Whew! Long day. But the **heart** I saw in the OR today, and the stamina, was overwhelming. I have to write.
Not rich patient gets neuroendocrine tumor just like Steve Jobs. Not rich patient has not good insurance.
No one like to take case.
Except one. A mostly vascular general surgeon. The patient is in forties, and a new parent of a baby less than ten weeks old. General surgeon has heart.
Due to money issues, General Surgeon does not have old physician assistant. Old one left for Kaiser for better hours to be with family and better pay. New physician assistant does not have priviledges at this hospital. Even surgeon has to get emergency priviledge for pancreaticoduodenectomy at hospital.
General surgeon finds partner, another general surgeon, new to group. They go do case.
Now, I as anesthesia, and everyone else, know that this surgeon usually does amputations, revascularizations, and dialysis access grafts. Not liver transplants like other guy that won't touch this patient. So I prepare for a long case. With lots of 'fluid shifts'. This means, blood loss, and massive resuscitation. I plan arterial line, central line for CVP, and large bore peripheral i.v., general anesthesia, and blood bank ahead for transfusion.
What made this case different? Heart.
It started in pre-op. Patient didn't understand what was happening. Did not sign consent. With translator, I went over anesthesia and invasive monitoring, step by step. Then, 'I am not a surgeon but I watch surgery, I will explain the basics.'. The cancer is in the pancreas. Pancreas is connected to small part of small intestine. Once tumor is out, it is hard to reconnect. It has to be rearranged, the surgeon knows how. The pancreas is between the liver and the spleen way in the back. You will have no pain. You might need to sleep overnight so you may get more pain medicine. Then you will wake up with a breathing tube. The number one complication post-op is pneumonia. You will have to exercise your lungs after surgery to prevent this. Coughing and exercising the lungs might hurt. Be sure to take enough pain medicine so you can work out your lungs. You won't become a drug addict.
During the case, I gave Reiki, Deeksha, Karuna Reiki (TM), most impoartantly, the Happy Trails. His energy felt completely absent in the yellow solar plexus chakra. I balanced the chakras. I was fully aware of his consciousness, and sensed he was happier outside than in, and also trying to 'regroup' on his life plan. He saw us all working, thought it was interesting. And he had a message for me: your life will be good.
All this happened up before the time the surgeon had to decide whether to operate or not. Most Whipples turn out to be inoperable, and we close without doing the operation. He asked, 'how old is the patient?', I answered and shared about the new baby, and the surgeons' demeanor changed. He relaxed. Compassion filled him. I can't remember the last time I saw compassion from a surgeon in the OR. Compassion-surgeon? Almost an oxymoron. But he did. He was able to reach around, something, and that meant he could proceed with the operation.
We were there for eight hours. The tumor was socked in. The assistant was kind. But what blew me away was the scrub tech who gave break. When she heard the age and the new baby, she cringed. She came to look at the patient when the regular scrub came back. She walked away. And then she came back, asked, 'Do you mind if I pray for this patient?'. I said, "I will join you.". She knelt, put her right hand on the patient's head, and prayed. I felt her energy. She did not know I did. And she left in a hurry when she was done. I said the patient's name to her-it's "Jim--the patient's name is Jim.". She nodded her thanks and left.
There was bleeding. I am at a loss in my hospital. Stat labs take one hour. Even from the OR. I hate it. There is a device called an iStat that is used in the heart room and ICU. But not the main OR. I had been talking with an administrative nurse about us borrowing it, but 'they were discussing it' yada yada.
I called her on it. With this case. She said, 'I'll work on it.'
I used it. It showed up. Just like at my old work. I got the secret code to make it work, the cartridges. And in less than one minute, I had blood gases, lytes, and hemoglobin and hematocrit. And ionized calicum.
This was key. Blood products have chelates in them, special chemicals to absorb calcium to keep the blood from clotting. Well, when given to a patient, guess what? They suck up the patient's calcium too. You have to replace it. I ran tests each hour. And replaced everything while in the OR. There was a while where there was no clot. We fixed it. With blood products. (If you ever wonder where your donated blood goes, that's it.)
The surgeons got all the tumor. I tucked my patient in to the PACU, and then spends the night in the unit.
He got his chance. I got my iStat so I could take care of him better. And a Scrub Tech openly blessed him in the OR. And both surgeons had COMPASSION. Sometimes the OR is like trying to push a rock uphill. Everything runs out or the wrong equipment gets pulled. But today, we overcame those obstacles. With love.
The patient was so vulnerable. He knew he was at the end of his rope in preop. I hope the Reiki made a difference. It looks like it did. ; ) That's our secret. ; )))