Thank you to my faithful blog readers. And for those who emailed and asked if I could blog more about my day to day life as a surgical resident, this one is for you.
I have never been in a war, but that day I felt like I was in battle. Life and death, the scale was tipping towards death and our whole team knew it. It was all so very unexpected. It all happened so fast. By the time I got involved, the patient, a woman in her early thirties, mother of two small kids was already on the cold hard steel, under the bright fluorescent lights with 4 men crowding around her open belly using everything they had been trained in the art of surgery to save her life.
The morning started like any ordinary 24 hour call for me. Woke up, did my devotion and prayer, prepared for work and then walked my 12 minutes to the hospital. It was a Wednesday which meant I got to dress up in my cute little outfit and wear my heels. The one day a week I actually get to dress up at work and feel like a girl:)
“Where are you?” I texted my partner in crime noting that I had not seen her for a while. She has been more than a colleague, a friend, a confidant, my supporter and cheerleader. Our calls together are usually eventful, if you like drama and chaos, take call with us and you will not be disappointed! It’s as though there is a billboard on the highway that says ‘only the craziest stuff and the sickest patients allowed, no easy patients today.’
“Come to OR 1 NOW, ruptured triple A!” Adrenaline pumping, I left the surgical floor and ran upstairs to my call room to change from my pretty little green dress and 4inch heels into scrubs and my deep pink and blue danskos.
Within ten minutes I was in OR 1. They had already opened the belly and two vascular surgery attendings and two chief residents were scrubbed hands deep in the belly doing all they could to control the bleeding. I assigned myself the task of working the rapid transfuser, which transfuses blood products in a flash. It’s quite uncommon for a young person to have a AAA unless they have Takayasu’s, Cogan’s (vasculitis) or Marfan’s syndrome. She did not fit the picture of any of these syndromes.
A little over 2 hours later, the bleeding was controlled, the aneurysm repaired and the belly left open. (We leave belly open to prevent abdominal compartment syndrome and then close later when patient is more stable).Our patient was transferred to the SICU very unstable and continued to require a significant amount of blood products. She was bleeding from everywhere. She had the deadly triad that signals bad news in very sick patients; coagulopathy, hypothermia and acidosis. I left the unit for a little while to do a case and when I returned about 2.5 hours later, it was reported by the SICU team that she had just had a bloody bowel movement. Badness, not good.
The gastroenterologist fellow and attending were at the bedside with their towers and equipment shortly after they were notified. A bedside colonoscopy revealed black mucosa of the colon (again not good, means dead colon, a known complication of AAA repair). We got her ready and transported her back to the operating room for a subtotal colectomy. She continued to ooze from everywhere even in the operating room. The interns took turns running down to the blood bank to bring blood products. All hands were on deck.
This was the second of two nights I have had to stay at my patient’s bedside for the entire 12 hours! Nurses and junior residents brought me snacks, and the nurse who was assigned did not take a break that night. We worked like a well oiled machine as though we were extensions of each other; each knowing what the other needed and what needed to be done!
80 units of blood products later around 5am everything that was bleeding seemed to stop. Her blood pressure stabilized, her heart rate was not beating rapidly anymore. We sent labs and her acidosis had resolved, she was not coagulopathic anymore and she was warm. We high fived each other, our weary bodies ready to hand over the patient to the oncoming team. I silently said a prayer of gratefulness, we had won the battle this time around.
Our patient did very well and was discharged a few weeks later. I saw her in the office and she looked great. I am convinced you can’t face death head on like that and remain unchanged. Surgery is a team sport, every part of the team is equally important. Its always a pleasure when those patients that you worked so hard to save come back with their families to show off their progress. How often we take life for granted, we aught to be more grateful.