Calm hands, warm heart of Green Lane's Dr Finucane

WARREN GAMBLE catches up with a former punk rocker now dedicated to repairing tiny hearts - and the reputation of her beloved profession.

In a lift at Green Lane Hospital Kirsten Finucane gets a friendly dressing-down.

"You make sure you're eating properly," says a hospital colleague. "You're looking too skinny."

The country's leading children's heart surgeon admits she has not had much time for meals in the past week. Or much else.

As the public face for the hospital's stored-hearts controversy she has spent long hours fielding a torrent of inquiries from concerned parents and the media.

That is on top of the life-and-death demands of her profession, the minutely skilled repairing of hearts the size of walnuts.

Despite the cancellation of non-urgent treatment this week so staff could deal with the heart library issue, Dr Finucane has been in emergency surgery for four days.

Beyond this there is her own family, psychiatrist husband Greg Finucane, and the demands of three young boys aged 9, 3 and 1, "who always seem to be hungry".

The 40-year-old, who dreamed of being a farmer, played bass guitar in a punk rock band and used to grow faint in operating theatres, handles it all with calm assurance.

In her public statements she has walked a delicate path between admitting the flaws in the systems used to collect the 1350 hearts (many taken without consent), sympathising with parents' distress, and emphasising the library's lifesaving benefits.

Although many of the hearts were taken from dead children long before patient consent was an issue, she does not excuse herself from more recent mistakes.

It was revealed this week that four hearts were taken without consent during the 1990s, and one in 2000, due to processing errors.

"I feel I had a responsibility to make sure this collection of hearts was done properly and I failed in that responsibility within the last few years myself.

"We should have worked out a way that the system had no loopholes.

"We haven't been stealing them intentionally.

"It's definitely been a process of doctors not realising some of these cases slipping through the loopholes."

Dr Finucane acknowledges that in the earlier days of the collection doctors had a more patronising and distant relationship with parents of sick children, which played a part in the lack of consent.

In some cases parents were sent home before their children's operation, and were not present when they died.

But she says it is unfair to use modern-day ethics and cultural sensitivities to judge her predecessors.

Dr Finucane says there are no excuses for the failures, but there are contributing factors, mainly to do with the enemy of all doctors - time.

There is no time to examine a young heart, which can be bypassed only for a limited period during surgery.

The public system's constraints on resources and time had contributed to the more recent mistakes.

"The whole service is working flat tack just to look after live patients.

"Part of the reason this tragedy occurred is just lack of time to really think about it and get the correct processes in place to make sure these hearts weren't taken without consent."

In earlier days surgeons would have no understanding about what congenital defects they were dealing with, let alone being able to fix them, if they did not have access to the heart collection.

Dr Finucane says that despite the increased knowledge today, she would not have been able to learn and improve her skills without the collection.

She would encounter some defects only once in 10 years, and without the ability to examine such rare cases in the library her job would be much harder.

One example of the library's lifesaving advantages was a complex technique called the Norwood operation.

It is performed on babies born with essentially half their heart missing.

In New Zealand, until it was first carried out in 1996, all babies born with the syndrome died.

When the operation began the survival rate was only a third; now due partly to the surgeon's ability to examine the hearts of babies who died in the operation there is a 70 per cent success rate.

"Being able to examine aspects of the repair closely ... means the next baby is more likely to make it through."

Kirsten Finucane tried to stop herself following in the medical footsteps of her late father, John Mercer, a general physician at Green Lane.

As a child she dreamed of being a farmer, at Epsom Girls' Grammar she toyed with the idea of engineering.

But gradually her desire to work with people, to help others, led her to medical school in Auckland.

In her fourth year of training she married fellow student Greg Finucane.

Her first experiences of operating theatres as a student were disastrous.

"Every time I went into theatre I felt faint.

"I would be put on the end of retractors and I would feel faint and I would have to go and sit down.

"It was really humiliating."

But in her sixth year, a stint in a remote Nepal hospital where she was pitched into a hands-on operating role steered her towards surgery.

Her house surgeon years at Palmerston North further encouraged her to use the technical talents in her hands.

On Manawatu nights in the mid-1980s those hands could also be found running over a bass guitar.

With her husband she was part of alternative band The Thin Red Line, a mixture, she says, of punk and folk, and an outfit called The Clear. Staff at Green Lane we told this part of the story to raised their eyebrows at the thought of the clinical director of paediatric cardiac surgery having such a noisy past.

She says her interest in children's heart surgery was inspired and nurtured by Green Lane's senior cardiac surgeon Alan Kerr.

She spent six months of her first year of surgical training working with him, and he first suggested to her father that she should train as a paediatric surgeon at Green Lane.

In the short term now she is concentrating on ensuring the consent processes for the heart collection are watertight, and dealing with the families.

All parents contacted have been distressed; some were angry, some became more philosophical that their child's organs have been used to help others.

She has offered the hospital's apologies and as many details as the parents have wanted, but she is not planning to be involved in any of the handing-back ceremonies.

"You do grieve a lot and if you are there watching families' grief and you have a sense of responsibility it really does hurt."

Longer term, she is already planning to begin training her successor to take the service further.

"I still have these dreams in another 10 to 15 years of buying a lifestyle block and doing a bit of farming."