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Erschienen in:
20.09.2018 | Gallimaufry
Gallimaufry
Erschienen in: Indian Journal of Thoracic and Cardiovascular Surgery | Ausgabe 4/2018
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1.
In Dr. Denton Cooley’s unit, the infectious disease guy was saying that they were having problems with Serratia marcescens infection. Dr. Cooley said, is that the Mexican resident we just hired? Let’s fire him!
2.
At the Henry Ford Hospital, at the Vascular Surgery Department, we had a system where we would call all our post op patients for follow-up angiograms and all their angios pre-op, post op and chest X-rays were put up for review. One of the patients who had an aorto-femoral bypass was a heavy smoker. Though his graft looked good, his chest X-ray showed a mass in the right lower lobe. In retrospect, it was evident on the X-ray taken 6 months ago also and we had missed it. The Chief was very upset and said that we should have taken care of the lung lesion first. The chief resident said that it wasn’t so bad after all as the patient could now walk and walk by himself to the radiation department for his treatment.
3.
Dr. Denton Cooley, after he finished his surgical residency at Johns Hopkins went over to Guys Hospital in London for a Registrar’s post. In those days, the Thoracic and Cardiovascular Department did all the lung resections etc. Lung diagnostic procedures were done by rigid bronchoscopy. It was not easy to do bronchoscopy on an awake patient despite local anaesthesia. The operating room orderly saw the difficulties Dr. Cooley was having with doing a bronchoscopy. He finally got so tired, he said Doctor, just hold the bronchoscope steady and I will thread the patient on the bronchoscope.
4.
MID CAB—Minimally Invasive Direct Coronary Artery Bypass Surgery: As the cardiologists were getting more and more involved in angioplasties, a few surgeons led by Mani Subramaniam thought they could do a coronary artery bypass surgery (CABG) by small left anterior lateral thoracotomy dissecting the internal mammary and putting it on the left anterior descending (LAD) coronary artery. All of us thought that it was a good alternative to angioplasty of the LAD. All of us surgeons started doing it. The only problem with the procedure was herniation of the lung as we could not approximate the costal cartilages. So in one of the conferences, Dr. Cooley said it was a fine operation. One of the patients came back and was asked how he was doing. He said he felt fine, just that when he coughed, his cigarette packet in the shirt pocket popped out.
5.
The parallel heart: In the late 1960s, we were experimenting with heart transplant. In this procedure, we did not take out the recipient heart but put in an additional heart. We could get a few animals to survive for a day or two and it was interesting for the cardiologist to read the electrocardiogram (ECG) with 2 hearts beating. This was graphically brought forward by Dr. Christiaan Barnard when he had to operate on his son’s teacher who needed a heart transplant. The operation didn’t work out and the patient died on the operation table. So when he came out and told his son that the operation didn’t work and the patient did not survive, his son said, why did you have to take out his heart? At least he was living. You could have just supported him with another heart and he showed him ECGs of two hearts beating in a patient.
6.
Smart as a pig: In 1968, in Salt Lake City, we were doing an aortic valve replacement. At that time, coronary artery angiograms were not routinely done before valve replacement surgery. No cardioplegia was available and we used to use a direct coronary cannulation by the Spencer Mallette coronary perfusion catheter. The blood was taken out with a Y connecting from the arterial line. Most of the time, it gave excellent myocardial protection. But this day, in spite of a technically perfect procedure, the heart would not beat when we tried to come off bypass. We tried several times without success and we could not understand why the hell the heart was not beating despite all our tricks. Dr. Nelson said, in times like these, we feel like a pig looking at the wrist watch and wondering how the damn thing works. Unfortunately, the patient passed away and on the autopsy, we could see there was early bifurcation of the left main and the coronary perfusion catheter had gone into the Circ leaving the entire anterior heart unprotected.