Under Thy Fingers*

My phone rings while I am taking ward round.

“Doctor, you must come quickly,” says the ER nurse, “We have a stab-heart in Casualty.”

And I run, like they tell you in med school to run for stabbed hearts.

What do you do for a stabbed heart again? I prompt myself as I run.

The nearest cardiothoracic unit is 300km away.

This is what you do for a stabbed heart: you follow the steps.

Upon arriving in Casualty, the seventeen-year-old young man (a child! My brother’s age) is supine, receiving face mask oxygen while several clinicians (two doctors, two nurses) try to get IVs going on his shocked system.

There is no space for me, but I am the surgical intern on call so this is “my” patient.

I start the paperwork to avoid redundancy because the last place you want to be is on the receiving end of a used needle during a resuscitation.

This is what you do for a stabbed heart: you say your ABCs.

(You can say your prayers too, under your breath, if you want.)

You order labs. You fetch the mobile X-ray yourself because the radiographer isn’t running fast enough. You run everywhere because nobody ever answers their damn phones on the first ring.

And then the two consultants look at me and say, “It’s your patient. You’re scrubbing in.”

And I HATE surgery.

Usually.

We start draping the patient before he is well asleep. While the anaesthetists insert arterial and central lines, we stick a tube in his left lung and boy, does he have a lot of blood in his chest.

Then: Incise the skin over the sternum.

Usually one would make an effort with cauterizing bleeders and stripping the periosteum, but nobody is having this child die on them, and it has already taken too long to get him into theatre.

Then: Divide the sternum.

We use a STERNOTOME. Not a pneumatic saw or an oscillating saw, oh no. An old fashioned hammer and chisel, basically. Blood and bone fly everywhere.

You crack the chest. And…

Even though you can’t yet see the heart, you can see what it does. You see it beating like a panicked butterfly behind a thin membrane.

By Michele Parliament, click for source.

Two gorgeous lungs push towards us with every breath. (Our patient is not a smoker.)

You don’t see a defect in the pericardium, but you know it is there.

Then: Divide the pericardium.

Blood gushes outwards.

The little heart beats furiously.

I reach out my hands.

It is alive. It is electric. It is beating and wonderful and I think I might cry.

How different from the cold leathery formalin-infused heart of our med school cadaver.

Hearts are strong and they are fragile, and as we reflect it from its home we see the 2 cm wound in the left ventricle.

One surgeon’s hands repair it, but an entire team has played its part.

By the time his sternum is wired shut, his HB has gone from 5 to 9.

He goes to ICU, still intubated. It is hard to breathe on your own with a cracked chest.

And I am electrified. It is as though my entire career has come into focus. This is the life-affirming moment I hoped for (but did not get) back when I delivered my first baby.

The human heart is strong, and so very fragile.

“Clover Heart” By Fay Helfer

*from The Edwin Smith Surgical Papyrus, Vol 1: Hieroglyphic Transliteration, Translation and Commentary.