr. Dexter was beloved by students, faculty, and hospital staff for his endearing and engaging manner. His fascination with pulmonary embolism rubbed off on me and led to my clinical investigations and subspecialty career interest in that challenging field.
When I was a 1st-year cardiology fellow, in 1979-1980, Dr. Dexter was the attending physician on the cardiology consult service. One day, he noted that he was short of breath while making rounds and asked his good friend, radiologist Harry Mellins, MD, to obtain a chest X-ray. The diagnosis of pulmonary edema was unequivocal, and Dr. Dexter was quickly admitted to our Coronary Care Unit. As the CCU fellow, I spent many hours with Dr. Dexter as we treated him conservatively for an acute myocardial infarction and post-infarction angina.
At night, the CCU phones were filled with “get well” greetings from his students and friends worldwide. I spoke to most of these callers, who were generally not shy about providing advice from afar on the optimal management of his condition.
The most invasive approach that we debated was the placement of a Swan-Ganz catheter. At that time, emergency coronary angiography was unthinkable. William Grossman, MD, who directed our Cardiac Catheterization Laboratory, was fond of stating definitively that “there is no such thing as an emergency cardiac catheterization.”
I was present when Dr. Dexter coded. By all clinical criteria, he was dead after prolonged resuscitative efforts failed. However, we could not bear the thought of losing him. The cardiac surgery fellow who participated in the decision to try all heroic measures had been a medical student in Dr. Dexter's laboratory. We rushed our dear patient and mentor to the operating room. Dr. Dexter was fortunate because the first of the 2 daily cardiac operative cases had just concluded. Therefore, we were able to “crash” onto bypass.
In addition to the emergency coronary artery bypass grafting (without preoperative angiography) that was performed by John J. Collins, Jr., MD, we were concerned during the code about the adequacy of myocardial protection. Therefore, I was instructed to fetch nifedipine (which was not yet in general use) and to administer the contents of a 10-mg capsule sublingually and buccally while the CABG was being performed.
Miraculously, Dr. Dexter survived this ordeal with no hypoxic brain injury and with minimal myocardial damage. We were able to enjoy his presence and teaching for more than a decade after that dramatic day.