Saturday, March 2, 2013

Messages From My Patients: Chapter 31

July 19, 2008
L.M. thoracoscopic-assisted atrial fibrillation ablation
Start 0815 End 1930
I wanted to run when I met her. Anterior airway, Mom of an OB RN, poor access.  Five feet tall, impossible airway. S got the airway. I got the aline. MH got the IJ central line. The case went on and on. R finished it. I thought I could sign it out to N but it was too cardiac. I had a PMS-fueled meltdown at the front board. I prayed, “your will not mine Lord.” When C had to go and get my kid from school for me. I ate with W, P and MM and said, “I wanted to run but my turn was to suffer today..”
That night, I felt my patient’s spirit come to me. She said, ‘It’s going to be all right. You will have a husband (and a family).
I felt better but worried she may have crossed over in the ICU.
When I did my post-op check Friday I made sure everything was okay. When I went to go, she said, “I love you, doc.” She sounded like the spirits that visit me after they pass. But she was alive…and using her voice!

A woman, L. M., the mother of a nurse on labor and delivery, had irregular heart beat. The formal procedure for this is the 'MAZE' procedure--surgically separating both atria from the ventricles and then sewing them back on, with the exception of the natural conduction pathway from the sinoartrial node (atrial 'pacemaker') to the bundle of HIS. It requires full cardiopulmonary bypass.
My surgeon wanted to do this with radiofrequency ablation, 'burning' a scar at the atrioventricular junction, circumferentially, 'sparing' the electrical pathway where the electricity ought to go. This is how we go for 'cure' for intractable atrial fibrillation--eliminate the electrical 'cross-talk' in the heart. Unfortunately for me, my surgeon wanted to accomplish this not with a scalpel (old-school MAZE) but with a Microwave-On-A-Stick, accompanied by much cursing and swearing and yelling from him.
The case ran seven hours and fifteen minutes straight in the O.R.
Technically she was a challenge. There was no room to put in the breathing tube--the senior cardiac anesthesiologist got it. I did the insertion of the invasive arterial monitoring for blood pressure, the 'lifeline' monitor cardiac anesthesiologists follow closely throughout the case. And my student was able to insert the big i.v. monitoring lines in the neck under my supervision.
At the end of the day, three o'clock, there was confusion over staffing issues. This case was still going. I was technically on cardiac call, but since we were off-pump, it was not officially a 'cardiac case'. My relief refused, citing, 'this case was too cardiac'.  I decompensated in front of my peers at the main 'control center' for all assignments in the O.R.  I pulled out of that nose dive with a prayer of acceptance. A nurse friend agreed to go to school as a favor to me and pick up the kid from down the street. 
Quite unexpectedly, the spirit of the patient contacted me that night at home, with a message of compassion that gave me a great deal of hope. Yet at the same time, I was concerned about her health. Until this time, the only way someone could 'talk' to me like this was after making their 'Transition'.
I checked on her the next day in ICU. She was fine. And said, unlike any other patient before, 'I love you Doc'.  
It made all of my suffering worthwhile.