Final Thoughts Prior to Surgery

Quiet Day for Abigail

I’m sitting  here at Abigail’s bedside. She’s has had the quietest “all-natural” day yet. By all natural, I mean the quietest day while not under some kind of sedation.  Of course, it’s 8:18 pst, and she’ll likely be up for the evening in about an hour.  It’s quite funny, actually.  We have had the sweetest nurse, Bridget, a mother of three who you can tell has had years of doing this. She just has the touch.  She keeps volunteering to take care of Abigail each day, and she’s been on duty for the last three days.  But curiously, we haven’t had anyone volunteer for two consecutive night shifts with Abby!  Apparently, the drugged babies are much  easier to take care of as opposed to the un-sedated, hungry babies.

They are giving Abby about 10 Ccs of milk every 3 hours.  She is receiving most of her nutrition from the IV that is inserted into her belly button.  The doctors understand the benefits of breast milk (so much so that mothers who pump receive a meal voucher for the cafeteria as an incentive to pump), so they have been slowly introducing the milk into Abigail’s diet.  However, they don’t want to give her too much because they are afraid that having to digest too much food will consume valuable oxygen.  She, of course, can’t nurse for the same reason--too much hard work!

A Description of Tomorrow’s Surgery

The faint of heart may not want to read the following entry.  But for everyone else, you may find this fascinating.  We met tonight with the surgeon’s assistant (we haven’t yet met Dr. Reddy, which to me is a good sign--if he were terribly concerned about the outcome, perhaps he would want to meet us prior to the surgery).  His assistant explained the procedure. I will give you my English-major, mortgage-banker, laymen’s version of it.  For anyone with a real grasp of the vocabulary and anatomy of the heart, please feel free to correct me (or just don’t tell me and let me go on thinking that I’m smart--after all, I did stay at a Holiday Inn Express last night).

They will begin my making an incision into the skin which will expose the sternum.  They then take a saw and cut down the middle of the sternum (I assume from top to bottom).  I also assume that they do this so that they can open the rib cage to gain access to the heart.

The first thing they will do in relation to the heart is the open the protective sack around the heart, the pericardium.  Once inside, their first objective is to remove the blood from the heart and stop it from beating.  What??  Are they crazy?  They are going to stop her heart from beating?  It actually never dawned on me before three ago that they would need turn the heart off to fix it.  I guess not doing so would be analogous to an auto mechanic trying to repair an engine while the car’s on.

They call that a heart-bypass, a term I’ve heard for years, but have never took a second to understand what it really means.  They will hook a machine up to the valve in her heart that lets new blood in from the brain and body. That machine will then take the blood before it gets a chance to enter the heart, and then run it through a mechanism that oxygenates the blood, replicating what the lungs do.  This heart and lung bypass machine essentially takes the place of the heart and lungs during the surgery.

Once the blood is removed from the heart, they will then actually give the heart some type of tranquilizer that stops it from beating.  Abigail will forever be able to say that her heart has skipped a few beats!

With most of the blood, pumping, and beating out of the way, they can they begin their tedious work of moving the aorta, pulmonary artery, and the more complicated, delicate, and risky procedure of moving the coronary arteries--without which the heart would not receive its supply of blood to keep it alive.

They will use pieces of the pericardium--that protective sack around the heart--to patch the two holes in her heart.  At the end of the surgery they will likely sew in (very lightly) some temporary, tiny pace-makers into the pericardium. They do this as a precaution because sometimes the electrical systems of the heart are damaged during surgery, and they would use those pacemakers to stimulate the proper electrical flow in the heart after surgery in case of an emergency.  Those pacemakers actually protrude through the skin and once they are sure that they won’t have to stimulate electrical flow in the heart, they will “simply” pull these tiny pacemakers through the skin and dispose of them.  Amazing.

They may also leave the sternum “open” for a few days after surgery as a precaution.  That means that they purposely won’t “put it back together” which allows the heart more room to heal, and makes it more conducive to re-entering for surgery if they go have go back in due to an emergency.  In this case, they would just sew the skin back up, watch things for a while, and then--usually bedside in the NICU--they would open the skin back up and  fix the sternum.  They do that by binding it together with some type of wire, which allows the bone to fuse back into one piece.  Again, amazing.

I find these details fascinating. Even though I am as protective a father as they come (boys, I know what you’re thinking, so stay away if you value your lives).  I don’t want anyone to harm a hair of my daughters’ or son’s heads.  But tonight I am grateful for what might seem on the surface as a violent act with the saws, machines, and scissors.  I am grateful tonight for modern medicine and for doctors, nurses and surgeons who sacrifice much to take care of my little girl.