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.
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.
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.
*from The Edwin Smith Surgical Papyrus, Vol 1: Hieroglyphic Transliteration, Translation and Commentary.
OOOOOOO neeeeee … dis waarom el liewer ‘n onderwyser geword het. Hou verby maar my hoed af vir julle!
Oooh! You had my heart racing for a while there! What an experience!
It was!!! I think my heart was racing the entire time, too.
OMG ! This is beautiful !!!
This is why we crazies go into this field.
Yep – we certainly chase that high 🙂
This is a beautiful post. I’m reminded again, why I choose Medicine.
Such important moments to keep us going!
Thank you, Megz. This is almost unbearable – beautiful, sad, moving, joyous. To hold a heart and save a life, thank you.
btw, do you want Lissa Rankin’s most recent book on doctoring? If so, just email me with your post address and I’ll send it your way.
I’m glad you liked it! Sorry for not replying to your email yet – I’ll get on it!
This is seriously powerful. flip. Thanks for sharing.
Oh, I’m glad you enjoyed it.
Gosh I just found your blog and I am absolutely in love with it! This article is wonderful.
You might be interested in what I have just started *Cue shameless marketing* Dear South African Doctors
So awesome to meet you – and I’m happy to encounter your blog, too!
The first time I touched a beating heart was truly fascinating. It’s something 99.99999% of people will never do and you’re right. It’s astonishing how dually strong and fragile it is. I can’t say I ever want to have to do it again, but in a way, I’m grateful for the experience. I’m glad this case went well for the patient. Intern year is unforgettable, right?
Reading this during my Cardio block in second year and realising that this is the stuff dreams are made of, well the beating strong heart that is. Amazing post, so motivational.
Abongile, I’m so glad you found some inspiration here. Keep going. By now you’ve gone through cardio and you’re on to the next thing. Medicine is a hard world, but also rewarding, and beautiful. Be amazed. And look after yourself. ❤