otra cirugia (another surgery)

Today I returned to the Hospital Publico Maternal Infantil for another cardiovascular surgery.  This time the surgery was for a 13 year old girl who had an atrial-septal defect, that means a hole between two sides of her heart that serve as a kind of reservoir for blood. (Not the ventricles which do most of the pumping.) 

Unlike last week, this girl had a nearly fully grown heart.  I was blown away by what it looked like while it was moving.  When we are taught about the heart we are taught that the electrical impulses that cause contraction, move through the muscle in a particular pattern, but then when we talk about the heart pumping we almost describe it as a uniform stiff strong contraction.  For me this is not what it looked like at all.  For me her heart wiggled and danced with waves of motion that were so soft and elegantly coordinated.

The surgery required temporarily bypassing her heart using a blood pump.  As soon as the bypass was complete her heart almost looked deflated.  The heart is meant to be dynamic in size so it can effectively pump what ever blood comes its way.  With out blood flowing through her heart, it shrunk to less than half the size from before.

Next, in order to operate, they use a special "blood substitute" into the coronary arteries. This literally stopped her heart. They were then able to open her heart (by cutting into the right atrium) and sew closed the hole between the atria.  I was taking turns in the good viewing spot at the patient's head with the anesthesiologist.  At first when I saw them sewing the defect closed it looked like they were sewing up a valve.  I was not expecting the tissue to look like that, although it makes sense. (Sorry non-med people, you'll just have to trust me on this.)

The actual repair of the girls heart took, maybe, 5 minutes.  It was over so quickly I could barely comprehend.   After they finished and her blood was successfully returned to her own circulation, they continued to clean up and close up.  The thing that struck me during this process is that the free edge of her right lung kept moving in and out of the scene.  The way it moved reminded me of waves lapping at the shore.  It expanded into view and part way over the heart and then receded again with each breath. 


In case you haven't noticed I am trying to capture things that I find amazing and beautiful that I am sure I will loose sight of in in time.  The intimacy and trust in the OR and the view that it gives me of our bodies is something special. I am sure I will continue to appreciate this at some level, but I am also sure the novelty will wear off and I might forget how beautiful a heart beat is.