The other night on call I had a harrowing...err interesting experience. I was on overnight call and our upper year resident was busy doing a liver transplant. I was snoozing in my bed after being up til nearly 11 in another case.
My pager goes off, thus I report to the workroom to accept my fate. Appendectomy? SICU patient needing a belly washout?
No. Aortic dissection. Type A. (This means that the patient has high blood pressure and riped a hole in the inner lining of their aorta, the main artery coming out of the heart to supply the body with blood, and the blood forms a second passage between the lining and outer layer of the aorta, which in this patient went from the aortic valve all the way down to the abdominal aorta.
I was shocked. This is an open-heart procedure, and an emergency to boot. The patient was flown in by helicopter. And what'sw more, I've NEVER done a heart before. Cardiac anesthesia is a whole unique ballgame. Something reserved for people with significantly more experience than me. Shit.
It was like my stomach dropped through the floor. Instant nausea. I had someone to help me set up the room, but other than that, it was going to be just me with an attending. A nice one, but just me. I was terrified, to be perfectly honest. I felt completely unready...wronged, in a way, to have my first heart happen this way. THankfully one of the second year residents (the one on pediatric call) was there to help me, but I was scared.
For those of you who may not know, this kind of case involves VERY tight control of blood pressure so the dissection doesn't burst. It requres the placement of an arterial line (like an IV in the artery of the wrist), central line and pulmonary artery catheter (HUGE IV in the jugular vein, then thread a catheter all the way down through the heart into the big arteries of the lungs), intubation of course. Then there's cardipulmonary bypass where you put the patient on the heart-lung machine, deep hypothermic circulatory arrest where the patient is cooled down to 18 degrees celsius and you stop all the blood from flowing, while packing the head in ice.
Holy. Cow.
But you know what? I did it! I got all my lines on the first try (with support) and my patient did well. She survived and made it to rehab.
I guess I have mixed feelings about this. I feel like I wasn't ready and I stand by that feeling. I wish I had a chance to do non-emergent hearts before doing this one. I wish it hadn't been in the middle of the night. I wish I could have learned more.
Two things I learned from this. I'm not a baby anymore. They'll ask me to do anything and everything, and I have to do it. Period.
And I can survive. Even though they threw something really really hard at me, I made it and so did my patient. And in the end, I guess that's what matters most.
Stay tuned for more work stories. I have some up my sleeve and I need to be a better blogger :P
