Facing my second major cardiac surgery in 3-years :(

[ctsurgeryscrubrn]

Background: I wrote an article a little over a year ago about what 'Being on the table taught me about treating on the table'. I was diagnosed with Marfan syndrome as a child and required an AVR in September-2016. I am a scrub nurse on our high-risk cardiothoracic surgery team, and chose not to have that procedure done at the institution where I work mainly because of the privacy I sought.

Flash Forward: The AVR replacement has started to fail and symptoms have returned. Further scans have indicated an aortic arch aneurysm, requiring a very complicated open aortic surgery for total arch replacement. I am very scared given my own experiences scrubbing these cases - they tend to be some of our worst outcomes due to extensive bleeding often requiring Factor-7, and the need for long DHCA pump-runs. Having had previous aortic surgery only makes my surgery more complex due to the adhesions that are likely hindering the surrounding tissue.

Putting Faith in "My Team": Given the complexity of this surgery, I wanted to be operated on by my very own team. We had the consult this morning and it felt like it was the first time meeting everybody. Terms and concepts that are second nature to me as a practitioner suddenly became foreign:

• How long will I be on bypass?
• What temperature will you try to cool me down to and why do you need to pack my head in ice?
• Why would that be a complication associated with this procedure?

Feeling HELPLESS and HOPELESS:

Even sitting at the table with a team that I have operated with on some of the most complex cardiac cases in the world - working miracles every day, I felt helpless and hopeless. There was a natural barrier that they established and I could feel exactly where it began - a barrier of objectivity, the unknown, the risks, the things we all know about and can't control.

Cardiothoracic surgery is not an easy specialty - I've lived it - I've seen the fear in the eyes of our patients; I've seen patients whisper their last words before passing on our table; I've seen the promising do poorly and the unlikely do amazingly well. I've always wondered what is going through the patient's mind while they sit through a consult where they are told, in no uncertain terms, that we will crack open their chest with a saw.

I thought having my colleagues walking me through all of this would make it more palatable, but I felt like 'another case'. I could feel their unease knowing it would be 'me' on their table. I looked for the little signs - a gentle smile, a reassuring 'don't worry', an outreached hand to calm mine - I found no such signs. The lead scrub is a nurse I precepted when she joined our CT team - she is a friend and when we work together, we are seamless. Today, we felt world's apart.

I can't imagine the additional pressure they feel, and perhaps that's why having one of the highest risk CT surgeries with your own is not the best of ideas. But, I know that they'll bring their very best to that table (just like they do every day)...and then some.

Quote

Vulnerability is not winning or losing; it's having the courage to show up and be seen when we have no control over the outcome. Vulnerability is not weakness; it's our greatest measure of courage.

I am vulnerable and I am ok to admit it.

Have you operated on a co-worker before? Did you treat them differently and with more compassion, or did you maintain an objective presence?

The Case:

• Date of Procedure: 2019-Nov-19; 0700
• Patient: ________________
• Age: 32 / F
• Presentation / Dx: Aortic Arch Aneurysm of 4.7cm / Marfan syndrome
• Procedure: Total Aortic Arch Repair
• Team:
  • Attending: Chief of Cardiothoracic Surgery
  • First Assist: Attending Cardiothoracic Surgeon (Aortic Program Co-Director)
  • Second Assist: Attending Cardiothoracic Surgeon
  • Anethesia: 2 Attending + CRNA
  • Nursing:
    • 2 Scrubs / 2 Circulating (1 family liaison)
  • CCP: 2
• Position: Supine
• Aortic Clamp Time Target: 120 min
• Total CPB Target: 280 min
• DHCA Target: 18 degree C (cerebral) / 24 degree C (systemic) - ~55 - 65 min
• Selective Antegrade Perfusion: Yes - 35 degree C (bladder) - ~30 - 35 min
• Surgical Hx: AVR - September-2016 (post-op tamponade)
• Total Operative Time Target (incision-to-close) (min): ~660 - 720

[Kevin657]

dond't worry.best wishes for you

[beachbabe86]

yes, we operated on another OR nurse although she wasn't on our heart team. She chose me to be the circulator and I was happy to take care of her.

She did very well and came back to work , but left after a few months.

[beachbabe86]

Praying for you. I wish you the very best.

[FurBabyMom, MSN, RN]

I'm so sorry you have to have an additional surgery, but grateful that you're getting the answers and care you need. Will be keeping you and your coworkers in my thoughts and prayers.

Yes, I've cared for coworkers before and imagine I will again.

[Tigerlily8]

Hi,

I am a former ICU RN who was born with a bicuspid aortic valve. I was unaware and asymptomatic until my late 50's when I also gained weight and became hypertensive. I had my aortic valve repair surgery approximately 5 years ago. I recovered quickly from the surgery. Unfortunately, I experienced a brief single episode of afib with rvr post-op and am on metoprolol for rate control. I feel like I am less energetic than before surgery but attribute it to the beta blockade. Aside from that, I had an uneventful recovery and have no activity restrictions.

[RNNPICU, BSN, RN]

Wishing you best wishes on your surgery

[VNurse30]

Hope everything went smoothly!