Day 4

This morning I met Dr. Moore at the Baylor Heart Hospital where we dressed for our first surgery - another carotid endarterectomy. I've seen so many of these I feel like I could do it myself! umm not so much, but I did know exactly what Dr. Moore was going to do next this time and I've been able to compare and contrast the three surgeries. Today's surgery had many more complications than either of the other two. The man's carotid was buried very deep into his neck, which caused Dr. Moore to have to cut into a lot of the man's tissue (primarily adipose) and with that came a lot of excess bleeding. Also, he had a history of hypertension in response to anesthesia, so that was a complication that the anesthesiologist was continuously battling. The patient was initially placed under Dr. Moore's care to have a bypass surgery and a maze procedure (to correct atrial fibrillation that has not been receptive to medication) both of which were scheduled for today. However, because he is obese and has a history of heart disease, Dr. Moore suspected he may have blockage in the carotid. WHen this was confirmed with an ultrasound, his original surgeries had to be cancelled and the carotid surgery performed first since stroke is a major possible complication of open heart surgery. His other surgeries will be rescheduled for in about a week. Gonna be honest, I wish I could have seen the maze procedure instead :) Oh well, at least Dr. Moore caught it and the patient avoided major complications.

After the first surgery, we drove to Medical Center of Plano for a bypass surgery. During this surgery, I learned not only about the procedure from Dr. Moore, but also the anesthesiologist. He told me about what his responsibilities were during surgery, showed me how to put in a central line, and gave me a tour of the heart via ultrasound. I also learned about the importance of heparin (keeps blood from clotting, is injected at the beginning of surgery so the incisions don't clot before the surgeon can do major work) and protamine (reverses the heparin, injected at the end of surgery to help with healing). Also, he showed me how the heart-lung machine worked. Tubes from the machine are inserted into the aorta and right atrium. Deoxygenated blood entering the RA is picked up by the tubes and then transported to the machine to be repressurized and oxygenated. It is then pumped into the tube in the aorta to be transported to the body. It was really cool to see the heart almost deflates when the heart-lung machine is turned on - without the blood, the heart just shrivels up. The anesthesiologist was a really nice, informative guy and I really appreciated the time he took to explain everything to me.

I realized today that the tone of the operating room is set not by the surgeon or the anesthesiologist, but by the circulator nurse. This nurse's job is to advocate for the patient, to care for him or her before, during, and after the procedure, and to make sure everything is safe and sterile. If the circulator nurse is tense and uptight, then the entire room reacts to his or her energy in the same way. But if the nurse is relaxed and respectful of everyone, that becomes the tone of the room. Today we were lucky to have two really great circulator nurses. They cranked up the music and talked about fun things while still making sure everything was safe, the counts were right, and the patient was healthy. It really made the atmosphere more enjoyable and everyone felt more relaxed.