Scrubbed by Nikki Stamp

Author:Nikki Stamp [Dr Nikki Stamp]
Language: eng
Format: epub
Publisher: Allen & Unwin
Published: 2022-03-21T00:00:00+00:00

CRITICAL REFLECTION QUESTION

What do you observe about the life of a cardiothoracic surgeon in this case study?

I was enjoying my weekend, amazingly not at work. I was actually on a day off—although with heart surgery, there isn’t truly ever a day off. Phone calls or text messages still come through, asking questions or keeping you updated on your patients. Sometimes, you get called in to operate for an emergency or because one of your patients has an issue. Whatever the case, I was never far from my phone. The only time that my phone was really turned off was when I was on a plane, a brief, sweet respite.

The other reason I’d get messages was when something big was happening at work. I think because we’re all borderline obsessed with our jobs, we like to be kept abreast of anything and everything that’s happening, whether it involves us or not.

‘There’s a 40-year-old woman going on to ECMO. Massive LMCA infarct,’ read the message from my registrar.

There are three main coronary arteries that supply blood to the heart: the right coronary artery, and the left main coronary artery (abbreviated to the LMCA), which divides into two other branches called the left anterior descending and left circumflex. The left main supplies blood to two-thirds of the heart, and when a heart attack involves blockage of that artery it’s nicknamed the ‘widow maker’, since it can wipe out most of your heart very quickly and result in certain death.

A young woman really shouldn’t be having a heart attack so big that her heart fails so badly that she needs ECMO, where the patient is connected to a long-term heart-lung machine. ECMO is the crème de la crème of life support, taking over the work of the heart almost entirely.

It turned out that the woman had a condition called spontaneous coronary artery dissection (SCAD), which tends to happen in young women. The inner lining of the artery just tears spontaneously for reasons we don’t quite understand. When this happened, it fully blocked the blood supply to the entire left side of her heart. She was absolutely fine when all of a sudden she felt faint and sweaty and immediately knew that something was terribly wrong. Her husband threw her in the back of the car, not wanting to chance it for an ambulance (while it turned out to be a good call in this situation, I’d never normally advise this) and, as they pulled up at the hospital, not even five minutes away, her heart stopped. The ED flew into action and, happily, a short burst of CPR got her circulation going again. But what she really needed was her heart fixed so she was raced to the cardiac catheter lab, where heart diagnostics and emergency stents are done, where they tried to treat the massive heart attack.

The cardiologists worked for hours trying to open up her blocked artery but were unable to. And her heart was limping the whole time, barely able to carry on and sustain life.

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