My First Heart Transplant

7.17.2013

 

Greetings from Columbia University Medical Center: TAKE 2

 

Luckily today was a more successful day.  I CAN SAY THAT AGAIN. Excuse my lame humour. Upon arriving at the hospital, I texted Dr. Singh in the hope that I could get situated immediately and begin work.  False. He informed me he was in a meeting and that he’d get me when he was done.

 

In the meantime, I sat reading my book.  I decided, “perhaps I should try to obtain my Columbia ID now,” and walked to the office, but was essentially turned away because I did not have a “Uni ID.”  Figures, eh? I walked back to the heights caf, munched on a chocolate bar, and began to read again, living the intern life.  Then I got a second message from Dr. Singh that read “there is a heart transplant at 10:30 that you should see”. 

 

It literally took full effort for me not to reply “YES, YES AND HELL TO THE YES!!!”  Instead I typed something along the lines of, “Sounds good! Let me know where to go”

 

By 11:30 I had changed into scrubs and was in OR 22. I soon learned that the heart was flown in at 4:30 am that morning from the donor and the surgery truly began, including all preperatory phases, at 8 am. Unfortunately, I missed the majority of the actual implantation; however, I was able to observe the most intense of the surgical stages.

 

I stood there mesmerized, blood spouting in all directions, staring at a beating heart and comparing it to the X-Ray juxtaposed right by the 42-year old patient and her new heart. 

 

My main regrets were: 1) I should have just found my way to the OR as soon as I learned of the heart transplant and 2) I wish I had known more about the procedure prior to entering the OR. 

 

I arrived knowing that hearts are recieved from deceased or neurologically dead donors, but that was essentially the extent of my knowledge.

 

Luckily a PA (Physician’s Assistant) noticed my futile attempts to comprehend the steps of the operation and began explaining the pre to post- operative procedures to me.  Once a donor heart is recieved, it is often inspected to ensure accuracy of blood type and overall reliability. The patient recieving the heart is provided medication to suppress the immune system, as implantation of a new heart would activate such cells as lymphocytes that view the donated heart as foreign and potentially activate the immune system to combat the organ.  The operation begins by slicing open the sternum, followed by the pericardium, where the body’s main blood vessels (i.e. aorta and vena cavas) are dissected so that the patient can be temporarily attached to bypass to allow for continuation of blood and oxygen circulation throughout the body.  I’ll spare the great details, but the donor’s heart, which had been packed in ice for adequate preservation, is cut to fit onto the remainder of the patient’s left atrium wherein the blood vessels are consequently sutured back into their positions (this is the point at which I walked into the OR). The patient is then taken off of cardiopulmonary bypass and then the thoracic cavity is sutured and, in this patient’s case, stapled, back together.

 

Fun fact: Kelly Perkins, who receieved a heart transplant in 1995 while her 30’s, was the first one to mountain-climb up multiple peaks, including that of Mt. Kilimanjaro in 2001!

 

Thank god I had a PA there to explain the nitty-gritty details of the procedure.  Everything in the OR is sanitary. At one point I accidently grazed a blue tissue and all of the tissues then had to be replaced.  Also, even your backside is considered to be unsanitary.  Wow, what a change from Africa: from one end of the sanitation spectrum to the other.  The PA advised me of how nice her job is as compared with surgeons, because she essentially gets to do what surgeons do without having to undergo the long years of med school and training.  At that point I realized that I had to either become a surgeon or not enter the medical field at all.  Why?  Because I’m obstinate and desire to undertake the glory of conducting a successful cardiac operation or the predominant responsibility that comes with an unsuccessful procedure. 

 

Cardiac surgery is tough; physically, mentally, emotionally. My boss, Dr. Gopal Singh, a thoracic surgeon, was on call with cardiac surgeons 26 times last month.  He barely slept and brought a sleeping bag to Columbia University Medical Center because on the off chance that he wouldn’t have to fly to Texas to obtain a heart, or assist in a pulmonary transplant, he took naps at the hospital.  This field of surgery definitely does not go hand-in-hand with developing a family and more domestic life.  Nonetheless, I think this is a challenge I can take on. I’d rather be saving lives than sitting on my ass all day behind a computer screen, or playing chauffeur with my future (?) children. I need to fulfill my role and be the best person that I can be.  It truly is all or nothing.

 

Approximately only 2,000 cardiac transplants are performed annunally, and the fact that I was able to observe and slightly assist with such a procedure today is a phenomenal opportunity for someone like me, who dreams of becoming a successful cardiac surgeon.