January 28, 2007
1900 or 2000
I was working on Type A Aortic Aneurysm, Patient DL, a seventy year-old Korean I knew nothing about. Dr. M the heart surgeon was doing a cut down on the right femoral artery to cannulate. And I had just floated the swan and was looking over the drapes.
Her spirit came from behind me. She put her right hand on my right shoulder with a thump and grabbed it/shook it to get my attention. Her voice was calm, loving, “It’s going to be okay!!! You will have/are going to have a husband and another life (you will be happy)…”
Then she went away.
On the way home, she came to me in the car:
1) She is gong to talk to somebody in heaven about ‘the wait’ (how long I have been single and not complaining) when she gets there. She is not dead yet, it is not her time.
2) She asked me what I wish to have? (a baby) And not a happy family?? (oh, yes a happy family…and not to feel so dead inside.) She was very kind. I asked her what her last meal would have been had she been able to eat it (she had her aneurysm rupture as she sat down to eat her lunch yesterday). She said ‘nothing much. Something diced (asian). She didn’t really like it.”
3) Right now, she wants to tell me “You did a really good job taking care of me yesterday. Thank you. Thank you for telling me who you were and what was about to happen. I heard all of it. And I liked the part about no anesthetic because of the cardiac tamponade. It sounded like we were on T.V.” (It was 18-20 minutes from in-room time in the OR to incision. Typically it takes one hour for an elective case.)
(ed - she made it. She had an uneventful recovery, and was discharged from the hospital. This is the first time I got a Message from someone who was 'in-between' life and death.)
Note: A Type A Aortic Aneurym is a ballooning of the main artery from the heart. I have seen them as big as a can of cola with a wall that is as thin as the layer of skin on an onion. It can 'leak' and have the patient's own blood fill the pericardium, or sac that holds the heart. Then the heart can't fill with blood to pump through the body. Death is imminent. The aneurysm also can 'dissect' back to the coronary sinuses where the blood to nourish the heart goes into the coronary arteries. This produces a sudden and fatal heart attack that will not respond to Code Blue resuscitation. Anesthesia is very challenging in this situtation; it will lower an already low blood pressure. Patients who present like this, and trauma patients with hypotension, do not get traditional anesthestetic. It is a scopolamine, given in doses to block the memory and nothing more. If a patient in extremis makes it off the table, and lives to be discharged from the hospital, it is considered 'a save' and therefore justification for the little anesthesia that is given until the patient becomes stable in the O.R. As a result we say, 'Anesthesia is not a right--it is earned. You have to have enough blood pressure to withstand anesthesia before it can be given.' We also will cancel a case for a blood pressure that is too high before surgery. Any systolic over 200 or diastolic (bottom number) over 100 is great risk for stroke. Always take blood pressure medicine, if you are on it, at the scheduled time or earlier, with a small sip of water before surgery. This goes for seizure medication, and pain medicine too.