In the hand of the heart doctor

She searched for him. She dreamed of him. She trusted Dr. Gary Haas to save her son’s life. And he did. But last month, along a remote Texas road, no one could save his.

Time after time, he took a tiny, broken, brand-new heart — small as a golf ball, veins thin as thread — and made it strong.

Time after time, his hands, stiff after six, seven, eight hours of surgery, calmed a waiting, worrying mother exhausted by grief and dread.

Time after time, on hundreds of common days, the children’s heart surgeon created uncommon second chances. Routine miracles from his soft, skilled hands.

A baby from Wellington. A boy from Zephyrhills. A girl from London.

But there are no more miracles.

On Aug. 15, as the sun set on a deserted Texas two-lane east of Lubbock, there were no hands skilled enough to save Tampa’s Dr. Gary Haas.

No more miracles. Just a legacy.

***

No woman can prepare for the news: There are problems with your baby’s heart. Big problems.

Susan Thomas found that out in 1986 when her second son, Nathaniel, was born with a blocked aortic valve. Heart failure and severe lung congestion at two days old.

In one of the first such operations in the country, doctors at Shands Children’s Hospital in Gainesville saved baby Nathaniel by using a tiny balloon to open his valve. But the surgery was only a temporary fix, and for the past 14 years, Susan watched her athletic, vibrant boy grow up, knowing that one day, he would outgrow that valve.

One day came in May.

Susan, an elementary school computer specialist in Zephyrhills, about 30 miles northeast of Tampa, dreaded having to replace her mother’s fears with hard facts. But it was time.

Dr. Benjamin Victorica, the pediatric cardiologist who had helped save the newborn Nathaniel, delivered the news to Susan, her husband, David, and oldest son, Travis, with uncharacteristic firmness: We need to replace the main pumping valve of Nathaniel’s heart in the tricky, complicated surgery known as the Ross Procedure.

Susan’s e-mail to her family and friends describes the doctor’s urgency:

May 2000

After the exam, Dr. Victorica stood stoically before us . . . and let us know that time is up. We discussed the technical terms and the changes in Nathaniel’s heart, which I understood more clearly than ever. There is no more waiting to see what, who, when, why, and certainly no more ifs. When I asked, WHEN?, he twitched that right jaw in a downward motion, like he does when he’s being very serious . . . and said firmly, “Now.”

We discussed surgeons, and I think there will be a problem. My biggest disappointment was that he didn’t give me a name for the guy who does the best Ross Procedures. I just wanted that name . . He mentioned a great surgeon in Tampa, at St. Joe’s, but he does not know how many RPs he has even done. As we talked further about choice of surgeons, he nodded and said, “but don’t spend a lot of time choosing. Find one you like and the first opening . . . TAKE IT!’

In other words, I have a lot of IMMEDIATE work to do!!!

Susan

***

For years, St. Joe’s was known only for patching up NFL players because it was the closest emergency room to Tampa Stadium. But that changed in 1993 when the hospital bought neighboring Women’s Hospital and set out to make a name for its Tampa Children’s Hospital at St. Joseph’s.

To do that, it needed a visionary pediatric heart surgeon, a star whose brilliance would build business.

If that doctor could be found in the shallow talent pool of about 50 such surgeons, it’d be expensive. At least $250,000 to $300,000 plus benefits and bonus for starters. St. Joe’s resident renowned adult heart surgeon, Dr.

Dennis Pupello, found Dr. Gary Haas, a pediatric heart surgeon in San Francisco. Haas was a number-two man who wanted to run his own unit.

“The negotiations with Gary were atypical of my negotiations with any other doctor,” recalls Michael Aubin, the hospital’s chief operating officer.

“We spent almost no time on how much money he would make but more time about the program, the kind of people we’d recruit to work in the program, how the unit would work with the patients.”

Haas seemed too good to be true.

His medical pedigree included residency at respected Massachusetts General and the UCLA Medical Center. He’d served a fellowship at Children’s

Hospital of Philadelphia, which rivaled Boston’s Children’s Hospital as the country’s best. He had taught surgery at UCLA and California State University at

San Francisco.

The big man with a full-moon face and gentle demeanor spoke softly — with words and with his blue eyes.

But, as Aubin quickly realized, Haas was as shrewd as he was sympathetic. He had worked in enough big-time hospitals to know how lethal the mix of egos and politics could be for patients.

“He had this dream of a patient being able to come into one unit and flow through the whole program and have continuity of care with one team and not be shuffled off from this unit to that unit,” Aubin says.

Haas wasn’t interested in a title or the preferred tee times that went with it. He wanted to pick the players on his pediatric heart surgery team of 50. And he wanted written guarantees that St. Joe’s was committed to building a world-class unit.

He got it. Haas signed on as medical director of Tampa Children’s Heart Center at St. Joseph’s in 1995. He brought along his wife, Heidi Hess, a nurse practitioner, who worked with him, and his teenaged kids from a previous marriage, Granville and Korianne.

And, right off, he stunned everyone. The man who could afford a trophy home facing Tampa Bay instead bought a nondescript house on the Hillsborough River minutes from the hospital.

He had work to do.

The year before he arrived, Tampa Children’s handled 26 pediatric heart surgery cases. Haas cruised past 150 in his first year. It will be 400-plus this year. Today, Tampa Children’s is Florida’s largest pediatric surgery center.

“Nobody, nobody. . . nobody could outwork Gary,” says Aubin,

“Nobody. If you tried, you would fail.”

Haas had a master plan to link Tampa Children’s to top pediatric hospitals in St. Petersburg, Gainesville, Orlando and Jacksonville. Because the number of patients would allow for the hiring of the top talent, this world—class consortium would be able to routinely treat the most complicated congenital heart problems.

Haas could have done it, says Dr. Jay Fricker, chief of cardiology at Shands Children’s Hospital in Gainesville.

“I’ve been in the business for 25 years, and I think there were two

or three surgeons that I’ve worked with who were as good as Gary Haas.”

Operating on an infant’s heart is the most difficult surgery, and that’s where Haas made his name.

“Gary Haas,” continues Fricker, “was about as innovative a pediatric cardiovascular surgeon as I’ve ever seen.”

***

Susan Thomas spent five hours a night for two weeks searching every crack and crevice of the Internet to learn about the Ross Procedure. She e-mailed top heart doctors for advice. She was in a perpetual state of controlled panic: She quickly had to make the biggest decision of her life: Who should operate on Nathaniel?

She wouldn’t consider any surgeon who hadn’t done at least 100 Ross Procedures, and she was ready to take Nathaniel to the University of Oklahoma or New York City — anywhere — to find the best surgeon.

She ended up finding him 30 miles from home.

Susan’s e-mail, May 15, 2000:

Looks like all the work I did paid off. Today we found our surgeon. Had I not studied, who knows, I might not be convinced right this minute . . . it would’ve sounded like Star Wars stuff.

But it was too easy!!!! I am exhilarated. Gary Haas has done about 100 Ross Procedures . . . This is the greatest relief . . . This guy made it all seem easy. We were with him about an hour. He was not even persuasive, just sincerely confident. His answers to my questions were perfect. He is the most focused, well-balanced individual I have ever met . . .

He had David and I laughing a few times at precisely the time we needed the break from seriousness . . . and he is VERY very experienced. All the numbers, calculations, and techniques I have studied so dutifully have been thrown to the wind now. This man will take care of our son’s heart . . .

David and I are absolutely giddy tonight . . . The surgery will be in June, right in Tampa at St. Joe’s.

***

Every mother with a desperately sick child recalls the same feeling after her meeting with Dr. Gary Haas: Relief. Pure, blessed relief.

His soft voice. His blue eyes. His total attention. He left parents with an instant, unshakable belief when he quietly reassured them: “Everything’s going to be OK.”

“He had a calming effect,” says Aubin. “You had to see him talk to someone. As intense as Gary could be sometimes, you’d see this big, gentle man reassuring a family that things were going to be OK.”

Susan Thomas put so much trust in Haas that she began to dream about his hands. She pictured him saving Nathaniel. She couldn’t get him out of her mind.

“I formed such a tight attachment to him,” she says, “because you have to understand. Nathaniel is the apple of my eye.”

And, of course, you understand. Every parent understands.

That’s why no parent cared when Haas ran around all day in his scrubs, usually stained with coffee or doughnut powder or Diet Coke. No parent of a sick child cares about clothes.

“He’d look like the guy who just came off 20 hours of surgery sometimes,” recalls Aubin. “Sweaty and grubby. He was sloppy. He’d spill his coffee or his soda and you’d just go, ’Gary, Gary, you’ve got to go see the parents. You need a nice jacket. Put on the white one.’ He was oblivious to that, it just didn’t matter.”

All that mattered was the kids. His own kids. Susan’s kids. Anyone’s kids.

Jim Paul, a supervisor of Tampa Children’s echo cardiography lab, tells you how much Gary loved kids.

Four-and-a-half years ago, Haas recruited Paul from Philadelphia and threw him a welcoming party. Paul’s son, Matthew, who is autistic, was then 3.

“Most people don’t want to be around kids with autism, they do funny, weird things,” Paul says. But at the party, his new boss made a point of playing with Matthew. He was the only grown-up who did.

“Gary was the only person who took the time. He came to work the next day and said, ’Your son’s so cute.’ ”

As Paul remembers the story, he starts to cry: “I can’t tell you how that made me feel. No one ever wants to be around my son.”

Paul’s loyalty to Haas locked in at that moment, and it soon grew to friendship and a shared passion for music, especially the guitar.

“It bothered Gary,” says Paul with a big smile, “that he couldn’t be Stevie Ray Vaughan.”

Haas always seemed to have a guitar nearby, including the on-call room at the hospital. He loved to play but was too shy for an audience. Paul finally coaxed Haas to get out his guitar and play at an office Christmas party, and everyone was stunned at his talent. But Haas discounted his ability. “He’d say, ’I’ll never be as good as Stevie Ray, damn,’ ” says Paul.

Early this summer, Paul took his own guitar over to Haas’ house and banged on the door. There was no answer but music was pounding from inside.

Paul walked around back and there was Haas, “in his boxers with his guitar and amp wailing away. Pat Benatar was on. He was learning a new song.”

Haas loved learning anything that could be analyzed, says Paul. “He’d dissect a song, take it apart and put it back together just like he would a heart.”

“Gary was big,” says Aubin, “and he did everything big. He would go buy bagels for the staff. There would be four people on, he would buy five dozen bagels. And then he’d be inviting people from the next unit over. Send Gary to Checkers, he’d get the biggest. If you saw Gary with a drink, it was the biggest drink that could possibly be sold. That was Gary. Big.”

And he expected big things from his surgery team.

“When things went bad, he’d raise his voice,” says Paul, “but then he’d find you later and apologize. He wanted you to emulate him. If he was here at 3 o’clock in the morning, he expected you to be here.”

Adds Aubin, “Gary could rub people the wrong way because he was constantly, constantly pushing for his program. He lived for the program.” The flip side, continues Aubin, is that Haas could be vulnerable.

“Gary would stick to his word even if you stabbed him in the back. Even then, he was just too nice sometimes.”

Haas was never more vulnerable nor more hurt than in 1996 when he and several others were hit with a malpractice suit.

“He was devastated,” recalls Aubin. “He was in disbelief when the parents sued. For him, it was like somebody had cheated him in the worst way. He had given his all, everything he could.”

Baby Anthony was born near Tampa in 1996 with a heart defect that wasn’t diagnosed until he was brought to Tampa Children’s with trouble breathing at two months old. Haas operated on Anthony, but the day after the surgery, the baby suffered a complete cardiopulmonary arrest, the lawsuit claimed.

Seven days after the operation, Anthony developed seizures. The lawsuit charged that neither Haas nor another surgeon was available to operate for more than seven hours after the seizures and the delay left Anthony with brain damage and blindness.

A mediator recommended — and both parties accepted in July 1999 — a $4.2 million settlement that included a trust fund for long-term medical care. Haas’ malpractice insurance provided $500,000 of the settlement amount.

Today, Anthony, who was 4 last month, lives with his parents in Lake Worth. He receives extensive therapy and has regained some sight. He can walk, but he needs a plug in his throat to breathe, a stomach tube to eat, and he has permanent brain damage.

Because it was risky surgery, Haas could have turned down the case. But Haas wouldn’t turn away anyone.

Even the attorney who filed the malpractice suit conceded that Haas “was an exceptionally talented fellow.”

“I know this case is not representative of the results he had,” says Miami attorney Gary Fox. “But even the best of people sometimes make mistakes, and when you’re involved in this kind of field, the mistakes are magnified.”

The lawsuit didn’t change the way Haas approached his work.

“If someone brought him a kid who needed the most complicated surgery that no one else in the world would do,” says Aubin, Haas would do it. Turn down any kid? “Never.”

Haas never doubted his ability. When he told Susan Thomas the words she wanted and needed to hear, he told her the truth: “I have never lost a patient on the table.”

***

Of Susan’s many, many fears, two were prominent: That Nathaniel wouldn’t make it through the intense surgery. Or, that the donor valve used to replace Nathaniel’s weak aortic valve would be rejected by Nathaniel’s body. If that happened, if the valve from the cadaver were rejected, Nathaniel would face a second surgery.

Again, Dr. Haas assuaged her fears in the most surprising way.

Susan’s e-mail to her friends and family explains it all:

Nathaniel went in at 8 a.m. on June 8 and at 2:30, Haas popped out into the waiting area with his surgical garb on, so suddenly it was StarTrek-like, where they beam you into location. So there he was, materialized, in my face, saying “we have a decision to make”. Everyone with us became statues and you could’ve heard a pin drop. Quickly, I was aware of no one but him, and he said rapidly: “He’s still opened up but I’ve done something that I want you to know about first. I looked at his aortic valve, and said, ‘Hey, I can do something with this’. ”

YEAH?

So then he proceeded to say that Nathaniel’s pulmonary valve, which was good and strong, was now in the aortic position, looking beautiful, and that he trimmed and crafted Nathaniel’s OWN defective aortic valve and created a third leaflet with pericardial tissue . . . and THIS way, this WONDERFUL way, meant (no cadaver valve) and Nathaniel’s heart would be all his own, so there’s no worry about rejection. . . . I don’t even remember what I said to him, but I remember glancing once at my brother, Fred, who was beaming at me, smiling . . . (Dr. Haas) left as suddenly as he entered, and David and I fell apart. Whew. What a wonderful thing.

Love, Susan

***

Policemen report traffic accidents with a stark equality.

When you die suddenly on a two-lane road, it doesn’t matter if you pushed pencils for a living or if your hands saved hundreds and hundreds of babies and children.

On the evening of Aug. 15, Haas, 47, was on his way to Arizona to take his son to college. Granville, 19, was driving on a highway north of the tiny town of Dickens, Texas.

The Texas police officer recorded the end of Dr. Gary Haas’ life with five lines on a form:

“Unit 1 was northbound on TX 70. While traveling north, the driver of Unit 1 heard a loud pop noise. The tread had separated from the tire. The driver of Unit 1 lost control of the vehicle, overcorrected to the left and then to the right. Unit 1 then went into a skid and rolled approximately 3 times on its L&T (left and top). The passenger of Unit 1 was ejected. A speed of 80 mph was found on yaw (skid) mark.”

Haas was riding in a black Ford Explorer on Bridgestone/Firestone ATX 15 tires. Exactly one week earlier, Firestone had initiated a recall of 6.5 million of the tires.

Haas, who wasn’t wearing a seat belt, was conscious when paramedics reached him. He told them he was a doctor, that he knew he had serious internal injuries, and he instructed them on what to do. He worked until the end, trying to save his own life. But soon after the emergency flight reached a Lubbock hospital, Haas died. The cause: Blunt trauma to head and torso.

Granville, who wore a seat belt, had cuts and bruises.

On the day Mike Aubin returned from vacation, first thing, 7:30 a.m. Aug. 16, a Wednesday, word hit St. Joe’s that Haas was dead. Aubin gathered himself and went to console the staff.

“And then I went outside and bawled my eyes out,” he says.

Why, why, why wasn’t Gary wearing his seat belt? Aubin’s sure he knows: If Haas was caught up in a conversation, passionately expounding on something, he’d easily forget to put it on.

And why was he on a road off the beaten path? Simple, Aubin says. He must have seen a detour that interested him. That’s the way Gary was: He was just an off-the-beaten path, curious, extraordinary kind of guy.

They held a memorial service for him a few weeks ago, and hundreds of mothers and fathers and babies and toddlers and teenagers showed up.

They all sang “He’s Got the Whole World in His Hands.”

Susan Thomas thinks each of those parents prayed the same thing she prayed: Thank God, thank God, Dr. Haas was there when I needed him. How many other children, how many other parents, won’t have that chance?

They can’t believe he’s gone. Or what a void he’s left.

“It’s not real. Gary went away on vacation and hasn’t come back. It’s just not real,” says Jim Paul. “I still think I’ll see him coming down the hall with two Diet Cokes and saying, ‘Jim, you want one?’”

But in one place, in the operating room, it is real, Paul says, and “we cry sometimes.”

“When I go to the operating room, and he doesn’t show up and he won’t.”

No pediatric heart surgeries were cancelled the day after Gary Haas’ death. That’s the last thing he would have wanted.

Haas’ protege, now his replacement, Dr. Victor Morell, operated the morning he found out.

“But it was very hard to do surgery that morning with tears coming out of your eyes,” recalls Morell.

Susan Thomas still cries, too. And she still dreams of Dr. Haas, the man who fixed her son’s heart so completely that Nathaniel’s back on the golf course, back on the basketball court, back to being a regular kid.

In her dreams, she hears the doctor’s voice, she sees his eyes, she pictures his big, healing hands. “And I get comfort.”

Jim Paul gets comfort from many things. Some are tangible — Tampa Children’s will name a new addition after Haas, and his fellow heart surgeons want to have a procedure Haas invented named for him — and some are intangible, like their love of music.

Two years ago, as Haas headed out for his frequent drive to Orlando for work at Arnold Palmer’s Children’s Hospital, Paul handed his boss a CD and told him to give it a listen. You’ll like it, Gary, he said.

It was Andrea Bocelli’s “Romanza,” and Haas liked it. He loved it. He loved it so much he got a speeding ticket because he kept playing one song over and over and over.

“He was enthralled by it,” Paul says. “He kept hitting repeat on his CD player.”

The song was on the last track: “Time To Say Goodbye.”

Paul Lomartire has been a reporter at the Palm Beach Post since 1989, contributing stories to features, metro and sports. Previous newspaper stops include the Miami News, Wichita Eagle and Tampa Tribune. He has also worked as a longshoreman, shopping mall janitor and various factories. He lives in Tampa with his wife, a cancer research data manager, and their 15-year-old son.