An infant struggles for life, and her only hope is Dr. Gordon Cohen and his surgical team.
"We have to do it right because this is what's going to be keeping her alive," he said.
"Baby Brenda" is Dr. Cohen's first patient today. The nine-month-old has cardiomyopathy, a disease that's completely destroyed her heart.
She needs a transplant, but tiny donor hearts are scarce.
"Frankly if we don't do this soon, she's not going to survive. So either we do this now and bridge her to the transplant or there won't be anything left to do," said Dr. Cohen.
For the past two weeks, Brenda's been confined to a life support machine called extracorporeal membrane oxygenation, or ECMO. It breathes for her and pumps her heart, but it can't keep Brenda alive much longer.
So today Dr. Cohen will give her a temporary experimental heart, the Berlin Heart. There are no other options.
"The issue for the Berlin Heart is you can't stay on ECMO long term, there are too many know complications associated with it," he said. "Prior to the Berlin heart there was really nothing else."
Getting Brenda ready for surgery takes time. Just transporting her down the hall without disturbing ECMO and her blanket of tubes is a delicate process.
The operation will be even trickier. Most heart surgeries in O.R. 12 start at 8:30 a.m., but preparations begin much earlier by a team of experts.
"We have another one of the scrub nurses, you have one to three anesthesiologists, we have two profusionists, another scrub nurse," said Dr. Cohen.
"There's three surgeons, so there's usually two of us doing the operation. So, everyone's who's here should be here. There's nobody who's extraneous to the process."
When the team takes their place at the surgery table, Dr. Cohen always stands on the patient's right side. Next to him is an experienced scrub nurse.
"The scrub nurses know the operations as well as we do, I would argue even better than we do. Because I would say more than half the time I don't even have to ask for an instrument, I just put my hand out and they give me the right thing," said Dr. Cohen.
Together they will race to save baby Brenda's life. It will be tiring, like running a marathon.
"I mean frankly you know we go through a lot of training to become pediatric heart surgeons and we go through a lot of years of practice and we draw about that cumulative knowledge and experience," he said. "So there are a lot of different components to draw upon."
In O.R. 12 the room fills with cardiologists, profusionists, scrub nurses, researchers and surgeons. Few words are spoken as the team preps a nine-month-old baby for surgery.
The sound of Brenda's beating heart breaks the silence. But, it's that machine - ECMO - doing all the pumping. It can't keep her alive much longer.
So, today, Dr. Cohen hopes to buy Brenda time until she can get a transplant. He has just one option left - an artificial device that sits outside the body called the Berlin heart.
"And what the Berlin heart has done is allowed us the opportunity to get patients from their end stage heart failure through the long waiting time into a heart transplant," he said.
Well aware there's no room for error on this day or any day, Dr. Cohen focuses on his patient and tries not to think about Brenda's worried parents in the waiting room, at least not now.
"I try not to think about it that way, I try to think about the operation and I try not to think about, you know, what's on the other end that there's a parent sitting out there waiting to hear, a family out there waiting to hear because I don't want it to impact what I'm doing here," he said.
"I want to be focused on the operation, making sure it gets done correctly. It can be difficult, I mean one time recently actually, my own son got injured and he ended up in the emergency room in Harborview and you know I get a phone call and I'm in the middle of doing an operation, you can't walk out of the operating room, but my own son's in emergency room in Harborview so I had to get through the operation first and put that out of my mind and then I could leave and go and be with my son," he said.
"Fortunately that doesn't come up hardly ever, you know, but it came up, but the patients fine and my son is fine."
Hopefully, baby Brenda will be fine, too.
But, it's a setback when Dr. Cohen sees firsthand the size of her damaged heart.
"This heart is five times what it should be," he said.
Clearly, Brenda needs the Berlin heart.
While it's assembled, Dr. Cohen and the rest of his team spend more than an hour getting Brenda off ECMO and onto another life-support system, a heart lung machine.
"And you'll see the heart slow down and stop. You can see the heart change, it's a different color now it's not pink. It's not beating anymore."
Beeps from the monitor no longer echo in the room. Brenda's heart sits silent. Unmoving, it allows Dr. Cohen to do his work.
This is only the sixth time he's implanted the Berlin Heart into a child. Even so, he's among a handful of surgeons in the country who has the experience to do it.
It was three years ago when a toddler named Angel received the region's first Berlin Heart. Dr. Cohen performed the breakthrough operation and made medical history in the Northwest.
The experimental heart kept Angel alive until he could get a transplant. A month-and-a-half later, he did.
Dr. Cohen successfully completed that surgery, too.
"If we don't do things like that, our patients won't get hearts," he said.
Today he continues to work tirelessly with researchers to perfect the Berlin heart and make it available to kids across the country.
Why is it so important to make sure the FDA approves it?
"When a kid has end stage heart failure so their heart doesn't pump well anymore, they're going to die and there are not a lot of options to get them from the point where their heart is failing and a heart becomes available. And we're all well aware of the fact that there's a shortage of organs," said Dr. Cohen. "So the Berlin Heart offers hope. But we are able to put this in and the patients can actually be on the floor and they can interact with their parents, they can go to the playroom, they can go outside, they can still eat food, they can be healthy, and they can be healthy and they can wait for a heart transplant. "
Baby Brenda's operation began early on a drizzly morning. It is now almost noon. For the past three hours Dr. Gordon Cohen and his team have been on the job -- standing in one place -- focusing on giving their nine month old patient a Berlin Heart.
Finally Dr. Cohen begins attaching the experimental device to his patient.
"We put it into the heart, it comes through the diaphragm and out the abdominal wall. So this valve here functions very much like a mitral valve would.
The artificial heart flutters and then rhythmically pumps blood - and life - through Brenda. It does the work her damaged heart cannot.
"And at the time of the transplant obviously we take the heart out, take this out and put a new heart in," said Dr. Cohen.
Two more hours tick away before the last stitch is made. It seems like a long time, but not to a surgeon who can spend as many as 18 hours in one surgery.
Still, there's no time for a coffee break, Dr. Cohen immediately heads to the waiting room. He doesn't want Brenda's parents to worry one minute longer.
The family doesn't speak English. An interpreter helps Dr. Cohen explain what just happened to their baby.
"And here she's just closed up with staples and those will come out in a few days, the staples won't hurt. And right now she's doing OK," he says.
The surgery is a success, but Brenda isn't out of the woods yet. She still needs a heart transplant. When that time comes, Dr. Cohen will once again be by her side.