HEARTLAND FOR PROFIT

Monday afternoon.  Phillip Gold, chief of Cardiac Surgery, pushed open the scrub room door with his hip as he tied the surgical mask over his scrub cap.

“Where’s our patient?” he demanded. 

The heavy metal door to operating room nine crashed open answering his question.  The impact threw Charles Campbell, chief resident in Cardiac Surgery, off balance as he straddled the dying patient and performed CPR.  Forced to grab the railing of the gurney, Charles stopped compressions. 

“Someone else take over CPR,” Phil commanded the crowd accompanying the stretcher.  “And where the hell is anesthesia staff?” 

 “I thought I’d see what we had before I paged him,” replied the dark-haired young man much too inexperienced to be at the head of the table alone.     

“Get McGreggor here now.” 

Phil turned to Charles, “What do we have?”

“Sixty-year-old man five days post infarct who’s probably ruptured his ventricle.  We’re over thirty minutes into CPR.  I thought we should at least - -”

“Let’s get him on pump,” Phil interrupted. 

“Why the bloody hell didn’t you call me sooner?” roared Ian McGreggor, chief of Cardiac Anesthesia.  The burly Scot was still pushing his full red beard under his surgical mask as he displaced his resident from the small space at the head of the table. 

“We probably can’t fix this guy,” Phil answered, “but he’s young – too young to give up without trying.  Let’s get him on pump, get some blood to his brain and see if there’s anything we can do.”

“You can cut in two minutes,” Ian replied.

“Ready, Kathy?” Phil asked the scrub nurse.

“Any time, Dr. Gold” she answered stacking instruments on her scrub table.

“How long for the pump, Jim?” he asked the perfusionist.

“I’ll be ready when you are, Dr. Gold.”

They moved the patient from the gurney to the operating table and positioned him. 

“No scrub, Charles.  Gown, glove and go,” Phil said.  “If he’s ruptured, it’ll be messy when we open the pericardium.  Be ready for sucker bypass, Jim.  Ian, give the heparin now.  Becky, get the third year down here in case we need some vein.” 

“Already paged her,” the circulating nurse replied as she sprayed a brown liquid over the patient’s chest.  

“Knife,” Phil shouted over the background noise. 

Charles made a single slash with the scalpel down to the breastbone.  Phil resumed chest compressions as his resident reached for the saw to divide the sternum.  The surgical jig saw ground through the bone in seconds.  Phil cranked open a heavy stainless steel retractor revealing the bulging sac around the heart tense with dark blood. 

“Pump suckers on full blast,” Phil said.  “We’ll open the pericardium from above, suck it out, and get a cannula in the aorta.” 

As Charles incised the pericardium, a half-gallon of blood filled the chest and poured onto the floor. 

“Get some sheets over here,” Phil yelled straddling the sticky red pool congealing at his feet.  “Get some blood in the room and get those damned suckers up, Jim!”