Due to an unexpected and very unusual twist in end of rotation plans last week, it turns out I am doing the very last rotation, the last 28 days, the LAST TINY LITTLE PIECE OF SCHOOL OF MY WHOLE ENTIRE LIFE with...
Kids with cancer. And blood diseases. (Also known to us as, hematology and onocology or- as everyone prefers to skip most of that- heme/onc.)
It is kind of sad.
I don't like any of the stories these patients have. All of their stories, so far, are very sad. These children are the living examples of the weakness of humanity. They are so innocent and sick.
My two patients are:
Sweet little M, 2 years old, with a big hard tumor in her belly and metastases to both her lungs. She hasn't been in the hospital long enough to know that not everything we do hurts so she has a raging case of White Coat syndrome. Take the white coat off and she is one sweet little pea. Approach her in the white coat and you will wish for a fate worse than death!
Today we heavily sedated her and punched holes in her hip bones to get some bone marrow. Ouch. Luckily, there was no cancer there so most likely she'll never have to have that done again- unlike kiddos with leukemia, who get it done weekly.
And little Mr. R... is an 11 month old baby who has a recently resected very rare brain tumor. Actually, they haven't even been able to diagnose it exactly yet. So, he's going home tomorrow while things get figured out. He has an 8cm scar across the top of his skull and a lop-sided little smile that would outcharm Elvis Presley. This little man may have to have chemo that would irreversibly scar his kidneys and he may not and end up leading a perfectly normal life.
Its this dichotomy of good and awful that seems to follow us around our whole lives... we can hardly enjoy the one without the other popping up and looming over our heads, threatening to destroy everything.
Or maybe that's a lie, and there are some things that cannot be destroyed... even by death. Give us peace in our hearts Lord. Let it be a long, long road with a good, good end.
Tuesday, October 27, 2009
Thursday, October 01, 2009
A Transplanted Heart
My cardiology rotation really started off with a bang.
On Monday, we were chilling in the cath lab, and had just finished a right heart cath that showed a woman had a pulmonary capillary wedge pressure of 47. That, my friend, is heart failure. Dr. H is the only heart failure cardiologist in Oklahoma and he is pretty darn amazing. I had no idea when I was assigned this rotation just how freaking cool it was really going to be. When an organ donor in Oklahoma dies, Dr. H is the main person who decides who will receive the heart. And that is a pretty gigantic responsibility. He is a pretty amazing man and I am lucky to get to learn from him this month.
Keep in mind, there are only between 9 and 13 heart transplants a year in Oklahoma and the surrounding areas including western Arkansas and southern Kansas. So when Dr. H told me that a donor heart was available on Monday morning, and that I could go watch the transplant, I had no idea how special of an experience it actually was.
One common myth about organ transplants, including hearts, goes something like this: "I don't want to be an organ donor because if I'm injured in a car wreck, they might see and then not try as hard to save my life." In reality, organs are never harvested "on the scene" of accidents. If the person dies in an accident, their organs don't receive blood and the tissue dies- and you can't put dead organs in a living person.
Organs are almost entirely harvested from people who receive brain injuries and later become brain dead on respirators. In the hospital, after it becomes apparent that the person is completely brain dead and never coming back, doctors talk to families about wishes- and that is the time when organ donation becomes an option. Usually, organs are harvested while the person is still on the respirator. That way, the organs receive a maximal amount of blood before being removed.
Circling back... so on Monday, I got to watch a heart transplant. This was definitely the most amazing thing I have seen all year, maybe ever. The doctor who performed the transplant was a little grouchy that day because he had already opened up the chest of the person receiving the heart when they found out the heart was coming by ambulance, not by plane. So basically, the man laid in the OR for and hour and a half with his chest wide open, just waiting for his new heart. I watched his old heart beat for about 30 minutes of that.
Kind of strange, just watching a heart beat. It looked sick and worn out, and you could tell it really needed to be replaced. How lucky he was. Although so incredibly sad that someone else- an 18 year old in Tulsa- was so unfortunate.
About 30 minutes after I arrived, Dr. Elkins received a call that the heart was only 10 minutes away. So, he proceeded to cut out the man's heart. Cutting a heart out takes about ten minutes, and isn't as complicated as you would think; I mean, there are only four vessels to sever.
Right after he finished, the OR door opened and simultaneously, a man yelled, "Heart's here" and a blue cooler flew across the threshold and slid about 10 feet before slowing to a stop at the foot of the operating table. It literally looked like it had just been taken camping. One of the nurses grabbed the cooler, and dragged it over to a big bucket of ice. I made my way closer and saw that the cooler said in big letters, "PLEASE, PLEASE RETURN TO HEART TRANSPLANT COORDINATOR OR THERE WILL BE NO HOSPITAL PICNIC THIS SUMMER."
No- just kidding. It said, "PLEASE, PLEASE RETURN TO HEART TRANSPLANT UNIT." The nurse opened it up and grabbed what, in comparison to the big ugly broken heart just removed, was a most beautiful heart, completely unblemished. After dunking it in ice a few more times, Dr. Elkins sewed the new heart in.
For a few seconds after it was reanastamosed, the blood pump was still on- meaning that blood was being diverted away from the heart. No blood was actually flowing through the heart yet. And yet, the oddest thing ever... the heart started to quiver. (Or, in fancy medical terms, fibrillate.) Like, somehow it actually realized it had been reattached to a person. Crazy.
The heart quivered on and off for a few seconds and then the blood pump was turned off and the heart began receiving blood. At this, it really started fibrillating. Then, the surgeon took two tiny paddles and shocked it with just 10 joules. Also crazy- normally you shock someone with 300 just to get through their chest wall! The heart would probably explode right there on the table if you shocked it directly with that much electricity. However, the tiny paddles did their job and the heart started beating. Beautifully beating.
Eventually, the sternum was wired back together. (Watch that from two feet away and nothing that happens to you will ever seem that bad.) And with that the surgery was over.
Three days later, in the clinic, Dr. H looked sternly at a pretty 23 year old girl, his intense gaze nearly boring holes through her skull.
"There are certain things you are going to have to do to show me," Dr Horstmanshof paused-
"...to prove to me that you can take care of the incredible gift of a transplanted heart."
The girl just sat there, speechless. Incredible gift indeed.
On Monday, we were chilling in the cath lab, and had just finished a right heart cath that showed a woman had a pulmonary capillary wedge pressure of 47. That, my friend, is heart failure. Dr. H is the only heart failure cardiologist in Oklahoma and he is pretty darn amazing. I had no idea when I was assigned this rotation just how freaking cool it was really going to be. When an organ donor in Oklahoma dies, Dr. H is the main person who decides who will receive the heart. And that is a pretty gigantic responsibility. He is a pretty amazing man and I am lucky to get to learn from him this month.
Keep in mind, there are only between 9 and 13 heart transplants a year in Oklahoma and the surrounding areas including western Arkansas and southern Kansas. So when Dr. H told me that a donor heart was available on Monday morning, and that I could go watch the transplant, I had no idea how special of an experience it actually was.
One common myth about organ transplants, including hearts, goes something like this: "I don't want to be an organ donor because if I'm injured in a car wreck, they might see and then not try as hard to save my life." In reality, organs are never harvested "on the scene" of accidents. If the person dies in an accident, their organs don't receive blood and the tissue dies- and you can't put dead organs in a living person.
Organs are almost entirely harvested from people who receive brain injuries and later become brain dead on respirators. In the hospital, after it becomes apparent that the person is completely brain dead and never coming back, doctors talk to families about wishes- and that is the time when organ donation becomes an option. Usually, organs are harvested while the person is still on the respirator. That way, the organs receive a maximal amount of blood before being removed.
Circling back... so on Monday, I got to watch a heart transplant. This was definitely the most amazing thing I have seen all year, maybe ever. The doctor who performed the transplant was a little grouchy that day because he had already opened up the chest of the person receiving the heart when they found out the heart was coming by ambulance, not by plane. So basically, the man laid in the OR for and hour and a half with his chest wide open, just waiting for his new heart. I watched his old heart beat for about 30 minutes of that.
Kind of strange, just watching a heart beat. It looked sick and worn out, and you could tell it really needed to be replaced. How lucky he was. Although so incredibly sad that someone else- an 18 year old in Tulsa- was so unfortunate.
About 30 minutes after I arrived, Dr. Elkins received a call that the heart was only 10 minutes away. So, he proceeded to cut out the man's heart. Cutting a heart out takes about ten minutes, and isn't as complicated as you would think; I mean, there are only four vessels to sever.
Right after he finished, the OR door opened and simultaneously, a man yelled, "Heart's here" and a blue cooler flew across the threshold and slid about 10 feet before slowing to a stop at the foot of the operating table. It literally looked like it had just been taken camping. One of the nurses grabbed the cooler, and dragged it over to a big bucket of ice. I made my way closer and saw that the cooler said in big letters, "PLEASE, PLEASE RETURN TO HEART TRANSPLANT COORDINATOR OR THERE WILL BE NO HOSPITAL PICNIC THIS SUMMER."
No- just kidding. It said, "PLEASE, PLEASE RETURN TO HEART TRANSPLANT UNIT." The nurse opened it up and grabbed what, in comparison to the big ugly broken heart just removed, was a most beautiful heart, completely unblemished. After dunking it in ice a few more times, Dr. Elkins sewed the new heart in.
For a few seconds after it was reanastamosed, the blood pump was still on- meaning that blood was being diverted away from the heart. No blood was actually flowing through the heart yet. And yet, the oddest thing ever... the heart started to quiver. (Or, in fancy medical terms, fibrillate.) Like, somehow it actually realized it had been reattached to a person. Crazy.
The heart quivered on and off for a few seconds and then the blood pump was turned off and the heart began receiving blood. At this, it really started fibrillating. Then, the surgeon took two tiny paddles and shocked it with just 10 joules. Also crazy- normally you shock someone with 300 just to get through their chest wall! The heart would probably explode right there on the table if you shocked it directly with that much electricity. However, the tiny paddles did their job and the heart started beating. Beautifully beating.
Eventually, the sternum was wired back together. (Watch that from two feet away and nothing that happens to you will ever seem that bad.) And with that the surgery was over.
Three days later, in the clinic, Dr. H looked sternly at a pretty 23 year old girl, his intense gaze nearly boring holes through her skull.
"There are certain things you are going to have to do to show me," Dr Horstmanshof paused-
"...to prove to me that you can take care of the incredible gift of a transplanted heart."
The girl just sat there, speechless. Incredible gift indeed.
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