Pushing the limits in surgery

Dr. Emond in 2008 had lured Dr. Kato away from the University of Miami, for his rare expertise in intestinal transplants and so-called ex vivo operations for cancer, in which the surgeon cuts out abdominal organs to get at hard-to-reach tumors, and then sews the organs back in. Most important, Dr. Emond saw in Dr. Kato a willingness to push the limits of what could be done surgically to help patients.

“He brought his culture of innovation,” Dr. Emond said. “And his personal capability, his ability to work for long hours, never quitting, never giving up, no matter how difficult the situation, carrying out operations that many would deem impossible.”

In his first year at Columbia, Dr. Kato and his team operated successfully on a 7-year-old girl, Heather McNamara, whose family had been told by several other hospitals that her abdominal cancer was inoperable. The surgery, which involved removing six organs and then putting them back in, took 23 hours.

More and more patients from around the country, and around the world, began seeking out Dr. Kato for operations that other hospitals could not or would not perform. He had also begun making trips to Venezuela to perform liver transplants for children and teach the procedure to local surgeons, and he created a foundation to help support the work there as well as in other Latin American countries.

As Dr. Kato’s colleagues struggled to save him, a waiting list of surgical patients clung to hopes that he would soon be able to save them.

Gradually, Dr. Pereira said, there were signs of recovery.

“You come in early in the morning to see him,” he said. “The hospital hallways are empty and everybody’s looking at each other, scared and anxious. You go into the intensive care unit dreading bad news, and the team is giving you a sort of hopeful thumbs-up that maybe he’s looking better.”

Dr. Kato spent about a month on a ventilator, and a week on ECMO. Like many people with severe Covid, he was tormented by frightening and vivid hallucinations and delusions. In one, he was arrested at the Battle of Waterloo. In another, he had been deliberately infected with anthrax; only a hospital in Antwerp could save him, but he could not get there. He saw the white light that some people describe after near-death experiences. “I felt like I died,” he said.