Tuesday, May 13, 2014

Miracle in the Operating Room

This post conforms to the blog rules. Recently I witnessed a miracle. I was on the Acute Care / Trauma surgical team. When someone comes into the emergency room and the ER doctor thinks they need a surgeon, an AC/T resident is consulted. During the day and even overnight, we operate: taking out inflamed appendices and gallbladders, draining abcesses, debriding necrotizing infections, and repairing trauma patients. Whenever someone comes in with a gunshot or stab wound, or after a car accident, the AC/T team is paged and responds. It can be a very dramatic scene: a dozen people crowding around a person with nasty wounds, urgently managing serious injuries. The role of the medical student in our institution is: A) don't get in the way and B) look like you're trying to help. I usually end up getting the warm blankets and C-collar, putting in a Foley, and then standing around stupidly. Most of the traumas I've been paged for haven't exactly been movie-quality. In fact, some are downright boring: the patient is stable, just has a few fractures, and we roll them to the CT machine and stand around while the images populate with (surprise) the fractures we already knew were there.

But one day, someone came in from a bad, bad accident. He'd been hit by a car as a pedestrian. I got the page while sitting with the residents right outside the door of our last trauma. "Another autoped," I overheard a nurse say. "But this time a head lac; exposed brain."

I raised an eyebrow. "Lac" is short for "laceration," And a cut so bad that the brain was exposed sounded awful. The other day, we had a motor cycle crash, which gave the man a twenty-centimeter head laceration down to the skull. But exposed brain? That was a new level. They wheeled the unfortunate man in, and I couldn't see brain, but I could see lots of blood.

To make a long story short, he crashed in the trauma bay. "Crashed" means "died" in medical slang. He "desatted" (had very little oxygen delivery to his tissues) to 54% (you're at 99-100% reading this) at one point, had a difficult airway to manage, lost blood pressure, we couldn't find a pulse... Finally, the AC/T attending shouted to the bay at large, "I'm doing an ER thoracotomy."

I couldn't believe my ears. I'd read that ER thoracotomies existed, but I had no idea they were really done. But before my eyes, she seized a scalpel and there, in the ER, without so much as a surgeon's cap, she slipped her blade through the skin, a red line of blood springing up as if from a paintbrush. With one stroke, she cut down to ribs, then exposed his heart and lungs. She did open heart massage, and clamped his aorta. Then, just like that (with his chest open) we wheeled him to an operating room. There, I scrubbed in with the attending and two of the residents.

The patient was in a shaky situation. I watched his exposed heart as it beat an organized but thready rhythym. It wasn't enough to generate a pulse, meaning that his brain (and everything else) wasn't getting blood. The attending couldn't even feel a pulse in his aorta. Her gloved hand up to mid-forearm in his body, she shook her head. "I can't get a pulse." After some discussion with the anesthesiologists, she shook her head again. "We're slamming blood and fluids, the aorta's clamped, he's on epi, we gave intracardiac epi... Am I missing something? I'm thinking this is futile." The residents stopped their work in the abdomen.

I looked down at the patient. I had been slipping off spontaneous prayers and and fragments of Hail Marys during the case, because this was the most desperate I'd ever seen a person on the operating table. Now I knew something drastic needed to be done, because this was very likely the day of this man's death. Why had he lasted so long, though? With an injury like this, with a heart like this...why was he still hanging on? Somehow I knew the answer.

"He needs help to avoid hell," I thought. "Who do I ask?" And I couldn't think of anyone for a moment. No saint's name came to mind, even though I scrambled to find one. Then a name came to my mind: Chiara Lubich.

"Chiara," I prayed, "help this man to live long enough to make it to purgatory."


"Oh," I heard the attending say aloud, her hand still buried in the chest of my spiritual brother. "Whatever you guys just did, it worked. I've got a good pulse at the aorta now. Yeah, it's good."

I could barely control my excitement. We all looked down at the heart. It was contracting much more efficiently now, with a confident double "lub-dub," rather than a wimpy "meh." And then people sprang back into action. The residents closed the abdomen and the attending began to close the chest. The aorta was unclamped. Plans were made to transfer the patient to the ICU.

But a change happened after the aortic clamp came off. The heart again began to beat inefficiently. As soon as I saw it, I knew what would happen next. "Thank you, Chiara. That must have been just enough time. Thank you, My Lady; thank You, my Jesus. I trust You." I was full of joy and peace. The patient was pronounced dead shortly thereafter.

As far as I can tell I witnessed--maybe even took part in--a miracle. When you read this, thank God, and pray for the souls of those dying right now.

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