The turning point: His heart failing, a writer finds cutting-edge medicine in a place where basic care once was hard to come by.

• Author: Martin, Edward

It's dark. I try to move, but I'm wrapped like a mummy in warming blankets. A second ago, it seems, it was daylight and a nurse was asking me my name. Tubes protrude from my right side. They feel like garden hoses. Smaller ones sproud from my arms. One is in the big vein in my neck, the one that bulges when I laugh, except I don't laugh as much as I used to, before my heart began failing. I free my left hand and wave feebly. "You want to know what time it is?" a nurse softly asks. I blink. "Eleven o'clock." It's night? Seven or eight hours must have passed.

For many of them, I learn later, a surgeon with thin gray hair and sharp blue-gray eyes bent over me. They had deflated my lungs, and through a four-inch incision under my right breast he tunneled through my chest. Bypass surgery six years ago had left dense scar tissue. Beyond it lay my motionless heart. "We can fix it," he had told me a few weeks before, "if we can get to it." He would use a tiny camera and lights, long endoscopic scalpels like stainless-steel chopsticks and perhaps the robot they call da Vinci.

They had chilled my body core to about 80 degrees, nearly halting my metabolism. In nature, I would be dying of hypothermia, but here a machine oxygenated and circulated my blood. The surgeon's progress slowed. Though he had pioneered robotic and minimally invasive heart surgery, he had warned me this might happen.

For weeks now, I had bolted awake, dreading that in mid-operation he'd have to switch to a sternotomy. That's how they had opened my chest for the bypass. I had been unconscious, oblivious to the details, but a few years afterward had suited up in a surgical gown and mask to watch a bypass for a story I was writing. I remembered the patient's torso drenched in copper-colored antiseptic. I remembered the soft buzz of the small reciprocating saw as they split his breast-bone and, with a muffled pop, pried it apart and inserted a retractor to hold it open. Doctors in Charlotte said my previous surgery had made it so dangerous they were afraid to crack open my chest again. They didn't consider this less-invasive procedure an option. The clock moved. Before the surgeon had started work, his assistant had told him it looked hopeless.

[ILLUSTRATION OMITTED]

Eleven o'clock. Darkness. Under the blankets, I move the fingers of my left hand like spider legs, inching up my stomach. I feel my navel, my rib cage and, now, the middle of my chest. There's stubble where they shaved it, just in case. My fingers search. No bandages! A tube runs down my throat. I'd laugh if I could.

This is partly about medical technology such as endoscopy, robotics and cryosurgery and partly about W. Randolph Chit-wood Jr., the cardiothoracic surgeon many believe is the best in the world at them. In January, in a hospital in the one-time tobacco town of Greenville, he cut open my heart and sewed a nickel-alloy ring about 1 1/4 inches in diameter around the base of my badly leaking mitral valve so that it again seals between beats. Then, with a probe chilled by argon gas to 130 degrees below zero, he scarred my heart--good scars this time--to block errant electrical impulses that cause atrial fibrillation. That's what, through a stethoscope, had made my heartbeat sound like a stutterer with hiccups. Either eventually would have killed me. Together they were wasting no time. Three days after I woke up, I walked out of the hospital. I went back to work in two weeks.

But this is equally about Greenville, the spot it has come to occupy in the state and national medical landscape and how, 40 years ago, at the mercy of politics, regional rivalry and academic competition, it almost didn't Chitwood's team makes incisions for robotic surgery while, opposite, he studies a 3-D image of the heart. get to appear on that map at all. One turn of events underscores its present status. When I set out to find a surgeon who might be able to fix my heart without the sternotomy, Charlotte doctors referred me to one at Duke University School of Medicine in Durham and another at Cleveland Clinic in Ohio, by reputation the world's best heart hospital. When I contacted them, I found that Chitwood had trained both in Greenville.

When it comes to medicine, Greenville is an unlikely locale for those North Carolinians accustomed to seeking care in larger cities. "It's probably more recognized outside the state than at home," says A1 Delia, a former East Carolina University researcher who's now an economic developer in Kinston. Case in point: He recently received an inquiry from John Paul II Hospital in Krakow, Poland, which was interested in affiliating with the medical school and Pitt County Memorial, its teaching hospital.

More of Chitwood's patients--he has performed 600-plus endoscopic valve...