© University of Wisconsin- Madison Medical School, Edward Joseph, photographer.

The surgeons repeat this procedure with the vena cava, the large vein that supplies carbon-dioxide-rich blood to the heart. When done, there will be a loop that bypasses the heart and lungs entirely: clear plastic tubes will direct venous blood to the heart-lung machine (pictured in foreground above) instead of the right atrium. After the machine oxygenates it, a second hose will return blood into the aorta, near the heart's output. The aorta will be clamped to prevent blood from entering the heart.

Quickly, please
As the surgeons work patiently, the atmosphere is more calm-before-the-storm discussion than the "clamp, sutures, what's the EKG?" from "ER." Still, one way to pass the time, at least among those on the periphery, is to discuss last night's episode of the emergency room drama.

9:55 The resident continues "harvesting" vein from the leg. A pale pink piece of vein, about the diameter of a soda straw and about 10 inches long, is emerging from the flesh, marked with occasional sutures where branch veins have been sewn shut.

10:10 Amid techno-chatter about recent operations, much of it unintelligibly masked by numbers and initials, the resident starts sewing up the foot-long incision along the inside of the right leg.

10:21 The surgeons place the aortic cannula, and a "point of no return" is passed in the operation. Smith is about to become one of an annual total of 150 bypass patients whose life depends on this team, and on the cartful of tubes, filters and pumps called the heart-lung machine. An operator with 18 years experience is at the controls.

10:25 The aortic cannula is connected, and the surgeon pulls the strands of the "purse strings" closed around it, sealing the joint between plastic and human artery.

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