Saturday, October 14, 2006

More CTS

73 hours at the hospital this week. Last night I thought that I would probably break 80, but fortunately that was not necessary. This week I have seen several bypasses and an aortic valve replacement as far as heart surgeries go. The aortic valve replacement surgery was a little dicey, when the surgeons tried to take the patient off of the heart/lung bypass machine (keeps the blood circulating while the heart is stopped) his right ventricle did not function properly; the only reason they could come up with was that they might have accidentally messed up the right coronary artery. They did a bypass on that, and since they were so busy I got to sew up the patient’s leg (they had removed his saphenous vein for the graft). It took a while, but it didn’t look too bad when I was done. Finally we took the patient to the ICU, where he proceeded to code. The surgeon at first thought he wouldn’t last the night, but he eventually stabilized and was doing better the next morning.

As far as thoracic cases go, I watched a joint otolaryngology/cardiothoracic surgery on a man with a narrowed portion of his trachea. They had to open up the neck, and basically cut out a portion of the trachea then sew the two ends together. At the end they took the most massive suture needles I have ever seen, and sewed his chin to his chest to make sure that the patient wouldn’t move his neck the wrong way and kill himself. The sutures have to stay in for a week, seeing them made me want to hold my chin really close to my chest for the rest of the day. Yesterday the other student went into a bypass, and I saw two very quick procedures, a sympathectomy and an esophageal dilatation. The sympathectomy was the removal of a couple ganglia in the sympathetic chain to treat a woman’s hyperhidrosis—essentially she has had really sweaty hands, armpits, and feet since she was a child, and it has been embarrassing as well as a nuisance particularly when she has to handle paper at her job. As soon as the surgery was over she was cured. When I saw her this morning she was talking about what a miracle it was.

The rest of yesterday was very relaxed. One of the patients I saw in the morning wanted to set me up with her grand-daughter (not surprising, I'm quite a catch:) who is apparently a first year at another medical school. I rounded on patients with the attending, pulled a chest tube, and (!) ate lunch for the first time in a week. That, however, was a trade-off for not getting dinner. At about five, when I was getting geared up to leave, a man came into the ER with a ruptured esophagus. He went to the OR at about six, and I stayed to watch. When esophaguses (esophagi?) rupture, one tries to repair them in the first 12-24 hours. However, this man had had symptoms for more than a week, and was thus very infected. The ER put a chest tube in, and (I did not go down) you could smell him throughout the entire ER. In the OR, they opened his chest, and his left lung and chest wall were completely covered in white gunk. The surgeons spent two hours peeling it off. The esophagus was a mess, and was impossible to repair, particularly with the infection, so they stapled his stomach closed, opened his neck, pulled out his esophagus through the hole (the distal end was very nasty looking), cut it, and sewed the remaining end to his skin to form a “spit fistula” through which his saliva can drain into a bag. They then put a tube into his small intestine to feed him. He will have to remain like this for the next 6 months which will allow him to heal up. Then, they will re-open him, make a tube out of a portion of the stomach, and attach it to what is left of the esophagus which will allow him to eat. The reason for his rupture is because he is an alcoholic, now anything he takes by mouth will immediately drain into his ostomy bag. I wonder if he will stop drinking, or if he will put the alcohol directly into his intestine tube? The surgery finally ended at 11:30, and I got to come home and sleep for 3.5 hours before going back this morning. I wrote notes on four patients, then my intern told me to go home which I gladly obeyed. There is bypass scheduled today, and I was very afraid that I would have to scrub in on it which would have meant I would be there til 5 or 6 pm. I’m happy with 8am:). Now I can write up a couple H&Ps that are due, put together the presentation I have to give on Wednesday (I’m presenting the tracheal stenosis patient because he has some very nice CT images), and actually study for the exam that almost half my grade will be based on. Sad story of the week: I set my VCR to tape Lost this week, but when I got home it never started recording:(. Now I’m going to have to try watching it on the ABC webpage and put up with the constant freezing and re-starting of the images.


Blogger Tiara said...

Hi, your blog is very interesting...did the woman with hyperhydrosis report any compensatory sweating?

Sweaty Palm Diaries

3:39 PM  
Anonymous Alice said...

Esophageal rupture. Complicated esophageal rupture. Wow. That's worth staying up till midnight to see. :)

4:26 PM  
Blogger Chris Emlyn said...

Tiara, the woman hadn't reported compensatory sweating at the time she left the hospital, but it does eventually occur in ~85% patients with this surgery. According to one study though, ~94% of people with CS are still glad they had the surgery. A different study had a lower satisfaction rate at ~85%.

Alice: It was pretty neat:).

5:14 PM  

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