In the latter part of November 1944, Dr. Blalock said that he was going to have to learn to do the subclavian-artery-to-pulmonary-artery anastomosis (creation of an artificial ductus arteriosus) so that he could perform the procedure on a patient. He wanted to assist me in doing one on a dog and then do one or two with my assistance. He came in as scheduled and assisted. He had often observed when I performed various experimental procedures, but he had not participated in them.
On the day he was scheduled to perform the procedure, he telephoned early in the morning. The condition of the patient on whom he planned to operate was deteriorating so rapidly that he could not delay the procedure. He said I should meet with Elizabeth Sherwood, the general operating room supervisor, to go over the instruments he would need and to provide any laboratory equipment that she didn't have.
I promptly went to see Miss Sherwood, who had not yet heard of Dr. Blalock's plans. She had all the necessary instruments for general surgery, even small instruments for pediatric surgery. For vascular surgery, the only thing she had was bulldog clamps (Serrafines) for the temporary occlusion of blood vessels. I actually had little more. She had a great quantity of all kinds of almost any suture material for almost any surgical procedure, except vascular suturing.
Since vascular suture material was not commercially available, the needles had to be threaded with 5-0 braided, treated silk, which was much finer than horse hair. Each operation required four to six sutures. The needles were 1 1/8 inches long. In performing an end-to-end anastomosis, the needle length could be tolerated because the vessels could be rotated. The needles, however, were too long to maneuver in performance of the end-to-side procedure of subclavian artery to pulmonary artery. Therefore, they were cut to a length of a little less than 1/2 inch, on the eye end. Using a spring-type clothespin to hold this eye end of the needle, a new point was honed on each needle with a fine emery block. Cutting, sharpening, and threading needles had been part of my routine for all the experimental vascular procedures that I had been performing, beginning with the coarctation bypass procedure (see fig. 13). I had to inform Dr. Blalock that he would have to use the same type of suture material I had been using.