Non-standard Operating Procedure

Surgical waiting rooms are miserable places. But nice miserable places. The one at our hospital was very nice. Comfy chairs, big screen TV's and right next to the cafeteria in case you wanted comfort food. But their miserable because they are all about the waiting, and there is nothing fun about waiting. Our hospital had a pager system. Once you checked in at the waiting room you were given a pager, like you were waiting for a table at Olive Garden, and periodically it would go off. You'd go to the desk and they'd give you information. The first time it went off was two hours after they had take dad to the Operating Room. They told us that all was going well and then he had been put on the heart and lung machine. Good news, they said, and then sent us back to purgatory. The operation was planned to go like this: The would make an inscision in the sternum and pry the ribs appart exposing the heart. Then they would attach dad to the heart and lung machine which would then essentially replace all the functions of his heart. After that they would attach the pump to the heart. Fire up the pump, unhook the heart and lung machine slowly and the right side of the heart kicks on, the pump picks it up and heart function is now given an artificial assist. Another hour later the VAD coordinator came out (dressed in scrubs) and told us the operation had gone well, they were just finishing up, in an hour we would could see him in the ICU. We were so relieved. We thanked the doctor and breathed a sigh of relief. We sat back and relaxed, it was just a matter of crusing to the finish line now. An hour and a half later we went up to the ICU to see him. When we arrived they told us he had not been brought in yet. We took a seat in the ICU waiting room. Shortly thereafter the VAD coordinator came in and said there had been a complication. The right side of dad's heart had not restarted as the expected. They were using some medications and giving it a chance to rest before they tried it again. They would be in the O.R. for a while longer. We shouldn't panic, this sort of thing happens occasionally. They would keep us updated. We had returned to purgatory. About an hour later the VAD coordinator came in. This was her final story she said, and she was sticking to it, the attempts at restarting the right side of the heart had not been successful. The right side was not generating enough pressure to force the blood into the left ventricle. Instead it would just expand. They expressed surprise, this was not what they expected. So after trying to prop it up with medications, they decided to install a Right VAD as well. The thing about an RVAD is that it is a temporary measure. A "Bridge to Recovery" it could not stay in. But it would give the right side of the heart time to heal and then they would try it again. The surgeon came in shortly after. He was very surprised, he told us. All indications before the surgery were that the right ventricle was sufficiently strong enough. He thought they could have tried to limp by with medications but at the risk of the other organs. This way the other organs would not be compromised and the right side would have time to heal. They would leave it in for about 5 days, and then see how it went. That, they thought, would give the right side time to heal. Perhaps the right side had been traumatized by the installation of the pump, they speculated, and thats what went wrong. But with time they had hope that it would be restored to normal function and we could get on with life on the LVAD. The move from the elation of success to the sudden eruption of the complication was a body blow. I was blindsided. They had said everything was all right and now everything was not all right, everything was very far from alright. But the concern about the RVAD, the doctor said, was a future concern. Right now they had to make sure he had come through the surgery in tact. There were two key components. One was to ensure he was still mentally O.K. This meant he would need to wake up and be able to move his limbs on command. The next was kidney function. He needed to pee. If the kidneys didn't work, or his brain had been damaged the issues of the heart were irrelevant. In order to get to the heart round, we had to get through the brain and kidney rounds first. Shortly th