-
2. How It Comes About That a Successful Operation Ends in Disaster
- Temple University Press
- Chapter
- Additional Information
2 How It Comes About That a Successful Operation Ends in Disaster Somehow, the phone is in my hand. My eyes fight to focus on the aquamarine numerals of the digital clock that sits on the chest by the bed. I work to make sense of the time. It’s 2:24 and it’s dark and I didn’t hear the phone ring, although I know it must have, and I recognize the voice of the intern. He’s excited, disjointed, worried, and, worst of all, frightened. My sudden awakening and the disorganization of his thoughts which are virtually pushed into my ear by his anxiety make the tale hard to understand, but I know something very bad has happened. At first I don’t even know which patient he’s talking about. But he’s calling about Joe Santo, a thickset 51-yearold , whose left kidney had developed a cancer, which had (unusually, astonishingly) grown right out his back, pushing through the lowermost ribs so that he actually had a skin-covered lump there. It was the size of a grapefruit. Usually a cancer in the kidney “presents” with blood in the urine. Not this one. This one announced itself as a bulge in the back. 24 Two days ago I had removed the tumor, the kidney and the ribs—the whole “mass” was about the size of a football. This left a big hole and the skin would not come together to close it, so, a plastic surgery colleague swung a muscle flap over to cover the crater. To do this, he took muscle and skin from the back of the patient, preserved its blood supply , burrowed a tunnel underneath the skin and moved the muscle over to the left and closed the hole. A skin graft was placed over the “donor” site from which the muscle flap was mobilized. Mr. Santo would be left with some loss of strength in his shoulder, but the disability shouldn’t be too bad. This operation took almost six hours and we lost a fair amount of blood—not uncontrolled bleeding, but a steady ooze from the tumor’s “feeding vessels” so that, in the end, we gave him four units of blood. He seemed to do well after the operation. He was awake and alert. We were able to take the breathing tube out of his trachea the next morning. The wounds looked good and his remaining kidney functioned well. I was tired the next day but I had that good tired sensation. I felt fit when I saw him and spoke to his family again in the morning. I felt we had accomplished something. He had a pretty good chance, we all felt. So what’s the matter? “Slow down,” I say to the intern. He reports that Mr. Santo’s heart sped up suddenly, slowed down and then fibrillated in just a few seconds. A fibrillating heart’s muscle cells contract at random without relation to each other and can pump no blood. The heart just quivers . The chaos can sometimes be controlled by drugs or shocking the heart with a defibrillator. The intern tells me these things have been done, that the fibrillation has stopped and that the heart is beating but not pumping blood very well: he is in deep shock. I repeat the same A Successful Operation Ends in Disaster 25 [3.235.249.219] Project MUSE (2024-03-28 10:05 GMT) questions trying to focus on the problem. I wonder why this happened. Did we miss some telltale event earlier? Should we have done something differently? “What was he like this evening. Before this, I mean”? I say, trying to sound coherent, in charge. “He was fine. Good urine output. Good oxygenation of his blood. Normal blood chemistries were measured at 6 P.M. Stable blood pressure. He had some pain, but it was easily controlled with narcotics.” “How much morphine did he get?” I ask, wondering if too much might have depressed the activity of his heart. “The usual dose.” The list of causes of sudden shock or death after an operation is short: • internal bleeding • a collapsed lung • a heart attack • a blood clot which has broken loose from the legs or pelvis and lodged in the lung circulation, obstructing outflow of the blood from the heart to the lungs. Since all the blood pumped by the heart must traverse the lungs before it can be pumped out to the...