A TALE OF A STABBED HEART

SETTING: medium-sized semi-urban hospital in the Eastern Province, South Africa. ORIGINAL story at https://barefootmeds.wordpress.com/2015/10/28/under-thy-fingers/ ALSO, I'm participating in NaLiWriMo with @margosita soooo if writing a novel is a bit much and you're addicted to lists, join us ;) NALIWRIMO LIST APPERS
  1. I am on call
    For twenty-four hours, every case that comes in, admitted or not, is "mine". But I'm just an intern? Even better.
  2. The ward round is interminably boring
    Contrary to popular belief, our surgical wards are populated with rotting legs and terminally ill patients. They are awaiting surgery or social worker optimisation and their care takes a lot of time, but there is little exciting about it.
  3. 11h03: One phone call
    The nurse in the ER: "Doctor you must come quickly, we have a stabbed heart." I know it's serious because she doesn't say "doctor" in quotation marks. (People do that okay)
  4. I promise to come immediately
    Because in med school they said, "If there's a stab heart, you RUN." They neglected to say where to.
  5. Self-doubt
    While I run to casualty I ask myself, "What do you do for a stab heart again?" I've dealt with hundreds of simple stabbed chest but this is my first heart.
  6. I am not alone
    Thank god. Someone has already put the young man on oxygen and four clinicians are trying to get IV access.
  7. It's a kid
    He is seventeen and was stabbed at school. Clinically, he is shocked. I remove his shoes and they are filled with his own urine.
  8. Bureaucracy is a bitch
    So much time is wasted opening a folder and all the nitty gritty paperwork. Ideally we'd want to open his chest within half an hour. Theatre is ready. The anaesthetist is ready. Blood products aren't ready because we can't order without a folder FFS.
  9. He is holding but not stable
    The kid is healthy enough that he can hold on, but his pallor, low BP and bulging neck veins scream CRACK MY CHEST NOW!
  10. 11h55: "It's your patient, you're scrubbing in."
    I actually kinda hate surgery but this is a little different. I had never been so happy to scrub in before.
  11. Multi-tasking
    While the anaesthetists secure their arterial and central lines, I get a chest tube in. His haemothorax drains 300ml.
  12. Let's open this chest
    We forego meticulous periosteal stripping in exchange for time. Our hospital doesn't have pneumatic or oscillating saws, so we use a sternotome. It's messy business.
  13. The pericardium is not penetrated...
    Or is it? We divide it just incase.
  14. BLOOD!
    So much blood. Good call.
  15. I TOUCH A BEATING HUMAN HEART
    And I swear the world stands still. I've held human hearts before, but never warm and electric and alive. I think I might cry.
  16. But time continues
    And the little heart spurts blood from a 2cm wound in the left ventricle.
  17. Two tiny stitches repair the defect
  18. 13h37: chest closed. Our patient is taken to ICU still intubated.
    You try breathing independently when your chest was just sawed in two.
  19. Two days later: he is doing so well that he is extubated
    But he will remain in a high care unit for a while. His drains are still draining a bit too much for comfort.
  20. We all have our career affirming moments
    I'm certain this was one of mine. Perhaps my first.