2nd
Five Awesome Things Accomplished at Washington Hospital Center Today
I’ve worked out an arrangement to shadow at the Georgetown-affiliated Washington Hospital Center for the coming year. I will (primarily) be taking in the sights and sounds of the echocardiography department there. Here’s what I did today:
1. Witnessed open-heart surgery (again). This is becoming routine! Well, no, not at all, though I can tell it has become that way for the surgeons. Actual conversation overheard: “Should I wait for you to finish before having lunch?” Response: “Yeah, wait up.” Some context helps here: the invitee was someone who was literally sawing someone’s chest open for a later surgeon to operate on. He was going to eat immediately after that.
I continue to be absolutely transfixed by the sight of a visible, beating heart in someone’s chest. It is … mesmerizing.
2. I’m starting to figure out cardiac echos. At least in the “apical four-chamber view,” I know that the right ventricle looks like a triangle, the left like a bullet, the right atrium like an oval, and the left atrium like an oval, too. I know that sounds kindergarten-like, but you trying reading ultrasounds. It’s not like the easy-to-read CT.
3. Sometimes you see a “mosaic” of blue/red on the echo. This represents typically a vessel that has seen stenosis (it’s smaller now). The analogy is to the hose. Sometimes water flows out regularly, in a “rope.” This is called laminar flow and is what happens to blood when the heart is working properly. Mosaic is as if you put your thumb to the tip of a hose, causing the water to stream out at great speeds and irregularly. This is analogous to the mosaic view in the heart and represents stenosis, or narrowing, of a channel there.
4. Some fistulas are “abnormal connection[s] or passageway[s] between two epithelium-lined organs or vessels that normally do not connect.” Sometimes they occur because something didn’t heal right. But sometimes the surgeon intentionally creates one! In dialysis patients, the surgeon creates a fistula connecting an artery (out-flowing, oxygenated blood) to a vein (in-flowing, deoxygenated blood). Dialysis, an artificial way to remove toxins from the blood when the kidneys aren’t functioning properly, can be done through a catheter in the neck. Yet introducing a foreign body (the catheter) to an artery isn’t as safe as introducing one to a vein. Thus, the fistula is created and the vein is used to tap the artery during dialysis.
5. Secured 2009 Halloween costume—scrubs from the aforementioned scrub-in session. Fittingly, I’ll be a surgeon this year. I’ve got the booties, the jumpsuit, and the surgeon’s hat. The only remaining item is the fake blood I will douse myself in. Stay tuned!
