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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.
I have to say that I am having a hard time reading through your posts! Is it perhaps because my husband had the surgery in February? I don't know but it really makes me uncomfortable!
ReplyDeleteI have a lot of respect for your passion for medicine and I am very happy that you are having this great experience!
I thought your husband had lung surgery? Did he have one of these procedures?
ReplyDeleteSydney:
ReplyDeleteWhat an experience you are having...love reading your reflections and insights.
M. Miner
No, he had a thoracotomy with decortication (your hwk to find out what this is!)
ReplyDeleteIt's just that the descriptions make me nervous:)
Really looking forward to your presentation even though I may keep my eyes closed...
Sydney, your reflections are awesome... interesting with great details. You seem so calm as you describe the procedures...how true about your observation on the circulator nurse. I had never thought about the role she would play in setting the tone of the room. I can't wait for your presentation. Remember that you will need to be up here Monday for a quick run through. My best time is after 9:25- 12noon. Let me know what works best for you.
ReplyDeleteThis is your last day to take it all in. I hope that you have enjoyed this experience as much as we have enjoyed reading about it!
After reading through your descriptions I can't help thinking about how fragile and robust the human body can be. We can have a small blood vessel burst and cause death, yet we can saw open a person's body, dirvert the blood from their heart into a machine, patch and fix and tinker, then put them all back together. Crazy.
ReplyDeleteI aminterested in how the heperin and protamine work.
Mrs. Gende - I did my homework! He had a layer of thick, inelastic tissue on the outside of his lung or lungs? In the decortication, they removed this layer to allow the lungs to fully inflate?
ReplyDeleteMrs. O'Rear - I can come in anytime. Maybe plan for 10:30?
Coach Savage - Heparin actually works through enzyme inhibition. It binds to antithrombin (an enzyme inhibitor) and activates it, which then inactivates thrombin. Thrombin, as you taught us, is necessary in clotting. So heparin doesn't break up already formed clots, it just keeps new ones from forming.
Protamine also relates to what we learned this year in biology. Originally extracted from shark sperm, it is now made by recombinant DNA technology. On its own, protamine has little effect, but when it binds to heparin, it forms a stable ionic pair which reverses the anticoagulant effect.