My 1st Day on the Job

Just to start off, I'm not a very good 21st century learner. It's not my forte. So if you all can just bear with me as I attempt to enter the age of technology, I will try my best!

Today was my first day with Dr. Moore, cardiothorasic surgeon. I met him in his office at the Baylor Heart Hospital of Plano, where he informed me about our surgery for the day. We looked at the patient's imaging, and he walked me through her procedure. After, we drove to the Medical Center of Plano where we first met with his post-op patients. The first was a woman who was 4 days out from an open heart bypass surgery. She was doing well so Dr. Moore removed the wires attached to her heart (implanted during surgery in case she experienced arrythmias and needed an external pacemaker). The next patient was a man who was also 4 days out from the same procedure, however was not doing as well. He had not yet been released from the ICU. Upon reviewing his films, Dr. Moore diagnosed him with non-cardiac pulmonary edema (excess fluid and swelling in the lungs) and prescribed steroids. We then went down to the surgical floor where we went to view one of Dr. Moore's friends performing a bypass surgery. He intended to perform this surgery with the heart still beating, without having to divert the blood to a machine. When we entered the room, the patient was in distress - his blood pressure was skyrocketing. But the anesthesiologist got it back under control and the surgeon could procede. This surgery was performed by removing healthy blood vesseld from the leg and implanting them around the heart so that the cardiac blood supply could be diverted around the blocked vessels. All went well until the doctor put the heart back into place (it had been lifted out of the chest so the backside could be exposed) - the patient began to experience V-Fib (severely abnormal heart rhythm). Just like in Grey's Anatomy, the surgical team charged the paddles and shocked the heart back into normal rhythm. The patient came out just fine. Next Dr. Moore's surgery began. His patient needed to have blockage removed from the right corotid artery, near where the artery branched into the external and internal corotid arteries. During this procedure, Dr. Moore made an incision below the patient's jawline, careful to avoid major nerves. He then exposed the area just above and just below the blockage, restricted bloodflow to the area, and cut the artery. He implanted a stent to divert the blood from this artery to continue blood flow to the brain (though this is helpful in recovery, it is not necessary because the left corotid artery can compensate for blood flow lost from the right corotid artery). Dr. Moore then picked out the blockage and then placed a patch (made from the pericardial tissue of a cow) over the cut artery. The patch is used to keep the artery from collapsing in on itself. This patient also came out fine, with no major complications. We had to watch her for a while because of the high risk of stroke after this surgery.

I really enjoyed my time today with Dr. Moore. It was nice to be able to contrast two different methods of correcting blockage in arteries. On the smaller vessels, like those surrounding the heart, the surgeon cannot just cut into the vessel to remove the blockage, like he can in a larger artery. Tomorrow, Dr. Moore believes we will have both an open heart surgery and another corotid artery procedure. He also hopes later in the week I will be able to meet with a pathologist and look a different cells and cultures underneath microscopes. We will see!