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Monday, April 21, 2014

Returning to Dartmouth

The space in the helicopter was limited, but I didn't notice as they slid the stretcher into the enclosed area and crawled in around me. The Ativan had kicked in and I felt safe in the hands of the emergency team that was transporting me. Why I had previously begged not to return to Dartmouth, I'm unsure of. I'm guessing I just did not have enough oxygen in my brain to make a sound decision. Obviously I was needing to return to the better hospital, with my own surgeon who knows my case and can save my life, and better care facilities. I wouldn't willing suggest staying at the local run down hospital's emergency department with staff that was untrained in severe cardiac complications, like the effusion and cardiac tamponade I was experiencing. Cardiac tamponade is a complication from open heart surgery that occurs from an excessive build up of fluid on the heart to a point where a chamber collapses from the pressure and is no longer pushing oxygenated blood through the body. It is a serious and deadly condition, not commonly reached in post op patients. I was young for an open heart surgery to happen in the first place, but the complication of the fluid build up in the pericardial sac around the heart is something that can happen to anyone. The concern is if it is internal bleeding and blood is building up, instead of fluid from inflammation, than there may be more serious problems. Either way the fluid must be drained off of the heart to relieve pressure so it can beat normally. A small amount of fluid, under 50 ml, is naturally lubricating the pericardial sac at all times with the body reabsorbing excess constantly. Any more than that affects the hearts natural function, and this is when a special procedure needs to be performed. Pericardiocentesis is a procedure where the fluid is drained off of the heart. It can be performed in trauma cases with a large needle inserted near the bottom of the breastbone, or in a Cathlab procedure where a drainage tube is placed. This is what I woke up to in the emergency room, and thankfully was postponed until my arrival at Dartmouth. The DHART (Dartmouth Hitchcock Advance Response Team) guys were prepared to perform this emergency drainage procedure if my condition worsened during the flight.

Once I was on board and the helicopter took off I was stable enough to twist and look out the window. I saw the lights from the city drifting farther away as we rose in the sky and noticed the sun had set sometime between me rolling out of the hospital and boarding my first helicopter ride. I also saw the frozen lake beneath, and stars twinkling through a clear windy space. The ride was rough but lasted less than twenty minutes, and I managed to fall asleep for the last fifteen minutes. I was happy that they moved me quickly instead of a bumpy two hour ride by ambulance in an unstable position. The air felt like a cool promise upon arrival back to Dartmouth, as they pushed me across pavement to the hospital I had departed days earlier. I knew I was in safe hands, and that my mother was on her way. The first new face I saw was that of my confident surgeon who grabbed my hand and reassured me that I was in his care now and I would be alright. I remember thinking 'I feel terrible, he will fix me though.' He stayed by my side the entire time, as they ran new tests due to LRGH not sending along proper records. I was poked and prodded a million times that evening, becoming used to the abuse on my body. I knew they were just doing their job and I did not complain. At one point I made sure that my blue spa socks, gifted to me the day before by a close friend, were removed from my feet and put in a personal belongings bag. I did not want to lose something so significant to me after one had already fallen off and I begged for it to be found while settling into the trauma room in Dartmouth's ER. Soon after, the DHART team disappeared as swiftly as they had swooped in to rescue me, and I never saw them again. New nurses took over my vitals and making me comfortable as Dr. Discipio decided what the next step would be. I told him to make the decision for me, because I could not think clearly enough to decide what I wanted. He gave me an option, we could try for a Pericardiocentesis in the Cathlab with a doctor that had to be called in to place the tube and Discipio would watch, or we could go to the operating room where my doctor would do his own procedure, of what I'm unsure, and they would sedate me properly. The doctor was called in and an emergency Pericardiocentesis procedure was performed before my mother even reached the hospital, while I lay awake through the entire thing.

The first step was using topical anesthetic around the ribs in the left 5th and 6th intercostal space. The area was painful to numb and I whimpered as the needles dug through my bones. Then a large needle was inserted at an angle into my torso, and I could feel the puncture like a balloon popping as it pierced through the pericardial sac. All was watched with ultrasound and X-Ray equipment to avoid puncturing the lungs or further complications. The needle was retracted leaving a white narrow tube in place that was maneuvered with a metal wire for better positioning. I felt pain in my shoulder blade, typical of having a tube between your heart and it's protecting layer. Once in place they used large 100 cc (or ml) syringes to start pulling fluid off of the heart. They got through 700 ml of fluid and began to slow down, wanting to leave a little fluid to naturally drain with the tube left in place, avoiding another painful complication called Pericarditis where there isn't enough fluid creating further pain. The fluid was tested on a table to my left to make sure it was not bloody or infection filled. It was neat to think the twenty people bustling around me were doing their little jobs so efficiently and quickly and yet so late at night. They were all busy with their tasks at hand and to my left and right were the two most experienced in the room, making sure the job was done right. After the fluid was pulled off, they asked how I was doing. "I can breathe!" I exclaimed in relief. It's amazing how immediate the change was that I felt and I was instantly happy for the procedure no matter how painful it was. Still more work was performed as the drainage tube was covered with gauze and dressing, and I was prepared to be moved to the ICU. On the way out the door yet another angel in disguise took care of me, covering my feet in a warm blanket and making sure my personal belonging's bag followed me to ICU. He held my hand and kept the operating team from sliding me onto the bed hastily, keeping them from jarring me around in my discomfort. I knew I was in a position where I had the best possible care, and all the many angels that followed me along the way made the traumatic experience a little easier. I was cherished as a child, respected as an adult, honored as a lady, and protected as a patient in the care of the medical professionals at DHMC.

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