I hold his heart in my hand, and squeeze, squeeze, squeeze, trying to maintain a steady rhythm of 100 beats per minute. The heart has lost its own ability to maintain the circulation of blood around the young man's body. With my hand cradling the flaccid muscle, I usurp the life-maintaining contraction. At the head of the table, the anaesthetists scurry about, injecting vile after vile of adrenaline, attempting to jerk the heart back to life. The man is not dead yet but kept in a deep slumber unaware of the struggle and the stress around him.
Fifteen minutes earlier, the youngster had been fully awake to this world. He was brought to casualties slumped over the shoulder of his friend, his gangster brother. It was this 'friend' who had applied the blade, with a smooth, vicious thrust, straight into his left precordium. The blade shattered his 5th rib, plunging into the soft recess of his right ventricle. The knife handler had quickly withdrawn his weapon. Knives cost money and he doesn't have all that much to spare at present.
My hand still cradles the heart, rhythmically squeezing the blood out. By now my hand is cramping but I cannot withdraw. Without an adequate circulation, irreparable damage will occur to the vital organs, including the brain. Then, I feel a slight twitch in my palm, very faint, quite easy to have been my imagination. Then another, stronger now. The man's heart is beating again. I let go, and all the theatre staff peer expectantly at the monitors: a normal sinus rhythm. I thank the Lord, we've been given another chance.
With the blood pressure rising, the stab wound to the right ventricle becomes very obvious again: a fountain of red spurts to the roof with every beat. My finger flies to plug the hole. Now the surgeon's skills will be put to their greatest test. While constantly moving and spurting blood, the surgeon needs to place a suture around the hole and tie it gently but firmly. If he handles the heart too much it may revert to a fibrillating rhythm, or cease beating all together yet again. The coronary artery lies just adjacent to the stab wound. Should the surgeon place his suture through this artery or tie it off, the patient will instantly have a major heart attack and a large section of his heart muscle will die off, severely decreasing his chance at life even if we do manage to close the spurting hole.
Downstairs, the young man's attacker paces the corridor. He prays that
the doctors do their job, he's not ready for a murder conviction, just
yet.
Miraculously, years of training and practice pay off, the surgeon places his stitches in the perfect position and the spurting stops. Again, I praise the Lord, this time with tears in my eyes.
Just Wow!!
ReplyDeleteAre you a CT surgery resident, if I may ask?
Also, I just found out that the first successful cardiac surgery was done for a case of stab wound to the right ventricle in Germany in 1896!
Hi Siri B!
ReplyDeleteThanx for your positive comments! I'm a junior general surgery resident. In South Africa we see a lot of trauma though and I've been fortunate enough to be involved with a hand full of stab heart cases. Its not the most complicated of surgeries but certainly very dramatic. And satisfying to the surgeon when it goes well! As the victims are often young and otherwise healthy they make rapid recoveries.
I always like to give them my two cents on what a close shave they've had with death. Patients don't always realise this because they are unconscious during most of the action. I live the the hope that they would bring their lives onto the straight and narrow path and discontinue high risk behaviour. I was reminded again just last night that as a doctor one can only do your job and what happens to the person after you've done your best is in their own hands. I treated a patient who had a sternotomy for a stab chest some years before. He is still a hard drug user. He is younger than I am and has no intention of making anything pf his life.
Oh! That is sad. He probably must not have had many good influences in his life. He might not know that there could be another way of life. Or he could be thinking that this is the easier way out. Don't let one situation dampen your spirit. 'Cause trying to make a change does amount to something. Maybe, one day you will see something positive come out of the efforts you put in. It may just be worth all the trouble you are going through.
ReplyDeleteIn India, the crime rates aren't that high, especially around where I live. In fact, I haven't seen a single case of stab chest. (I know, I shouldn't sound so disappointed, right!)
Keep faith, Dr. Guinevere. My best wishes to you, and I hope that guy turns out for the better.