Open Heart Surgery

Today, instead of our regular CPE duties (our supervisor is out of town for three days), I got to sit in on open heart surgery. For those in the know about such things, it was a Fontan procedure. The big daddy cardio-thoracic surgeon did it (actually he did part of it - more about that later). The patient came from halfway around the world for the surgery, which is actually the third in a sequence. This was a very chubby two year old, who was very unhappy with the world when wheeled into the OR, but silent shortly thereafter when the anesthetic kicked in.

Two other surgeons started the operation. Because of the past surgeries, there were a lot of adhesions connecting the lungs to the pericardium (at least I think that's what I saw) and they had to dissect them so that big daddy could do his thing. Took them over an hour with the scalpel, electric saw to the sternum, electro-cautery, and various other tools including a zillion clamps and retractors, to get the patient ready.

I'm not squeamish. That's a good thing, because this kind of surgery seems a cross between a butcher shop and plumbing work.

Big daddy surgeon came in after the initial prep work, finished separating out the artery that needed to be re-routed, got the kid on heart-lung bypass, stopped the heart with potassium (never realized how comfortable I'd become with the beep-beep of the heart monitor until it was silent), did the graft with a length of Gore-Tex flex tubing, put in pacemaker leads, reconnected all the appropriate arteries that had been sidetracked to the bypass machinery, and then unclamped. The blood started in to the repaired heart, and it started beating, slowly at first, then faster as the child was warmed up. When he determined that there were no bleeders, big daddy surgeon left the room so the two assistant surgeons could wire the sternum back together and stitch the muscles and skin. Unlike our newborns who undergo open-heart surgery, the patient's chest was big enough to accomodate the heart, even though it was swollen, so they could close her immediately.

Remarkable that the human heart can undergo such manhandling and holes and stitches, and come back, beating stronger than before. This child's future is still uncertain, but may be a lot better than it was before this surgery. It will be a trip to follow the patient in the CICU in a couple of days, and know I've seen that little heart, beating under halogen lights, bravely chugging along.

Metaphors abound.