The heart
When I was a little tyke, my sisters hatched a plot to send a Valentine's day card to everyone in the entire world. The idea seemed like a good one, so I joined in. Numbers such as 3 billion had no meaning in our brains. For several days we frantically attacked sheets of red paper, drawing numerous patterns and putting plenty of gibberish on them. In our minds, the heart looked liked a V-shaped thing with more blunted tops than a normal V would have. Eventually the idealistic ambition of the plan fell victim to reality and Mom placed all of the remnants of our project away in some manilla envelope somewhere.
How the heart ever came to be given the shape you see on Valentines day cards, I'll never know. It looks nothing like that in real life. At the beginning of the month, I began my rotation on one of the more amazing services we spend time on as residents. For the months of August, September, and October yours truly is on the cardio-thoracic surgery rotation.
My first experience with heart surgery came when I was a medical student. We usually worked with the chairman of the cardio-thoracic surgery department. He was a short man just barely over five feet tall who was about half as wide as he was high. He was rather dwarf-like in appearance, and had a temper to match. Stories of his wilder temper tantrums were passed from one rotation of medical students to the next, doubtlessly becoming hopelessly embellished with each recounting. However, though the intensity that made him a technically good surgeon also gave him a temper that made the entire OR staff live in fear of his shadow, he was a perfect gentleman to medical students. I have two very vivid memories of time spent with him. The first was being given the paddles at the conclusion of a valve replacement. Having watched him cut a heart apart and then put it back together, he handed me the paddles at the conclusion of the case to shock the patient back into a normal rhythm. Up until that point, shocking someone had been something read about in textbooks and described in lectures. When it came down to doing the actual deed, it no longer seemed quite so simple and straight-forward. However, under his guidance, it all went swimmingly and the patient's heart began pumping away like nothing had ever happened to it.
The other memory I have of him is watching him in one of the more intense situations I witnessed during medical school. I had happened by the post op area to see a sea of frantically scurrying ants. Perched on several stools above them all was this heart surgeon, neck veins bulging, red in the face, bellering out instructions like the survival of mankind depended on it. Apparently one of his cases had gone bad in the recovery room and had necessitated that he open the chest up then and there. I never found out what had happened and whether or not that patient made it. However, the image of him perched on those stools trying to control the process killing the person in front of him while also trying to captain the frantically scurrying assistants around him stuck in my mind. He was the stereotypical cardio-thoracic surgeon.
The rise and fall of cardio-thoracic surgery is somewhat of an interesting event. Several decades ago, the field was in its prime. Only the best of the best made it into the specialty. The reimbursements were among the most lucrative of all medical fields. There was no end of work. Then came the era of angiography. Cardiologists were given the field of cardiac catheterization by disinterested Cardiothoracic surgeons who had no interest in percutaneous interventions. However, eventually these percutaneous interventions became so effective that the procedures performed by the cardio-thoracic surgeons became required much less frequently.
Though they remain the most competent surgeons there are with regards to technical skills, the field has the feel about it of a lion growing too old to hunt slowly growing thiner and thiner. When I was an intern, two of our graduating chiefs specialized in cardio-thoracic surgery. Though both very competent, skilled surgeons, they had a very, very difficult time finding work at the conclusion of their fellowships. Nobody is hiring cardio-thoracic surgeons any more, and those who are do not pay well. Reimbursements for cardiothoracic procedures have been cut almost in half (without being adjusted for inflation) since the 1980's.
Perhaps we'll eventually develop an implantable device that cardiologists can't insert that everyone will need to have, and the field will have another heyday. However, for the time being, very, very few people in my generation have any interest in entering the field. It is too much work for inadequate reimbursement with ever fiercer competition among cardiothoracic surgeons for the available procedures. Having said that though, nothing else I have done during the last 3 years gives me the same level of awe as seeing a heart stopped, taken apart, put back together again, and then restarted to happily pump away as though it was perfectly normal to take a nap from time to time.
How the heart ever came to be given the shape you see on Valentines day cards, I'll never know. It looks nothing like that in real life. At the beginning of the month, I began my rotation on one of the more amazing services we spend time on as residents. For the months of August, September, and October yours truly is on the cardio-thoracic surgery rotation.
My first experience with heart surgery came when I was a medical student. We usually worked with the chairman of the cardio-thoracic surgery department. He was a short man just barely over five feet tall who was about half as wide as he was high. He was rather dwarf-like in appearance, and had a temper to match. Stories of his wilder temper tantrums were passed from one rotation of medical students to the next, doubtlessly becoming hopelessly embellished with each recounting. However, though the intensity that made him a technically good surgeon also gave him a temper that made the entire OR staff live in fear of his shadow, he was a perfect gentleman to medical students. I have two very vivid memories of time spent with him. The first was being given the paddles at the conclusion of a valve replacement. Having watched him cut a heart apart and then put it back together, he handed me the paddles at the conclusion of the case to shock the patient back into a normal rhythm. Up until that point, shocking someone had been something read about in textbooks and described in lectures. When it came down to doing the actual deed, it no longer seemed quite so simple and straight-forward. However, under his guidance, it all went swimmingly and the patient's heart began pumping away like nothing had ever happened to it.
The other memory I have of him is watching him in one of the more intense situations I witnessed during medical school. I had happened by the post op area to see a sea of frantically scurrying ants. Perched on several stools above them all was this heart surgeon, neck veins bulging, red in the face, bellering out instructions like the survival of mankind depended on it. Apparently one of his cases had gone bad in the recovery room and had necessitated that he open the chest up then and there. I never found out what had happened and whether or not that patient made it. However, the image of him perched on those stools trying to control the process killing the person in front of him while also trying to captain the frantically scurrying assistants around him stuck in my mind. He was the stereotypical cardio-thoracic surgeon.
The rise and fall of cardio-thoracic surgery is somewhat of an interesting event. Several decades ago, the field was in its prime. Only the best of the best made it into the specialty. The reimbursements were among the most lucrative of all medical fields. There was no end of work. Then came the era of angiography. Cardiologists were given the field of cardiac catheterization by disinterested Cardiothoracic surgeons who had no interest in percutaneous interventions. However, eventually these percutaneous interventions became so effective that the procedures performed by the cardio-thoracic surgeons became required much less frequently.
Though they remain the most competent surgeons there are with regards to technical skills, the field has the feel about it of a lion growing too old to hunt slowly growing thiner and thiner. When I was an intern, two of our graduating chiefs specialized in cardio-thoracic surgery. Though both very competent, skilled surgeons, they had a very, very difficult time finding work at the conclusion of their fellowships. Nobody is hiring cardio-thoracic surgeons any more, and those who are do not pay well. Reimbursements for cardiothoracic procedures have been cut almost in half (without being adjusted for inflation) since the 1980's.
Perhaps we'll eventually develop an implantable device that cardiologists can't insert that everyone will need to have, and the field will have another heyday. However, for the time being, very, very few people in my generation have any interest in entering the field. It is too much work for inadequate reimbursement with ever fiercer competition among cardiothoracic surgeons for the available procedures. Having said that though, nothing else I have done during the last 3 years gives me the same level of awe as seeing a heart stopped, taken apart, put back together again, and then restarted to happily pump away as though it was perfectly normal to take a nap from time to time.
posted by The Mad Hatter at 12:22 PM
0 Comments:
Post a Comment
<< Home