On my final week of surgery rotation, my last scheduled OR case was a tracheostomy wound repair. It was a relatively simple procedure, as it didn’t involve an invasive exploration of the thoracic or abdominal cavities.
During an idle moment around the operating table, I mentioned my first-ever OR experience to the scrub tech.
“It was a heart transplant,” I said. “The room was so calm and quiet, even into the early hours of the morning. It was almost… a spiritual experience.”
The attending surgeon looked up from the table as the resident continued to stitch.
“A heart transplant is a nice operation,” he said. “Easy and clean.”
“Easy?” I repeated.
“Yeah,” said the surgeon, shrugging his shoulders. “It’s all about connections. Blood flows through a pump. Now, liver and lung transplants, on the other hand…”
Soon, the operation was complete, the patient was taken to the recovery area, and that was that. I tried to remind myself that the case I had just seen might have been my last-ever surgical case in the OR, depending on what field of medicine I eventually decided to pursue. I found it hard to believe. It couldn’t be true.
That afternoon, however, I was invited to visit an open-heart triple-bypass procedure for the following morning, and I jumped at the opportunity.
The surgeon saws into the sternum, through an inch of solid bone, and it all begins. I stand there by the patient’s chest, gazing into its depths.
“Are we at the pericardium yet?” I ask, referring to the yellow layers of tissue that the surgeon slices with his electrosurgical knife.
“No,” he says. “These are fat layers. You’ll know when we get there.”
He dissects the last layers of yellow, and the first thing I see is the right atrial appendage, recognizable as the flap with indentations at its edge. It beats on steadily, without faltering, like a bird’s wing in flight. While the surgeon takes a short break to check on another patient, I simply stand there, balancing on the step-stool, mesmerized by the mystery in front of me.
Later in the procedure, I watch as the surgeon and the first assistant pour crushed ice onto the heart. The monitor flatlines, declaring “ASYSTOLE” in capital letters. Two long, winding tubes – one bright red, the other a deep burgundy – drape over the side of the bed and connect to the massive contraption known as the cardiopulmonary bypass (CPB). I try to fathom how all of this man’s blood could be flowing past my knees.
After the grafts have been sewn into place, bypassing the blocked arteries, the surgeon asks for warm blood from the CPB. He places a pacemaker to shock the heart back to life. We watch as the flatline on the monitor morphs into a rhythm we recognize. Inside the chest, the heart is beating again.
I ask, “May I touch the heart?”
The first assistant seems surprised at first, but then she says, “Of course.”
And for the first time, I do what I’ve dreamed of doing ever since I saw that heart transplant nearly two years ago. I reach inside this man’s chest and rest my hand on his heart. It’s warm. My fingers pass over each of the parts in turn – first, the right atrial appendage, then over the ventricles and the border of the left atrium. The attending surgeon encourages me to try the ascending aorta. It feels firm to the touch, just a bit more malleable than cartilage on a chicken drumstick.
“It’s beautiful,” I whisper through my mask, my palm rising and falling with each heartbeat. “It’s so beautiful.”
See also The Operating Room.