Heart Surgery

Like many others that have undergone heart surgery I am unable to find the right combination of words to adequately explain how miserable you can feel without dying. Fortunately, every operation done in a hospital (as opposed to those done on street corners) generates a document called the “operative report.” In addition to convincing the patient’s insurance company to cough up more money this report is a blow-by-blow description of what the cut-ors do to the cut-ee. Since this report is written in doctor-ese, I will translate into words that you can understand.

OPERATIVE REPORT

The patient was brought to the operative suite in the post-absorptive state. After the satisfactory induction of general anesthesia the patient was prepped and draped in the usual manner….

What that really means is:

The victim was starved overnight and was thus too weak to fight back. After being given a deliberate overdose of barbiturates and then an injection of arrow poison to paralyze him, the anesthesia guy shoved a plastic tube down the victim’s throat and started pumping his lungs full of a mixture of pure oxygen and toxic gasses. We then painted his body with Betadine to kill whatever germs that were feasting on his skin. Since Betadine looks a lot like blood, and there would be plenty of blood around later, we then removed it with alcohol. This caused any germs that may have lived through the Betadine to get drunk and fall off. If you think this is one ugly son of a bitch when he’s dressed, try looking at him naked. We covered up as much of him as we could except for what we were forced to look at.

Next comes:

The chest wall was opened via a midline sternotomy incision and the sternum being opened by with a Stryker saw. The sternum was retracted with self-retaining retractors while the greater saphenous vein was simultaneously harvested from the patient’s left leg…

Which happens to be doctor-talk for:

I took a knife and cut through the skin and muscle of the front of the chest. Since the knife wasn’t sharp enough to cut through bone I used an electric saw to split his chest bone in half. To keep everything out of the way some large self-locking pieces if steel were stuck inside and locked into position. While I was doing this a flunky of mine was digging a big vein out of the victim’s leg so he couldn’t run very far even if he did wake up.

So far it sounds pretty much like the Gestapo interrogating captured French resistance fighters, doesn’t it?

The saphenous vein was flushed with saline, inspected and found to be of adequate caliber and length. The pericardium was opened with Metzenbaum scissors and then retracted with 3-0 sutures attached to hemostats. The patient was connected to extracorporeal circulation via two caval cannulas placed via a right atrial incision and a central aortic cannula was placed in the aortic root via an anterior puncture…

This is where it starts to enter the realm of the totally incredible understatement.

The flunky flushed out whatever crap was inside the vein with some glorified sea water and we both looked at it to make sure he didn’t screw it up or not get enough in case we dropped any on the floor. After that I cut into the sac around the heart with some curved scissors. I found the heart where it was supposed to be so I stuck in a bunch of tubes connected to a big machine after deliberately stabbing him in the heart and the biggest artery in the body.

Now for some more doctor talk:

After partial extracorporeal bypass was established the aorta was cross-clamped and asystole was induced by cardioplegic solution delivered via the aortic cannula. Myocardial protection was obtained by iced cardioplegic solution applied within the pericardial sac. Cardiopulmonary bypass with extracorporeal oxygenation and somatic hypothermia was successfully established….

Buckle your seat belts folks. It will be a little bumpy when we pass over Albuquerque.

As soon as we had about a fifth of his blood supply outside his body I put a clamp on the big artery that leads away from the heart and takes blood to the rest of the body. Then I had the pump tech stop his heart with the same stuff they use to execute murderers in Texas. Since the heart was already pissed about stabbed twice I poured some of the same stuff that had been chilled to the temperature of melting ice onto the heart so it would chill out. The machine then took over the work of the heart and lungs, which was good because his heart wasn’t beating. We chilled the victim down to down to room temperature.

I’ll omit the details and will resume when the fun part of all this starts: when its time fix all the stuff that has already been done and then get the heart to start beating again.

After the patency of the arterial grafts was confirmed the aortic clamp was removed while circulation was supported via the aortic cannula. The venous cannulas were removed and the lungs allowed to reperfuse. The heart responded to the rewarming process by converting from asystole to coarse ventricular fibrillation which was converted via direct myocardial defibrillation. Mediastinal drains and bilateral thoracostomy tubes were placed, and then attached to water-seal drainage. The sternum and chest were closed in the usual manner. The sponge, needle and instrument counts were correct. The patient tolerated the procedure well and was discharged to the cardiac surgical recovery area in good condition.

Once we made sure that we hadn’t messed up the arteries that we came here to fix, we started praying this guy would wake up. We warmed him up and is heart started beating again but not in a manner that would be compatible with long life, so we hit with the jump starter and fixed that. We stuck in a bunch of tubes that somebody will have to remove later but at least they will keep his lungs from collapsing again. Once we made sure we didn’t leave anything behind we stitched up the big gaping hole we had made in his chest. The victim somehow managed to live through all this and was shipped off to the recovery room so we could all go home to watch the basketball game on ESPN.

If that doesn’t convince you to lay off the cigarettes and the bar-b-q pork, you deserve what happens.

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