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Using a very small scalpel, they begin to carefully probe the layer of fat around the heart to locate the arteries in question, which are scarcely distinguishable from the surrounding fatty tissue. The surgeons now wear glasses with powerful magnifiers built into the lenses. At length the heartbeat slows to a stop and the intricate repairs begin. Now the dark venous blood entering the heart is intercepted and routed through the heart-lung machine, which oxygenates it and returns it-now a brighter red-to the arterial system leading to the patient’s body. Tubes coming from the heart-lung machine-the “pump”-are inserted into the incisions, and at a given signal the heart-lung machine whirrs into action. My weak-in-the-knees feeling soon leaves, and the procedure takes on a magnetic fascination.Īn incision is carefully made into the aorta and one of the chambers of the heart, which continues to beat. The surgeons’ eyes reveal no amazement, no sense of drama-only deliberate concentration. Soft music is playing quietly over the intercom. Several cranks on a short lever spread the retractor apart-and there, between the patient’s spread ribs, is his beating heart.
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Reentering the room, I am stationed at the head of the operating table, where in full view before me I see that the patient’s sternum has been sawed through longitudinally and an ingenious retractor has been placed in the cleft. Then comes the whirring sound of an electric saw. I make an unscheduled exit to the hallway for a breath of fresh air and a reassessment of my determination to continue with this assignment. There is a snipping of scissors and more cauterizing. The vein being taken from the thigh will be used for the bypass grafts. This is to be a quadruple coronary arterial bypass operation-in other words, surgery to bypass obstructions in four arteries that feed the patient’s heart muscle. Nelson is making an incision in the left leg to locate a vein that will be removed. The senior resident, in one deft stroke, makes a foot-long incision the length of the sternum, following quickly with a cauterizing tool that seals off the numerous small vessels that have begun to bleed into the wound. Having taken their positions, they begin their work with an alacrity that is somewhat chilling to a newcomer. I stand slightly apart from them, an observer, scrubbed and wearing sanitized clothing.
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Nelson joins seven other members of the surgical team in the room: the senior resident in surgery a surgical nurse an anesthesiologist a heart-lung machine specialist a computer specialist and two other nurses, one of whom is in charge of the operating room. On the operating table under a bright light and surrounded by a jungle of glittering equipment is a sixty-year-old man being covered with special green drapes that leave a long, rectangular opening squarely over the middle of his chest and another opening over his left leg.ĭr.