Day 6: Operating on the Sickest Patient

On Friday, October 26, Niloo Edwards, MD, head of the division of cardiothoracic surgery at UW Hospital and Clinics, joined a Wisconsin delegation that journeyed to the Dominican Republic, there to spend a week providing free cardiac surgery to indigent residents in Santiago.
During his stay, Dr. Edwards and other surgeons operated on 11 patients, survived hurricane conditions and gained a greater perspective on health care in Latin America. The following is Day 6 of Dr. Edwards' blog of his experience. Return to Dr. Edwards' Blog: Day 1
Day 6: October 31, 2007
The patient we are doing today is the sickest of the group: The pressures in her lungs are almost as high as her blood pressure. (That's about 4 to 5 times higher than normal). The back pressure from her heart is so high that her liver is huge and she has signs of cirrhosis – liver failure.
Nonetheless, we decide to treat her, and I sign up to do her operation – more out of hubris than ability. We lay her on the operating table to put in an IV and she goes into acute heart failure.
Jose is good and quick – he gets her asleep and a breathing tube in her lungs in minutes; then he leans over to me and softly asks, "Do you really want to do her surgery?" I am having second thoughts, as well, but I know that this is her only opportunity. So I spend 10 minutes putting in the arterial monitoring line - by then, she has settled down and I have convinced myself I can get her through this.

She needs her mitral valve replaced and her tricuspid valve repaired. MacGyver has everything set from yesterday's planning session and it works like a charm. No leak. Surgeons are fond of the saying, "It's better to be lucky than good." Aside from the quick shower from the leaking ceiling things went without a hitch.

The Wausau team has a difficult triple valve (aortic, mitral and tricuspid). They breeze through their operation; they are clearly hitting their stride. Even their visitors notice; when I go in to see how they are doing I notice that the number of pigeons on the window sill has increased to eight.

The patients from Monday are well enough to go to the floor, but Bob warns against sending them out because there is no air conditioning and very limited nursing care outside the seven beds in the ICU, but tomorrow we will have to start sending them out to make room for the new patients.
Jake, Ivonne and Jody at dinner, after a long day at the hospital
PHOTO (above): Jake, Ivonne and Jody at dinner, after a long day at the hospital
Dinner is at an Italian Deli. The food is outstanding. We are eating tiramisu when the cardiology chief arrives. He apologizes for coming late but he was in the catheterization lab with a 36-year-old young man who just came in with a heart attack. He was unable to open the blocked blood vessel.
Bob, Fritz and I decide we should do his operation emergently, but the cardiologist tells us we will have to wait until Friday because the patient has to get blood ready for the operation. This means he has to find friends and family with the same blood type to donate. We agree to do him on Friday.
Fritz's patient for tomorrow has an elevated white cell count and we are worried she has an infection, so we move my patient from Friday for Fritz to do tomorrow. I will do 2 operations tomorrow if the white cell count comes down overnight, and this will open up a slot for the young man on Friday.
Go to Dr. Edwards' Blog: Day 7