I HATE when this happens

George K · "Now look here, you Baltic gas passer... " - Mik, 6/14/08

Yeah, I posted it, mostly, for @bachophile and @jolly.

I've been there, and I HATE when it happens.

You've spent the last 4-5 hours on a patient who's sick as hell. You've been able to wean him off the pump (heart-lung machine) and he's on a ton of meds to stimulate the heart and keep the BP up. It usually takes about 45-60 minutes to close. And then, when you close the chest, and by doing that, you compress the heart...which just can't pump any more. Things go to hell, and you re-open.

As much as I enjoyed heart surgery, it was these cases that made me question my tastes.

taiwan_girl

@George-K (and @bachophile and @Jolly)I am always amazed by your abilities

George K · "Now look here, you Baltic gas passer... " - Mik, 6/14/08

bachophile

Vasovagal. Why? God made us that way.

George K · "Now look here, you Baltic gas passer... " - Mik, 6/14/08

@bachophile said in I HATE when this happens:

Vasovagal.

Didn't see it too much, if at all, during cataract surgery. There's little, if any, pulling or pushing on the globe during the procedure. In the dark ages, when the eye guys would do retrobulbar blocks (look it up), it was more common.

However, if there was any muscle work being done, like strabismus surgery in pediatrics, it happened frequently.

Also, I saw it at least once, during an enucleation.

Jolly

@taiwan_girl said in I HATE when this happens:

@George-K (and @bachophile and @Jolly)I am always amazed by your abilities

Nah, George is pitching above my league. But the heart message story is pretty neat. I've only been around once when that happened (in the ED) and the patient didn't make it. My flawed understanding is that the patient rarely makes it.

George K · "Now look here, you Baltic gas passer... " - Mik, 6/14/08

@Jolly said in I HATE when this happens:

But the heart message story is pretty neat.

I loved working with this heart surgeon. He was an accomplished pianist, read a TON of books (mostly fiction). He never, ever, lost his cool and had remarkably steady hands.

He retired about 4 years ago, and had an intracerebral hemorrhage about 16 months ago. He was alone in the house, fell to the floor, hoping to not die. He spent a long time in rehab, and after about 8 months, was able to play "Spinning Wheel." He ultimately sold his Steinway...

A bunch of us geezer docs had lunch back in December. Heart surgeon is driving and now independent. He returned to golfing as well. He has a bit of a limp and a bit of a facial droop, but he considers himself lucky.

At the table are a general surgeon, an ENT, a heart surgeon, a urologist and a gas passer.

These guys were my friends. My partners? Not so much.

George K · "Now look here, you Baltic gas passer... " - Mik, 6/14/08

By the way...

This surgeon, though extremely talented, was not particularly liked by the cardiologists.

Seems that he had really good judgment as to who was a good surgical candidate and who was not. If a cardiologist approached him to do a CABG and mitral valve replacement on an 88-year-old in heart failure, he would refuse the case. With all the comorbidities, etc., the chances of a good outcome were slim.

Then, when his group's contract was up for renewal, the hospital didn't renew it, and they brought in another, more aggressive, group. These guys would, as we used to say, operate on anyone who could fog a mirror.

Guess what happened? Yup mortality went up.

Cardiologists didn't give a rat's ass, because the mortality statistic was surgical, and not on them.

Such is hospital politics.