"Clear!"

Everyone has seen somebody on tv yell "Clear" when a patient is shocked. I had the luxury of doing this yesterday. It was very exciting! A patient with atrial fibrillation had failed medical therapy and needed cardioversion to convert his heart back to sinus rhythm. Dr. T told me that I would get to do the case, as long as I knew the complications and how to treat them. I spent a good amount of time preparing all the possible complications and the treatment because I didn't want to risk not having the answers and therefore not getting the case. The biggest risk is asystole: completely stopping the heart. That's all he wanted to hear. So I was over prepared; but that is always better than being under prepared. So we set the patient up, the anesthesiologist sedated him and I started the defibrillator. On the machine, there is a strip where the heart rhythm is displayed. Dr. T warned me that while doing the shock, I needed to keep my eyes on the strip and not on the patient (who would jump off the table) to make sure that he didn't go into asystole. So, I set the energy to 100 joules, got the patient synced, charged the defibrillator up, and said "clear" and shocked the patient. I made sure to not even glance away from the strip. Luckily, he converted to sinus, and the cardioversion was a success!

Lub Dub

That is the sound the heart makes as it beats. Or at least if there are no mechanical problems. I got to watch open heart surgery this week. I watched them saw open the sternum, spread the chest cavity, and cut into the pericardium, where inside was the beating heart. Lub dub, lub dub. This patient had an aortic aneurysm and needed an aortic valve replacement. His aorta was huge. I was shocked at how big it was. No wonder people die if they got shot in the aorta!!!! Alright, I watched the beating heart for awhile. Then they put him on the heart-lung machine so that blood could completely bypass the system. After that was done, the doctor paralyzed the heart. So at this point, it's flattened out because of no blood, and not beating. Then the aorta was cut out. I was actually very surprised at the length of aorta removed from the body. He then took the new aorta and put in the new valves. And then the most tedious part of the surgery: sewing the new aorta into the system. Both ends had to be attached plus the coronary arteries had to be routed to the new aorta. He was sewing forever. I think there was something around 160 sutures used throughout the case. After all this is done, they SLOWLY fill the heart with blood, 100 cc at a time, making sure that the system reacted appropriately and that there were no leaks. Then they inserted a chest tube, and began to close him up. They "sew" the sternum back together with thick wire, and then close the outer layers. Sounds easy right? Hah, it was 5.5 hours of stressful surgery.

I was amazed throughout the entire surgery. I'm fairly certain the smile did not leave my face for the first two hours. I think one of the weirdest thoughts was that this man's heart was not beating, his lungs were not inflating, yes his brain was intact and blood was circulating through his system.

This was definitely one of the most memorable days of medical school.

My Sister's Trip to New Zealand

I don't know if anyone is interested in reading along about her travels, but she is studying abroad in New Zealand and just arrived this week. Her blog is:
http://mylifeinthelandofkiwis.blogspot.com/

I'm Scared of Dying

This is actually something we hear every single day. New patients will come in because they are afraid of having heart disease, not knowing about it, and dropping over dead. When a patient who has heart disease says that to Dr. T, he has an interesting response. "Well , you might as well get over that right now. You are going to die some day, it will probably be from your heart considering it's the number one killer in America, and as far as I know, we have no say in when that will happen." The patients usually look shocked and then nod their head in agreement. That usually ends the discussion.

Dr. T is so amazing with his patients. He knows how to talk to them, individually, when to take a more holistic discussion (this is Boulder) without compromising care, and being very kind to them.

A funny story: he has a patient who is in her late 90's. I saw that on the schedule and said "Wow, our next patient is 97!" And he said, "Oh it's going to be a lovefest in there! An interesting fact about her, she doesn't dream." My response "wow that is interesting but how on earth did that conversation ever come out."
We walk in the room, he gives her a hug, we sit down and she says, "Dr. have I ever told you that I don't dream." I almost fell off the chair laughing. He looked at me with a look that said "that's how I found out."

I've Been Dreading it For a Year

Cardiology. That's what I'm in right now. When I found out a year ago that cardiology was a required rotation of 4th year, I started dreading it at that very second. I'm now halfway done with the rotation, and surprisingly, I'm enjoying it. Like really enjoying it! My preceptor is AMAZING, and has taught me such interesting and applicable things that I enjoy going in each day. The week is split: 2 days in the hospital, 2 days in the clinic, Thursdays off, and we round every morning at the hospital. It's a great set up! So far, I've been in at least 8 angioplasties (heart catheterization with stent placement). It's very interesting to see the patient's and their family's reactions. For example: this last week a doctor from in the mountains called Dr. T to take a look at an EKG. The patient had some chest pain, had been ignoring it for a couple days, and finally came in. The EKG was abnormal, but nothing too significant. Dr. T wanted a troponin drawn, but because the patient was in the mountains, the blood wouldn't be processed until the next day. So he asked to see the patient the next day. The troponin was drawn and was VERY elevated. The patient and his wife were in complete denial that anything major was wrong. Dr. T had already put him on the schedule for an angioplasty because he knew it was bad. The patient actually sat there and tried to talk himself out of the angioplasty. We get back in the cath lab and he has a 100% occluded right main coronary artery. Not good. So yes, this guy was having a heart attack. The plaque actually was about 7 cm long. It was a tough case. Once, Dr. T saw the big blockage, he sent me out to talk to the wife and let her know that he was having a heart attack and that he'd be in the ICU overnight with a few nights in the hospital. The wife's response "A heart attack???? Really???" I mean, her husband is over 300 lbs and had bad chest pain and the cardiologist was very pushy to get him to the cath lab. What exactly did you think was going on?

So it's been an interesting two weeks.