Let's Talk Shop

Today I am going to discuss my technical expertise and passion for cardiac surgery.

It's been a long journey. Unfortunately, because of what I do for a living, I have to show it 'as I see it' and this is literally. So if close up views of surgery are too intense for you, you might want to opt for a different blog post, okay?

The only thing that interested me in Medical School was the heart.

Everything else I learned as a requirement. But this? I couldn't get enough! I studied it. I drew it. I aced the anatomy section on the thorax. I went to the asian market and bought pig hearts from the butcher just so I could learn how all the valves and the muscles worked.

And the very first time I saw Stuart Jamieson, MD,  show us how to tell the difference between an Aortic Valve and a Pulmonic Valve in lecture? I was hooked!

I asked to do a cardiac surgery rotation during my surgery elective. I worked with Dr. Jamieson, and this is the view I had while I worked as a first assistant to the fellow to open the chest.

I enjoyed everything and all things about that specialty, and a surgeon, hopefully, a cardiac surgeon, I was to be.

This is what it looks like when you are in on the field. With my residency, my heart surgeon used to let me be the 'designated heart holder' and retract with my hand so he could see.

All the extra time I had spend closing the leg in the heart room as a medical student paid off! In residency I would race the senior resident on the other leg, and even learned how to harvest vein.

I also grew close to the heart surgeon at my hospital--he would be my best mentor I ever had.

Heart surgery training is a long, lonely road. There is internship, then residency--five years in training--just to get IN to a hearts program. Then there are three years after that.

I didn't make it.

A really bad rotation on Vascular had me decide this wasn't how I wanted to live my life. I was working from three in the morning to ten at night every day. So I finished my second year, and signed up for Anesthesia training. I did my second year twice, because that is where I had to begin in Anesthesia Residency. It was a good fit with my personality and lifestyle. I also made it to be Chief Resident for my class.

I still loved the heart room. There wasn't any place else I would rather stay. This was my new view, from the head of the bed.

I did a fellowship. I learned transesophageal echocardiography (TEE).

I even did perfusion for one week in fellowship--I ran the heart-lung machine--just like this--with the perfusionist. I set it up and made sure the patient was asleep when they were on bypass.

I returned to teach. I taught many an anesthesia resident how to do hearts safely. I had extra training in pediatric hearts in fellowship. When I was pregnant I wondered if my child would pick up the knowledge of the healing that went on in OR 1...

Later I was invited to start a heart program at a local hospital... which I did.

The state surveyor said my CV was the nicest one they had ever seen, with the most qualifications.

I was super excited to bring this healing to the community where I now worked.

But it wasn't easy. A heart program takes people with experience to make it happen. And every hospital has their own culture.

Not many women succeed in community practice.

I had been offered jobs on the spot at St. Michael's hospital in New Jersey (I went for a training program in off-pump CABG), Cedars-Sinai in Los Angeles, and also at a local trauma hospital. The first I didn't want to relocate, and the second, I had just bought my house which was too far to commute, and the third, well--some of the heart surgeons there didn't like women.

I had forgotten, but a surgeon at the hospital closest to my home also had offered me a job while we played a game of golf together at a conference on anticoagulants in Austin, Texas, too. He was amazing person, very forward-thinking, and did one hundred percent off pump CABG for everyone.

I was that good.

It's been four years since I did my last heart.

I try not to think about it.

The Reiki training wouldn't have been possible with the hours I was expected to keep doing hearts. (I took a lot of classes at night for the Psychic Development in addition to the Reiki classes on the weekends).

And I'd have never been able to drop my son off at school every day, like I do, which is an important bonding time for me. (Hearts cut at eight, so Anesthesia must have the patient in the room by six thirty, and the room set up starting at six at the latest).

You can't do hearts forever. With training I put in about ten years in the heart room. That's as long as most people do...

(That's what I love about heart surgery the most--patients get better. You can see the pink in their cheeks the very next day after repair of their heart...)

Cardiac Anesthesiologists train in Thoracic Anesthesia too. I am very good with a bronchoscope. So when a colleague had trouble with a double-lumen tube, a nurse asked me to come in from the Doctor's Lounge into that OR to help.

I saw the problem immediately--it was a tight fit between the bronchoscope and the endobronchial lumen of the double-lumen tube. Instead of silicone, the team was using cetacaine spray, which is not flammable, but it not a lubricant either. Head of nursing had made the switch.

The surgeon was frustrated. So I held the tube, backing it up and advancing it with the surgeon who had taken over the placement (One I know, not this one, actually BILLS for it, placing the tube!).

My colleague was like, 'If you are just going to hold the tube I can do it...' and reached for the tube.

I didn't let them. I held my ground, and did what the surgeon asked me to do. It got placed perfectly.

My colleague challenged me.

I said, 'I have known this surgeon ever since I was a resident. It has been over twenty years (I stretched it  a little). I was calming him down. We have been through a lot together and we work well as a team.'

The other surgeon, the assistant, had been watching and listening. He was taking it all in. He is Sri Lankan. I enjoy working with him on thoracic cases. He always is respectful and level-headed.

After tube placement, we were both in the Doctor's Lounge.The patient needed to be prepped before he could assist.  I was post-call from a very long call, and on my way home. When we are post-call, our 'filters' don't work so well.

We were talking bronchoscopes, and somehow the conversation to a turn in a direction I normally don't discuss, especially in front of a heart surgeon.

It was like my heart spoke without my being able to stop it.

'When I started the heart program here, there was nothing. It was so hard. Do you know what happened? For example, once I was placing a double-lumen tube and I had requested a bronchoscope the night before. Do you know what they got me? A GLIDE scope from the E.R.!!! How was I supposed to check placement with that? (bronchoscope is long and thin fiberoptic, a glide scope is a shoe-horn type thing for intubation)'

And much to my dismay, I kept going, and under my voice I said, 'I get almost violent when someone threatens the care of my patients...they thought I was a total bitch and they freaked out and they never wanted me in there again.'

And he looked at me.

He listened. And he understood exactly where I was coming from.

Later, as we were talking Singapore restaurants in the area, he said, 'Give me your number' and he texted me a link to the restaurant he recommended. I took his contact information, his photo, and sent him the link to the new one I was sharing with him.

His acceptance and offer of friendship validated me as a healer, as a cardiac anesthesiologist, and as a patient advocate (of which I am a total bulldog! Just last week, I overheard some staff talking about how they have never heard me raise my voice in the OR but they did that day and it surprised them. The table was beyond its weight limit, and when unlocked for a turn, it started to tip. With the patient on it!!! So I said STOP as loud as I could, and got the lock back on. One inch more and the patient would have had his head hit the ground as the unbalanced table would have immediately fallen over)

He wished me Happy Mother's Day today. He sent a text. He even put a little smiley face at the end of it.

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I wouldn't have changed a thing with how it all turned out. Reiki is the way of the future. Energy Healing, Quantum Healing, and addressing Dis-Ease will one day be more important that anything that is the standard of care at this time. I look forward to helping to align the healing of the future with those who are the healers of today--both in mainstream medicine, and other healing arts.

I hope that the photos were not offensive to you in any way. They are technical, and are my expertise. They are not for everyone. But they are unfortunately totally normal for me, now that I have been in this field for as many years as I have...


Aloha and Mahalos,
Namaste,
Peace,

Reiki Doc


P.S. The heart symbol with the hands is a Seraphim symbol for Love. When I saw the Seraphim in October 2012, in meditation, it made that symbol and several others--harmony, Light....it was very nice. So now you know one Seraphim symbol...

Why Thoracic Anesthesia Is Fun

Thoracic Anesthesia, or the anesthesia that is given for lung surgery, when everything is going well, it feels like sailing to me.

I adore sailing.

With the open sky and the sea and the wind in my face it is just about one of the best things to do on Gaia. And you are one with the sea and with the vessel. You move automatically with the lines, the sails, the team, as One.

In the O.R. there are many task to do, all in quick succession. There are fine adjustments to make, just as do when setting your course on the water....sail and tack...sail and tack....sail and tack...

There is more invasive monitoring than in the average case, but not so much as a heart. It's doable.

After induction, which is a big deal because you insert a breathing tube that is adapted to allow to ventilate one lung independently of the other, you place your lines.

You need two very big i.v.'s just in case your surgeon gets into trouble, and there is bleeding. The blood flows thick and fast when something happens, and you have got to be prepared ahead. There isn't time to set up after a hemorrhage. Fortunately, this part is very rare.

Another thing you insert is an arterial line to monitor oxygen, ventilation (CO2 output), and blood pressure. The last time I put in a line, the anesthesia tech blurted out, 'wow! Did you see how fast that line just went in? Yesterday in the other room it took an HOUR!' I had gotten it on the first try at the same rate someone would put in an i.v. I laughed and said, 'That's because I used to do hearts!'.

My surgeon took notice.

Speaking about him, there was the following conversation in the O.R.:

me: (as we were preparing to turn the patient lateral and nurse was putting in foley and I was bronching patient to verify tube position) Would you mind getting me three blankets from the warmer? (I pointed to the equipment)
surgeon: (gives me the look, acts like he doesn't notice, then blurts out) Are you talking to me?
me: Yes. When we turn I am going to need to support the head more than this gel pillow. Three flat blankets will do nicely.
surgeon: I can't. I don't know where the equipment is!
second surgeon:  Here, let me get that for you. (goes to the warmer, takes out three blankets, and hands them to me)
me: Gosh, I am sorry if I was rude in asking the surgeon for help by getting a blanket in front of you. I've known him for like, ten years, since I worked with him someplace else. Everyone else was busy, and I was trying to save time by thinking one step ahead...
second surgeon: You know you're not allowed to think!


circulator nurse: (we are alone and she is prepping patient while surgeons both scrub)
That was the PERFECT answer to that situation. He literally said, 'are you talking to me?' Perfect tone, perfect reasoning, perfect timing, perfectly said.
me: You know I almost dated him?
circulator nurse:  You could have done better!
me: I'm serious! When he came to our hospital and was new, and single, the other heart surgeon tried to set us up. I saw that he was dark and handsome and exotic, and seemed nice...but something made me think work and dating might not be a good idea. So I never did. It's a good thing that I listened to my 'hunch'--it turns out he has a terrible temper, as you can see.
circulator nurse: (gives me an approving look,, and surgeon walks back into the room, and she lifts her finger to her mask as a warning for us not to talk on the subject)

Why do I share with you all of this?

Some people asked me what Thoracic Anesthesia is. And why I love it.

Besides, I always liked to work in the thoracic cavity--my goal at one point was to become a cardiothoracic surgeon! Not a cardiac anesthesiologist. The lifestyle was horrible! That is why I gave that first dream up.

We move on.

I love it when a case asks much of me. It is so fun and really feels like I am One with my equipment and my purpose and my team...is there much time for Reiki? No. But I do what I can <3

Aloha and mahalos,
Namaste,

Reiki Doc