Thursday, June 18, 2009
A surreal day
Yesterday was one of those surreal days. I found out only a few days ago that my partner was not feeling well and his problem was a serious vascular surgical problem. My gosh, a cardiovascular surgeon just like me who is now suffering from one of the very problems we treat every day!! To make matters crazy my partner asked me if I would operate on him and fix the problem!! After a long discussion we decided he was going to be most comfortable with me as his surgeon as opposed to someone he did not know. Anyways, I successfully operated on my own partner of 20 years yesterday and I am happy and relieved to report he is doing great today . Hope I never have to do that again---it was different. Thanks for following.
Friday, June 5, 2009
Acting on your own without direction can save a life
First off I am sorry for not blogging recently. My 7 followers deserve better of me. It has been a crazy time with graduation season in full swing.You all must understand that I really am still on cloud nine over my daughter's graduation from medical school. I had no idea what a wonderful feeling it was to be the father of a new physician. My Dad told me many years ago that it was a special proud day in his life when I became a physician and I thought he was being kind of sappy at that time. Well I guess now I know what he meant and I must say it really was cool--REALLY cool!!
Now for a new heart-warmed story
It was spring break time 1987. I remember that because my patient was home on spring break from Western Michigan University when he and a few buddies went out for a good time and a few beers in Warren Michigan. They apparently got involved in a little road rage incident on Groesbeck highway and decided to settle the squabble in a little rumble on the side of the road. Unfortunately, as so often happens, somebody invariably gets hurt and the ER gets busy with half drunk kids. My patient, a wrestler at college, was not prepared for the guy he decided to fight that night because he would never have guessed that his opponent was going to stab him in the chest with a six inch swithblade!! To make matters even worse the blade went directly into my patients heart!! It was at that point that the fight stopped and my frat boy was thrown into the car and taken directly to Bi-County hospital ER. With a trail of blood his friends dragged him into the ER screaming that their friend had been stabbed in the heart!!
Well, every ER has a ward secretary and they are
generally responsible for calling people who are needed and usually do so after the ER doctor asks them to call any specialist needed. This night Mrs Poole, without instruction, jumped out of the routine and made the command decision to call me as soon as she saw the injured college student come through the doors. Mrs Poole was a bright women and had been on the job many years. She also knew that I lived only 5 minutes away from Bi-County.
My phone rang at home at 11:30 PM. I had just gone to bed. The kids were all small and very much asleep. I answered the phone immediatly, as I so often did, so as not to awaken the babies.It was Mrs Poole. She said "Come now-Stab wound heart-Come now!!" I jumped out of bed,through on some jeans and a tee-shirt and jumped into my new Jimmy jeep. I hit the Hoover and 696 interchange moments later and turned left onto the service drive without using the required Michigan Left turn-a-round. I was well over the posted speed limit as I turned and thats when I saw the police car in front of me coming out of the Dunkin Donuts. I continued on and in the rearview mirror saw the flashers come on. I pulled over and the police were there in seconds--2 cops--both out of their cruiser. I rolled down my window and said" I am Dr. Caralis--there is a stab to the heart at Bi-County!!". I think they recognized me because it was not long before that I was chief general surgery resident and most cops knew us as the surgeons in the ER at Bi-county. In any case they acted and asked that I follow them to the ER. With flashers and sirens I followed them at 80 MPH to Bi-County. It seemed like no more than 5 minutes had elapsed from the call at home untill I was running into the ER following the drops of blood to the trauma room. I pointed to Mrs. Poole thru the glass window and gave her a thumbs up and mouthed "thank-you".
What happened next was quite surreal. The trauma room was in a state of anxiety and commotion. It was not chaotic, however, as everybody was doing their jobs. The patient had just arrested in front of them and they were in full CPR mode. Endo-tracheal intubation, large bore IV's etc all happening at once. Nobody noticed my entry into the trauma room except one ER nurse who saw me enter and go directly to put on a pair of surgical gloves. The stab wound was obvious to all and was right over the young man's heart. Just as I put on my gloves and grabbed a scalpel, the ER Dr. says very clearly and in a sort of helpless tone "If we just had a damn heart surgeon in this hospital we could actually hope to save this poor kid!!" Well, he had no sooner finished his sentence when I tapped him on the shoulder and said "Hi. I am Dr. Caralis and I am a heart surgeon !!"I will never forget the look of astonishment on that doctor's face or what he said, " IT"S A MIRACLE!!" I proceeded to perform ER anterior thoracotomy and pericardiotomy (opened the chest and the sac around the heart) and suture repaired the stab wound to the patients right ventricle of his heart. I then de-fibrillated the heart and restored normal rhytym and vital signs. I took him to OR and formally explored for other injuries and closed his chest . That young man survived and was discharged home 6 days later.
Mrs. Poole was given a special award by the hospital for her acting on her own without direction and for saving a life. She was voted Employee of the year. The ER doctor was a moonlighting medical resident who became a Cardiologist and practices in Ohio and still believes in miracles and always re-tells this story at conventions. I am still a heart surgeon and still cutting open chests for a living and will continue to do so until it just isn't fun anymore. That was a night I will never forget. It warms my heart just blogging about it. Thanks for following.
Now for a new heart-warmed story
It was spring break time 1987. I remember that because my patient was home on spring break from Western Michigan University when he and a few buddies went out for a good time and a few beers in Warren Michigan. They apparently got involved in a little road rage incident on Groesbeck highway and decided to settle the squabble in a little rumble on the side of the road. Unfortunately, as so often happens, somebody invariably gets hurt and the ER gets busy with half drunk kids. My patient, a wrestler at college, was not prepared for the guy he decided to fight that night because he would never have guessed that his opponent was going to stab him in the chest with a six inch swithblade!! To make matters even worse the blade went directly into my patients heart!! It was at that point that the fight stopped and my frat boy was thrown into the car and taken directly to Bi-County hospital ER. With a trail of blood his friends dragged him into the ER screaming that their friend had been stabbed in the heart!!
Well, every ER has a ward secretary and they are
generally responsible for calling people who are needed and usually do so after the ER doctor asks them to call any specialist needed. This night Mrs Poole, without instruction, jumped out of the routine and made the command decision to call me as soon as she saw the injured college student come through the doors. Mrs Poole was a bright women and had been on the job many years. She also knew that I lived only 5 minutes away from Bi-County.
My phone rang at home at 11:30 PM. I had just gone to bed. The kids were all small and very much asleep. I answered the phone immediatly, as I so often did, so as not to awaken the babies.It was Mrs Poole. She said "Come now-Stab wound heart-Come now!!" I jumped out of bed,through on some jeans and a tee-shirt and jumped into my new Jimmy jeep. I hit the Hoover and 696 interchange moments later and turned left onto the service drive without using the required Michigan Left turn-a-round. I was well over the posted speed limit as I turned and thats when I saw the police car in front of me coming out of the Dunkin Donuts. I continued on and in the rearview mirror saw the flashers come on. I pulled over and the police were there in seconds--2 cops--both out of their cruiser. I rolled down my window and said" I am Dr. Caralis--there is a stab to the heart at Bi-County!!". I think they recognized me because it was not long before that I was chief general surgery resident and most cops knew us as the surgeons in the ER at Bi-county. In any case they acted and asked that I follow them to the ER. With flashers and sirens I followed them at 80 MPH to Bi-County. It seemed like no more than 5 minutes had elapsed from the call at home untill I was running into the ER following the drops of blood to the trauma room. I pointed to Mrs. Poole thru the glass window and gave her a thumbs up and mouthed "thank-you".
What happened next was quite surreal. The trauma room was in a state of anxiety and commotion. It was not chaotic, however, as everybody was doing their jobs. The patient had just arrested in front of them and they were in full CPR mode. Endo-tracheal intubation, large bore IV's etc all happening at once. Nobody noticed my entry into the trauma room except one ER nurse who saw me enter and go directly to put on a pair of surgical gloves. The stab wound was obvious to all and was right over the young man's heart. Just as I put on my gloves and grabbed a scalpel, the ER Dr. says very clearly and in a sort of helpless tone "If we just had a damn heart surgeon in this hospital we could actually hope to save this poor kid!!" Well, he had no sooner finished his sentence when I tapped him on the shoulder and said "Hi. I am Dr. Caralis and I am a heart surgeon !!"I will never forget the look of astonishment on that doctor's face or what he said, " IT"S A MIRACLE!!" I proceeded to perform ER anterior thoracotomy and pericardiotomy (opened the chest and the sac around the heart) and suture repaired the stab wound to the patients right ventricle of his heart. I then de-fibrillated the heart and restored normal rhytym and vital signs. I took him to OR and formally explored for other injuries and closed his chest . That young man survived and was discharged home 6 days later.
Mrs. Poole was given a special award by the hospital for her acting on her own without direction and for saving a life. She was voted Employee of the year. The ER doctor was a moonlighting medical resident who became a Cardiologist and practices in Ohio and still believes in miracles and always re-tells this story at conventions. I am still a heart surgeon and still cutting open chests for a living and will continue to do so until it just isn't fun anymore. That was a night I will never forget. It warms my heart just blogging about it. Thanks for following.
Monday, April 13, 2009
Trusting your own instincts
As a young physician it is nearly impossible to trust your own instincts. This,I assume, stems from the fact that you are always surrounded by other physicians with more experience than yourself. It is natural to assume that those around you are right and you are wrong. This changes over time and eventually you become the experienced doctor, and then you must fight the assumption that those young people around you know nothing and your instincts are the correct ones. It would be nice in medicine if people could make decisions in a way that would not belittle the young and inexperienced but it many times just does not work that way. One of those times was many moons ago in South Chicago .
I was a med student early in my 4th year. I was on my first Obstetrics rotation at the Chicago Osteopathic Hospital. It was a sweltering hot summer night in the ghetto of South Chicago. Our patients came to deliver their babies after virtually no pre-natal care. It was a continuous stream of vaginal deliveries this night and the routine was for the med students to admit the pregnant patients. Our intern was supposed to help verify that what we said in our exam was correct. The resident on call was basically there to take care of "problem situations" and C-sections if needed. The intern was a guy named Abe and he made no bones about the fact that he did not like OB and that he only cared about getting thru to morning without any catastrophes. The resident that night was a guy named Rocco. He made it clear that his ass was not interested in normal vaginal deliveries and that he was very interested in laying down all 300lbs in the call room for a long summer siesta. There would be hell to pay if some dumb ass med student woke him up for no "good" reason. This is where it got interesting!!
I admitted a 27 year old patient who was clearly in premature labor at 36 weeks gestation. She was accompanied by her auntie as so many of our patients were. As usual there was no father present and also as usual she had not seen a OB/GYN physician during her pregnancy. On vaginal exam and on abdominal exam it appeared to me that the patient was in labor and that she was very large for her 36 weeks. It also seemed to me that there were 2 babies in her uterus!! My instincts told me that there was one head in the cervix and one head in the patients upper abdominal area. The auntie told me there was a strong history of twins in the family. I immediately told Abe the intern of my diagnosis of twins and asked him to wake up Rocco. He examined the patient and told me that my exam was in error and my reasoning was flawed. He said that he made the same error before and that the firm mass in the upper abdomen was the butt of the baby and not the head of a second baby. What did I know. He was more experienced and he must be right. Afterall, I was just a med student. I explained to Abe that I still thought intinctively that this women was carrying twins and that it was the only diagnosis that was consistent with the physical exam and history of this patient. I did not tell him that I thought I had way better instincts for clinical medicine than he would ever have--- but I thought it! I certainly did not go out of the chain of command and wake up the feared Rocco.
Well the night progressed and in what seemed like an avalanche of babies my "twins" got to the delivery room at about 3 AM. Abe was doing the delivery and I was in the delivery as an assistant. All went well and once the baby was out Abe starts to deliver the placenta--gentle traction ever so carefully so as to not rip the placenta, just like we had been taught. At this point I am starting to relax because clearly Abe was right and there were no signs of a second baby. He is feeling all cool and again explains to me how easy it is to think there are twins when there are not and that I should not get down on myself for being wrong. He proceeds to tell me that as I get more experienced I will get a better "feel" for the Obstetric patient. Just then at the exact moment he was delivering the last of the placenta we both saw it. We saw ever so clearly and ever so sadly the tiny right hand of the SECOND baby. Well all shit hit the fan!! Abe starts screaming--GET ROCCO!! Get ROCCO!! The patient wants to know "whats wrong, whats wrong" and I am immediately feeling sick that I did not have the convictions of my instincts.
Rocco came screaming into the room to basically deliver the second baby with the hand presentation by turning it into a breech(foot first) delivery and pronouncing the baby dead. Once the placenta had been delivered by Abe the baby was without oxygen for at least 10 minutes.
It was that case that taught me to trust MY instincts and not those of others. Common sense is not all that common and if God has gifted you with great instincts you should never ignore that which makes good sense. I was told by many physicians that I had natural instincts for Obstetrics and I am sure that it is this heart warmed story that convinced even me. Conviction of my instincts has served me very well through the years as a CV surgeon and I am sure it would have served me equally well if I had persued my first love--OB/GYN.
I was a med student early in my 4th year. I was on my first Obstetrics rotation at the Chicago Osteopathic Hospital. It was a sweltering hot summer night in the ghetto of South Chicago. Our patients came to deliver their babies after virtually no pre-natal care. It was a continuous stream of vaginal deliveries this night and the routine was for the med students to admit the pregnant patients. Our intern was supposed to help verify that what we said in our exam was correct. The resident on call was basically there to take care of "problem situations" and C-sections if needed. The intern was a guy named Abe and he made no bones about the fact that he did not like OB and that he only cared about getting thru to morning without any catastrophes. The resident that night was a guy named Rocco. He made it clear that his ass was not interested in normal vaginal deliveries and that he was very interested in laying down all 300lbs in the call room for a long summer siesta. There would be hell to pay if some dumb ass med student woke him up for no "good" reason. This is where it got interesting!!
I admitted a 27 year old patient who was clearly in premature labor at 36 weeks gestation. She was accompanied by her auntie as so many of our patients were. As usual there was no father present and also as usual she had not seen a OB/GYN physician during her pregnancy. On vaginal exam and on abdominal exam it appeared to me that the patient was in labor and that she was very large for her 36 weeks. It also seemed to me that there were 2 babies in her uterus!! My instincts told me that there was one head in the cervix and one head in the patients upper abdominal area. The auntie told me there was a strong history of twins in the family. I immediately told Abe the intern of my diagnosis of twins and asked him to wake up Rocco. He examined the patient and told me that my exam was in error and my reasoning was flawed. He said that he made the same error before and that the firm mass in the upper abdomen was the butt of the baby and not the head of a second baby. What did I know. He was more experienced and he must be right. Afterall, I was just a med student. I explained to Abe that I still thought intinctively that this women was carrying twins and that it was the only diagnosis that was consistent with the physical exam and history of this patient. I did not tell him that I thought I had way better instincts for clinical medicine than he would ever have--- but I thought it! I certainly did not go out of the chain of command and wake up the feared Rocco.
Well the night progressed and in what seemed like an avalanche of babies my "twins" got to the delivery room at about 3 AM. Abe was doing the delivery and I was in the delivery as an assistant. All went well and once the baby was out Abe starts to deliver the placenta--gentle traction ever so carefully so as to not rip the placenta, just like we had been taught. At this point I am starting to relax because clearly Abe was right and there were no signs of a second baby. He is feeling all cool and again explains to me how easy it is to think there are twins when there are not and that I should not get down on myself for being wrong. He proceeds to tell me that as I get more experienced I will get a better "feel" for the Obstetric patient. Just then at the exact moment he was delivering the last of the placenta we both saw it. We saw ever so clearly and ever so sadly the tiny right hand of the SECOND baby. Well all shit hit the fan!! Abe starts screaming--GET ROCCO!! Get ROCCO!! The patient wants to know "whats wrong, whats wrong" and I am immediately feeling sick that I did not have the convictions of my instincts.
Rocco came screaming into the room to basically deliver the second baby with the hand presentation by turning it into a breech(foot first) delivery and pronouncing the baby dead. Once the placenta had been delivered by Abe the baby was without oxygen for at least 10 minutes.
It was that case that taught me to trust MY instincts and not those of others. Common sense is not all that common and if God has gifted you with great instincts you should never ignore that which makes good sense. I was told by many physicians that I had natural instincts for Obstetrics and I am sure that it is this heart warmed story that convinced even me. Conviction of my instincts has served me very well through the years as a CV surgeon and I am sure it would have served me equally well if I had persued my first love--OB/GYN.
Wednesday, February 11, 2009
The patient will usually tell you the diagnosis if you just listen.
I guess there have been a million little tips through the years but none better than the one Dr. George Caleel ,in Chicago, gave me more than 30 years ago. He said, " Always walk into the patient exam room drying your hands and dispose of the paper towel in the room so the patient knows you just washed your hands" and always, always listen to the patient when they tell you what they think is wrong with them". He was the smoothest of smooth when it came to bedside diagnosis and was the best at garnering the trust of a patient in the shortest time span of any physician I have ever known.
As far as listening to the patient, I would be remiss if I didn't blog about the story of Shirley Fennington (name altered for Hippa of course). As an intern, the case of Shirley F. was without a doubt the most memorable examples of how important it was to listen. She was a 40 year old woman who had cut her finger at work and had come to the ER 9 days later with an infection in the finger where she had stitches. Her complaint was not her finger--her complaint was that she was having trouble opening her mouth and that she was concerned that she had "lock-jaw". Well, the ER Dr. of course thought she was a kook and sent her home on antibiotics and told her she had TMJ (temporal-mandibular joint ) dysfuntion and recommended she see an oral surgeon. This is where it gets interesting because I was the intern who got to see Shirley when she came back to the ER 3 days later no better and in fact feeling worse and nearly unable to open her mouth altogether. I reviewed her ER record from 3 days previously and saw her complaint about her thinking she was suffering from "lock-jaw". I asked her what she thought was wrong and with Dr. Caleel in my brain I listened to her. She again said ,and now with more difficulty, "I think I have lock-jaw". I called my attending internist, Dr. Dennis Packey, and told him we needed to urgently admit the patient and entertain the diagnosis of acute endotoxicity from clostridium tetanus ie Lock-jaw. Well you would have thought I had insulted his mother. He was all over this poor little intern and wanted to know where I came up with such a hair-brained bizarre diagnosis and did I know that he had never even seen acute tetanus--especially since EVERYBODY gets immunized with DPT booster shots in this country. I, of course, tell him that my diagnosis was easy and that I got it from the patient when she just told me and I listened and I was trained in Chicago to always listen to the patient. He laughed at me but came anyway to see for himself.
Give Dennis Packey credit because he did not blow Shirley F. off and send her home. No he did not. He admitted her to the floor for work up and cultered her infected finger since she worked in a tanning factory where she was exposed to animal hides on a daily basis. 3 hours later we were called to the floor where Shirley was admitted to a 4 bed ward (dating myself) and she was having trouble breathing and sure enough she was about to have cardiac arrest!! Dennis Packey looks at me and says "Oh shit!! you are right she has tetanus!!" Well the next 3 minutes was a blurr because we obviously could not secure an airway with oral intubation since we could not pry her mouth open and we certainly were not prepared to do a tracheostomy since none of us had the skill or equipment or lighting to do a tracheostomy.
Enter Paul Ruble. Paul responded to the code blue as he was the senior anesthesiology resident. He was told of the problem about the "lock-jaw" so he rather calmly and skillfully performed the first blind naso-tracheal intubation I had ever seen--SUCCESSFULLY! Well! I thought Dennis Packey was gonna kiss him. Once we oxygenated Shirley she promptly got a heart beat and then a pulse and then a blood pressure. She moved to the ICU at DOH hospital where she lived for the next 6 months on the medicine service of Dr. Dennis Packey. The diagnosis of tetanus was confirmed on the cultures of the finger wound with the classic organisms of Clostidium tetanus and the titers of endotoxin were the highest reported to the CDC in over 25 years. It was the only case diagnosed in Michigan in a decade and only the 25th case in the US since WWll. She did survive after about every medical complication including kidney failure. Her jaws , and respiratory muscles started to move at 3 months but it took another 3 months to ween her from the ventilator. She actually walked out of re-hab 8 months after she came in and told me what she had. Dr. Packey one day asked me who trained me in Chicago. I responded that it was Dr. George Caleel and he got a great big smile on his face and responded,"He trained me too!"I have not seen another case of tetanus in 30 years. By the way ,we checked and Shirley F had forged her immunization record at work and had not had her DPT booster because she was afraid of needles!!
As far as listening to the patient, I would be remiss if I didn't blog about the story of Shirley Fennington (name altered for Hippa of course). As an intern, the case of Shirley F. was without a doubt the most memorable examples of how important it was to listen. She was a 40 year old woman who had cut her finger at work and had come to the ER 9 days later with an infection in the finger where she had stitches. Her complaint was not her finger--her complaint was that she was having trouble opening her mouth and that she was concerned that she had "lock-jaw". Well, the ER Dr. of course thought she was a kook and sent her home on antibiotics and told her she had TMJ (temporal-mandibular joint ) dysfuntion and recommended she see an oral surgeon. This is where it gets interesting because I was the intern who got to see Shirley when she came back to the ER 3 days later no better and in fact feeling worse and nearly unable to open her mouth altogether. I reviewed her ER record from 3 days previously and saw her complaint about her thinking she was suffering from "lock-jaw". I asked her what she thought was wrong and with Dr. Caleel in my brain I listened to her. She again said ,and now with more difficulty, "I think I have lock-jaw". I called my attending internist, Dr. Dennis Packey, and told him we needed to urgently admit the patient and entertain the diagnosis of acute endotoxicity from clostridium tetanus ie Lock-jaw. Well you would have thought I had insulted his mother. He was all over this poor little intern and wanted to know where I came up with such a hair-brained bizarre diagnosis and did I know that he had never even seen acute tetanus--especially since EVERYBODY gets immunized with DPT booster shots in this country. I, of course, tell him that my diagnosis was easy and that I got it from the patient when she just told me and I listened and I was trained in Chicago to always listen to the patient. He laughed at me but came anyway to see for himself.
Give Dennis Packey credit because he did not blow Shirley F. off and send her home. No he did not. He admitted her to the floor for work up and cultered her infected finger since she worked in a tanning factory where she was exposed to animal hides on a daily basis. 3 hours later we were called to the floor where Shirley was admitted to a 4 bed ward (dating myself) and she was having trouble breathing and sure enough she was about to have cardiac arrest!! Dennis Packey looks at me and says "Oh shit!! you are right she has tetanus!!" Well the next 3 minutes was a blurr because we obviously could not secure an airway with oral intubation since we could not pry her mouth open and we certainly were not prepared to do a tracheostomy since none of us had the skill or equipment or lighting to do a tracheostomy.
Enter Paul Ruble. Paul responded to the code blue as he was the senior anesthesiology resident. He was told of the problem about the "lock-jaw" so he rather calmly and skillfully performed the first blind naso-tracheal intubation I had ever seen--SUCCESSFULLY! Well! I thought Dennis Packey was gonna kiss him. Once we oxygenated Shirley she promptly got a heart beat and then a pulse and then a blood pressure. She moved to the ICU at DOH hospital where she lived for the next 6 months on the medicine service of Dr. Dennis Packey. The diagnosis of tetanus was confirmed on the cultures of the finger wound with the classic organisms of Clostidium tetanus and the titers of endotoxin were the highest reported to the CDC in over 25 years. It was the only case diagnosed in Michigan in a decade and only the 25th case in the US since WWll. She did survive after about every medical complication including kidney failure. Her jaws , and respiratory muscles started to move at 3 months but it took another 3 months to ween her from the ventilator. She actually walked out of re-hab 8 months after she came in and told me what she had. Dr. Packey one day asked me who trained me in Chicago. I responded that it was Dr. George Caleel and he got a great big smile on his face and responded,"He trained me too!"I have not seen another case of tetanus in 30 years. By the way ,we checked and Shirley F had forged her immunization record at work and had not had her DPT booster because she was afraid of needles!!
Thursday, February 5, 2009
Follow up on my patient
As I promised in my last entry, my patient returned to the office after his successful mini-mitral valve surgery and I am prepared to report on his progress. Most notable was the way he walked in without any concern over movement of his chest. It was quite different to see an open heart patient with such freedom of motion so soon after operation. It was also strange to hear your patient ask if he could go back to work on Monday-16 days after valve repair!! It's all new and cool, indeed. More than anything it was super rewarding to see the echocardiogram that showed his mitral valve with absolutely NO LEAK. There is no question that a new era in valve surgery is upon us. Goodnight and Go Blue.( I just witnessed the defeat of Penn State in Ann Arbor).
Friday, January 23, 2009
very nice day
Not all days in the life of a CV surgeon are all that great. Some are downright dreadful and cause you to think that it has not been worth it. Mostly those days are a result of some dreadful outcome in some patient you were trying desperately to help, and in your attempt to help you end up killing a patient. Not so much fun. Even though you deep down know you meant well and you should feel OK in a few short recovery moments, it really never goes that way and inevitably you really do mope around for days and even weeks, at least inside, where it hurts the most.
But its not one of those days today--no sir! Today has been one of the great days. Today was a very gratifying day, indeed! I performed my first minimally invasive mitral valve repair today and the operation went perfect and the patient is doing great. I hope this does not jinx him.
I started my course work some 3 years ago and have been to Atlanta, Philadelphia, and Toledo to see variations of this operation performed. I never dreamed years ago that I would ever fix a heart valve without splitting someones sternum open. The anxiety over this change in approach has truly been great and even more than other changes I have experienced over the years. Today was the day to finally do the operation and with over 20 people watching and scores more at my hospital awaiting the result to officially kick off the start of our mimi invasive heart surgery program my team performed perfectly. I am very happy !! It is a wonderful feeling to have succeeded after all the planning, team meetings and dry runs. Oh God it could have been so different if it had not gone well. Hooray for us and it even feels good to blog about it. Have a great night and rest assured I will be smiling. I will keep you informed of my patient's progress. Goodnight moon!
But its not one of those days today--no sir! Today has been one of the great days. Today was a very gratifying day, indeed! I performed my first minimally invasive mitral valve repair today and the operation went perfect and the patient is doing great. I hope this does not jinx him.
I started my course work some 3 years ago and have been to Atlanta, Philadelphia, and Toledo to see variations of this operation performed. I never dreamed years ago that I would ever fix a heart valve without splitting someones sternum open. The anxiety over this change in approach has truly been great and even more than other changes I have experienced over the years. Today was the day to finally do the operation and with over 20 people watching and scores more at my hospital awaiting the result to officially kick off the start of our mimi invasive heart surgery program my team performed perfectly. I am very happy !! It is a wonderful feeling to have succeeded after all the planning, team meetings and dry runs. Oh God it could have been so different if it had not gone well. Hooray for us and it even feels good to blog about it. Have a great night and rest assured I will be smiling. I will keep you informed of my patient's progress. Goodnight moon!
Wednesday, January 14, 2009
One single bullet
One thing that is impossible to do when blogging about past memories is to sort out those memories that have relevance. But clearly, there are some stories that stand out and tonights tale may just have shaped an entire career.
It was a very hot summer night and I was the night intern at a community hospital in Warren Mich. As an intern I did not make the big decisions. Iwas there to get patients through the night so their doctors could make decisions in the AM.
I was hanging in the ER after I finished another history and physical on what seemed like an endless stream of patient admissions. The double ER doors swung open and to our surprise two young men in there early twenty somethings were screaming--"she has been shot, she has been shot-HELP!! HELP!!" Well, now the adrenaline kicks in and we all run out to find the most beautiful young woman lying in the back of a car. She had a bright red blood spot showing through her clothing that was very stylish and otherwise consistent with party attire. She looked to be around 20 years old and had a beautiful gold cross around her neck. We rushed her into the trauma room and immediately started our work-up exam and resuscitation. The GSW(gun shot wound) routine was in full gear as I started to ask the patient historical questions. It was not long before we all noticed that this young woman was NOT doing well. Blood pressure was not holding with large volumes of fluid, heart rate kept increasing, and her abdomen under a single bullet entry wound was rapidly enlarging. This young women was bleeding to death.
The blood bank was notified to send blood, the surgical resident was called and came quickly, and the OR was notified as was the surgeon on call. The surgeon was on his way from his home about 30 minutes away. Our job was to keep giving blood and fluid until the surgeon got there to explore the abdomen and stop what was now obviously a major vascular injury. Easier said than done. The surgical residents and I were losing this battle and with each minute she got more and more pale and to make matters worse kept repeating to us " I am going to die--Please don't let me die " Just as we were whisking her to the OR her father shows up and wants to see his daughter and in his state of shock starts screaming " oh GOD don't let my baby girl die" and then we rush into the OR.
We got her on the OR table, prepped and draped the abdomen and then we waited for the surgeon. We waited and then we waited some more. The feeling of helplessness consumed our emotions to the point that we honestly thought of opening her abdomen ourselves but NONE OF US were adequately trained to fix the problem. We needed the surgeon. Oh God did we ever need a surgeon who could save this girl's life and we needed him NOW!!
The surgeon did come and he tried with all of our help and all the blood we could muster and all the skills he had to save that beautiful young Italian American women and she died that night right in front of us on the OR table from a single 22 caliber bullet directly through her splenic artery. That my friends was when I vowed to train and then train some more so that I would never stand helpless and watch somebodies baby die ever again. I have never been the same since that night. I haven't saved them all over the next 25 years , but it is heart warming to know that I mastered the skill sets to dive in and save more than my share and thank God I no longer have to go home with that helpless feeling I had that night so many years ago.
It was a very hot summer night and I was the night intern at a community hospital in Warren Mich. As an intern I did not make the big decisions. Iwas there to get patients through the night so their doctors could make decisions in the AM.
I was hanging in the ER after I finished another history and physical on what seemed like an endless stream of patient admissions. The double ER doors swung open and to our surprise two young men in there early twenty somethings were screaming--"she has been shot, she has been shot-HELP!! HELP!!" Well, now the adrenaline kicks in and we all run out to find the most beautiful young woman lying in the back of a car. She had a bright red blood spot showing through her clothing that was very stylish and otherwise consistent with party attire. She looked to be around 20 years old and had a beautiful gold cross around her neck. We rushed her into the trauma room and immediately started our work-up exam and resuscitation. The GSW(gun shot wound) routine was in full gear as I started to ask the patient historical questions. It was not long before we all noticed that this young woman was NOT doing well. Blood pressure was not holding with large volumes of fluid, heart rate kept increasing, and her abdomen under a single bullet entry wound was rapidly enlarging. This young women was bleeding to death.
The blood bank was notified to send blood, the surgical resident was called and came quickly, and the OR was notified as was the surgeon on call. The surgeon was on his way from his home about 30 minutes away. Our job was to keep giving blood and fluid until the surgeon got there to explore the abdomen and stop what was now obviously a major vascular injury. Easier said than done. The surgical residents and I were losing this battle and with each minute she got more and more pale and to make matters worse kept repeating to us " I am going to die--Please don't let me die " Just as we were whisking her to the OR her father shows up and wants to see his daughter and in his state of shock starts screaming " oh GOD don't let my baby girl die" and then we rush into the OR.
We got her on the OR table, prepped and draped the abdomen and then we waited for the surgeon. We waited and then we waited some more. The feeling of helplessness consumed our emotions to the point that we honestly thought of opening her abdomen ourselves but NONE OF US were adequately trained to fix the problem. We needed the surgeon. Oh God did we ever need a surgeon who could save this girl's life and we needed him NOW!!
The surgeon did come and he tried with all of our help and all the blood we could muster and all the skills he had to save that beautiful young Italian American women and she died that night right in front of us on the OR table from a single 22 caliber bullet directly through her splenic artery. That my friends was when I vowed to train and then train some more so that I would never stand helpless and watch somebodies baby die ever again. I have never been the same since that night. I haven't saved them all over the next 25 years , but it is heart warming to know that I mastered the skill sets to dive in and save more than my share and thank God I no longer have to go home with that helpless feeling I had that night so many years ago.
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