The Time Bomb: Epilogue
In my last post, I described the frightening story of a patient who was diagnosed with an aortic dissection and whisked away by airlift to a Super-Hospital for treatment. Due to the demand of all and sundry who have threatened to lynch me if I did not tell the rest of the story, here is the rest of the story, as far as I know it.
The patient faced a truly brutal and frightening surgery. I had it described to me by a nurse who has sat in in one, and here is my best attempt to relate it. Anyone out there who knows more, feel free to correct me because this is all brand-new turf for me. But here is the bare-bones version.
The patient's body temperature is cooled down to 60 degrees- at which point the brain is nearly completely inactive. The patient is then nearly completely exsanguinated in order to reduce the risk of a high-pressure bleedout when the aorta is disrupted. The affected section of the aorta is resected, and a large-bore graft made of synthetic material is carefully and meticulously sewn in. Once the grafting is complete, circulation is slowly restored, while the graft is watched for any sign of a leak. If no leak is found and the patient stabilizes sufficiently, he is closed up and taken to intensive care for monitoring.
Fifty percent of the patients who undergo the procedure die on the table. Of the survivors, a majority end up with renal failure and spend the rest of their lives on dialysis or looking for a kidney transplant. Many suffer brain damage of varying degrees. Some suffer catastrophic embolisms, strokes, and heart attacks. The other side of the surgery is not a pretty picture, unfortunately.
The patient in question made it through surgery. I am told that he did exceptionally well, that although he came out of it all just a little on the "goofy" side, that seems to be resolving. His kidneys were a little slow to get going again, but his creatinine is almost normal. I don't know if he remembers what happened.
But he's alive and doing well. You can all breathe again.
And regarding Nurse Dynamite: She's fine too. She says that this was a case that scared her. And when a veteran like her gets scared about a patient, you can bet that it's a close-run thing.