My Heart Beats for This

I am currently in the middle of my cardiology rotation, which is kind of like an elective. I wanted this rotation because I knew that my cardiology basic sciences were not very strong, and a large portion of the board exams will be comprised of cardiology question stems.

It has been somewhat difficult getting a good schedule because everyone is in the midst of spring break, and not all the doctors are in the office. Moreover, a lot of them are only in clinic for the morning, or just the afternoon, and the remainder of the day is spent reading echocardiograms or in the cath lab. For my level of training they have deemed it appropriate to spend my time in clinic rather than on the hospital floor or in the cath lab. They scheduled one day to be spent with cardiothoracic surgery.

Now, I dig surgery. I dig it a lot. But only in about 2 hour increments. After that, the time spent standing at the table locks up my back and makes my ankles throb. This is part of why OB is probably a good fit for me. Most of the surgeries take under two hours.

Anyway, on this day we did two procedures: a mitral valve repair and a 3 vessel coronary artery bypass. I was braced and ready for a long day, and the ensuing night to be spent curled up in my chair, trying to avoid the residual discomfort. Some things happened that I was not ready for:

1. Me: "So do you give a negative inotrope or chronotrope in order to do this procedure? What's your target heart rate?"
Surgeon: (in Rastafarian accent) "No I do not give any inotropes or chronotropes. I give ice."
Anesthesiologist: "Our target heart rate is zero."
Me: "Oh."

2. Watching the surgeon cut through the sternum with an electric saw, and push the chest apart.

3. Watching the heart lurch about inside of the chest ("lurch" is a more accurate descriptor than "beat" since it's contracting in multiple planes at once).

4. Watching the heart stop when they dump a bowl of ice into the chest, then sitting there dumbly and watching it be still in an open human chest and thinking, "That's not supposed to be that way!"

5. Watching the heart slowly try to start beating again as it warms. It's eery.

6. Holding a beating heart in-hand, while retracting it so the surgeon can attach the vessel graft to the coronary artery.

7. Watching the heart be re-started by DC cardioversion.

8. Watching a person's entire blood volume pulse through a bypass system roughly the size of a garden hose, and feeling that the temperature of the stuff in that hose is warm.

Now I am seated [somewhat] comfortably in My Spot, thinking that I need some Tylenol, but not yet willing to get up and go after it. Tomorrow, it's back to the clinic.