10th
Peds Cards
So much to say, so little time till my ride to the beach gets here :)
I’m back home in San Diego, where the weather is sweet and the shadowing opportunities—thanks to a family legacy of doctor-dom—are even sweeter.
Today at Rady Children’s Hospital in San Diego I witnessed a catheterization on a two-year-old, open-heart surgery on a 19-year-old, and the long-term care of a bunch of babies born with half a heart whose heart was then “built from scratch” surgically. It was an eventful and good day.
What follows are my random, disconnected observations on the whole experience.
First off, let me share an important realization about pediatric cardiology, some dots I had yet to connect previously. Namely, pediatric cardiology by nature deals with kids with congenital heart defects. That is to say, they were born with a heart that is mal-formed or doesn’t work properly. (I mentioned the “half-a-hearts”—there are also children born with hearts that are “mis-wired.”) Cardiologists, by contrast, deal with adults whose hearts have aged and otherwise been damaged by time and cheesburgers, but were (probably) A-OK to start with.
Second, let me say that these are my observations, and that I often don’t know the correct medical terminology. Moreover, though I was positively awed by many of the experiences described below, sometimes I didn’t know what exactly was going on—at least at every step of the way. And that’s OK…medical school (and residency and fellowship…) is four years for a reason!
Third, how did a young pre-med have such a cool opportunity? Answer: my parents, who live in San Diego, are doctors and they were able to arrange it. I’m not bragging; I just feel like I ought to explain to other pre-meds how I was able to hook up this opportunity.
On to the meat of the matter…
Let me discuss the catheterization a bit. I had witnessed one catheterization in the past but was not pre-med at the time and thus did not appreciate it. A couple of notes this time thru: first, a “sheath” gets put into the vein—a vein which goes from your groin all the way to your heart. (Yes, the sheath, and all the stuff that comes later, is inserted through the groin. If you feel around down there you’ll pick up a pulse, too, btw.) Next, through that sheath, goes the catheter, which is basically a wire. After that comes the balloon. Now some balloons are meant to crush the cholesterol and plaque in a given artery—in the attempt to avert a heart attack or similar. In this case, in a child with a hole in her heart (ASD), the balloon’s pressure was much lower, the balloon was in fact shaped like a dumbell, and with the thin/middle part actually *expanding to fill the hole.* To what purpose? To measure the size of the hole, so that subsequently, little ($10,000) mesh mechanical disks can be implanted—again via catheterization—which will epithilialize; that is to say, eventually be grown over with tissue, closing the hole. Cooooool beans. One thing to note about this case was that, post-op, the young girl lost the “p wave” part of her normal heart rhythm, as indicated by an EKG. But this righted itself after a few minutes.
The next thing I saw was an open-heart surgery. It was *remarkable* to behold. Honestly, I didn’t really know what was going on. All I know is that that Nine Inch Nails music video with the beating heart is pretty much what open-heart surgery looks like. The procedure was to replace a nineteen-year-old’s aortic valve.
I saw this big pulsating whoopie cushion of a thing—the heart—amid two flanks of roast beef (the chest walls). It was the most visceral thing…I want to be a surgeon. Aaaaaaaanyway, I also learned why Obamacare wasn’t going to work from the Chief of (cardiothoracic) Surgery…haha. His thesis was right on but could certainly use some support! I should mention that I scrubbed in on this procedure an was directly above the pulsing heart. I should secondly mention that at one point the pulsing heart ceased pulsing—by design. Then a perfusionist stepped in to essentially continue the cycling of oxygenated (and now, cooled) blood throughout the body after the heart was stopped.
I also had an interesting discussion with the anesthesiologist. His quip about Michael Jackson’s untimely demise? “Never hire an a cardiologist to do an anesthesiologist’s job!” (Michael Jackson likely died of an overdose of propofol, a new-fangled anesthetic. It was administered to the King of Pop by a cardiologist.)
I closed the day out with rounds. Here I saw the long-term maintenance—with diuretics like Lasix and anti-platelet treatments like Plavix—of the tiniest little cardio patients you’ve ever seen. Many (a remarkable amount) were born with half a heart. Those hearts are then converted into full hearts via a number of surgical procedures, which I find positively remarkable. That said, the long-term prognosis is unknown from this new procedure. Note though that the long-term prognosis for having half a heart is not good either!
More later? I didn’t even talk about the half of it. But my beach ride is here! Catch you all lataa~!
