CABG Thinking

Recently, in April 2021, following a particularly strenuous camping trip to a very remote part of Australia, which included 8  crossings of the Finke river (which, unusually, had water in at the time) I found I had the very good fortune to be eligible for a CABG (or cabbage as it is pronounced) and was living in a country where I would get one for free – simply because I needed one!

I needed a CABG (in my case basically a heart rebuild) because I was having a deal of difficulty breathing – and had severe mitral valve regurgitation, too. Something to do with my not having won “the genetic lottery” according to my Cardiologist, Dr Angus Baumann.

Me post operative and yet to be ‘woke’

Wikipedia tells us the first Coronary Artery Bypass Graft  (hence CABG) was performed in the United States on May 2, 1960, at the Albert Einstein College of Medicine-Bronx Municipal Hospital Center by a team led by Robert H. Goetz and the thoracic surgeon, Michael Rohman with the assistance of Jordan Haller and Ronald Dee. Much was learned from this brave experiment. And it is that learning – and the ongoing nature  of  learning – that makes the CABG the incredible life-saving medical intervention that it now is. 

Once considered  (in the early 1960’s) as ‘a procedure that can only be guessed at’ it has become one of the most commonly undertaken major surgical procedures. Available in many parts of the world, the consequent several million procedures that followed that brave initial CABG experiment 60 years ago, have been well documented.

The painstaking analysis of the issues, interventions and outcomes thus documented created a data set that has enabled highly motivated and highly skilled cardiac teams around the world to develop protocols and processes that deliver consistent beneficial outcomes.  Whilst the basic process is essentially the same – many cardiac centres around the world have tried new ideas, new techniques, new protocols, new drugs, etc.  Documenting these variations, and the related outcomes, thus the global data set has been constantly enriched – to the extent that it is now possible to follow a necessarily very complex procedure with a very high probability of success.

It was whilst lying there in my ICU bed in Adelaide, after having been ‘walked’ for the first time by the physio team (an apparently vital component of a speedy post-operative recovery – as discovered from the data) that I realised just how BIG a thing the CABG is. By this I mean the CABG process.  

The CABG process was developed by the very people who use it and, to my mind, stems from the deep care they clearly have for their patients. Anaesthesiologists, Surgeons, Doctors, Nurses, Perfusionists, Physiotherapists, Pathologists, Pharmacists, Dieticians, Cleaners and Caterers – and more  – work together as a team to strive for the CABG outcome ; a life saved and effectively re-made. It struck me that this process came from the people who wanted it. It’s a bit the like the Internet in its early days. It wasn’t commanded by some Government. It didn’t stem from the business plan of some company with an eye to ‘delivering shareholder value’.  No. The Internet came from people who thought it would be ‘a good idea’ to enable  people, any people, to readily and cheaply share information. It is much the same with the CABG.

The CABG is a classic example of what can be achieved by sharing information. At its roots it came about because certain humans wanted to help other humans – and had an idea how to.  Fortunately those certain humans – medically trained humans – were smart enough to realise they needed a rich, diverse source of knowledge upon which to build reliable, repeatable process.

Whilst the CABG itself is fiercely complex, it  has a very high yield of positive outcomes.

In post-operative recovery on the Cardiac Ward, and with a bit of time on my hands, I began to think about how the CABG process might be applied to other fierce problems that we face as humanity.  Climate change was the first thing that I could envisage applying CABG thinking to. After all, it is humanity, and indeed all of life on Earth, that will have to contend with the consequences. Taking a CABG approach would remove the emotional component of actions that are deemed necessary by the data.

Homelessness, Domestic Violence and similar wicked problems might also be best addressed through CABG thinking. A move toward data-driven actions and away from opinion-led reactions might be all these wicked problems need to achieve resolutions that would doubtless improve the lot of all humanity.

Now  I’m not suggesting that data  alone is they key – far from it. It is my direct experience that the care expressed by the individual carer, enhanced by the data and process available to them, is what really matters.  We are humans, we are conscious and we know we are all connected and ‘in this thing together’.

Whilst COVID19 continues to challenge us globally – it also reminds us of what we are collectively capable.

For those who, like me are algorithmically afflicted: CABG thinking + Human Care = Goodness