Transplant

This week has been rather busy. I can’t really recall off hand what went on Monday and Tuesday, but Wednesday was lecture from 6:30-6:30. I had to present the tracheal stenosis patient to my classmates—typically one presents the patient’s chief complaint and students have to ask questions about the history and try to come up with a differential diagnosis. Three other students went before me, and each one took more than a half hour to present, which made me a bit nervous because I didn’t think I could stretch my presentation out past 15 minutes. Thankfully by the time it was my turn we only had about twenty five minutes of class left so the doctor heading the discussion told me just to breeze through, so all went well. I decided to skip the last lecture since 11 hours was quite enough for me, and went back to the workroom thinking that I would check in and be told to go home, then I could go to school, stop by the meet the surgeons cocktail party that was going on (I probably would have just ended up standing by the hors'douvres table cramming food down my mouth avoiding social contact anyway), then go to the library, study (which I haven’t had time for yet this week), change, and go to Bible study (this night each of us was going to share favorite passages—my choices were Job 19:23-27 and Rom 8:18-39). Unfortunately, when I got back I was told that a heart bypass which had started in the morning was still going so I had to scrub in. It ended up being the CABG that would not die. The patient, showing flagrant disregard for my plans, refused to stop bleeding (apparently he had an anti-phospholipid syndrome that messed with his clotting factors). As the hours ticked by, my plans became increasingly shorter. I managed to hang on to the hope that I would at least make it to the tail end of Bible study, but that hope, like so many, at last died a horrible death. The CABG went on til about 11:00pm, the doctor had been pretty calm the whole time, but afterwards he told me he thought that the patient was going to die on the table. I wrote the op note and went home for the three and a half precious hours of sleep I would get before coming back to the hospital.

Yesterday I went in, saw several patients, then scrubbed in to two cases. The first was a lung tumor removal, the second was a left lung removal. The fellow had to go to clinic, so I first assisted the surgeon (ie I held retractors). I got a very good view though, it was quite interesting. And between cases, I managed to go to the free drug rep lunch hidden back in the general surgery offices. After the lung removal came the exciting part. A heart in Colorado had just become available for transplant, and was a match to a man in the city in which I live. One of the surgeons had flown out early in the afternoon, and was on his way back with it. I was not on call so I could have gone home, but since this was possibly a once-in-a-lifetime opportunity I stayed. It was definitely worth staying for. Two surgeons worked together to get the patient ready—they opened him up while the donor heart was still in the air so that he would be ready for transplant as soon as the heart arrived. At 8:30 a group of people walked into the OR wheeling an ice chest. The surgeons put the patient on heart lung bypass (a machine that keeps blood circulating through the body when the heart and lungs are not functioning), cut out the patient’s heart, and tossed it, still beating, into a bowl. It was huge from chronic heart failure. The donor heart was much smaller. They prepared it, and sewed it in over about an hour’s time. Then, they monitored it, and finally closed at 2:00am. The other student and I left at about 2:30. Since we had to be back at 6:00, I considered not even going to bed because I was afraid if I did I would not be able to get up. I was too tired though, so I decided to take an hour nap before showering and going back. Although I have no memory of this, I somehow ended up getting out of bed, turning my cell phone alarm off, and getting back into bed, because when I woke up (I even left my bedside light on so I wouldn’t fall too deeply asleep) it was 6:15. Since I live a half hour away from the hospital, I had to page my intern and tell her I would be late, fortunately she was all right with it.

I finally got to the hospital at 7:00, and just had to see one really repulsive and manipulative patient. Naturally he was the type who likes to hear himself talk, and since I am too nice to be rude (I need to work on that) I had to sit (by his order) and listen for a good long while to his theory about constipation, his self-remedy, and what we as compassionate hospital staff should do about it—no more details needed. He was really freakish, he would make horribly suggestive comments to every female who walked by (he’s 62 by the way); if I were one of them I would have walked in and knocked him out. Plus he referred to himself in the third person. But, he does have serious physical problems and still needs good care regardless of his personality.

I was hoping that we would be allowed to leave early, but this was not to be. We had to round and do floor work until 4:00. Now I need to go to bed since I have had 6 hours of sleep in the last 60 hours (I am still surprisingly energetic, I am sure it is all going to hit me soon…)