cardiac pumper: Wounded healer

My workplace is a host to a myriad of interesting personalities.

Well I guess it's also true for every other workplace.

The characters that roam where i work comprise a unique group of individuals that range from being annoying to being humbling. Yet all of them are colorful enough to paint a rainbow of vivid hues. And these hues do make my workplace a little more exciting. :-) On one end, there is a green eyed monster, an orange (read: hazardous) terrorizing goblin, a gray energy sucking vampire, a cyanotic feasting parasite. We also have a fresh white affable angel, a golden altruistic Buddha, a purple gentle fairy on the other end. There are many more characters of various shapes, colors, sizes but I only mentioned the outstanding ones.

Earlier this year, the colorful set of characters welcomed a new comer. It was me who discovered that in our midst, we also have a rusty badminton playing zombie. And the funny thing is that this badminton playing zombie makes use of twin sites to make a smash, instead of a shuttle cock. The badminton playing zombie even taught me how to play! We made use of transducer cable lines as our net and wore heightened emotions as our uniform. And all of these happened in the sterile environment of the operating suite. For the badminton playing zombie is a doctor (an anesthesiologist who for anonymity will be referred simply as “the doctor”)

So what am I really writing about? Well, to the uninitiated, I will come across as someone who visually sees colors through individuals and then post his thoughts on line. So to start it right, I will give a quick background of what happens during a bypass surgery. And also of what transpired at the time of the discovery of the badminton player.

If you have read the posts in this blog, you will know that this author works as a perfusionist in a cardiac center in the Philippines. My work as a part of the surgical team is to support the cardiac patient through the use of a heart lung machine.

The open heart surgery starts with the patient being put into deep sleep by the anesthesiologist. Then the surgeon cuts open the sternum to reveal the heart. After the heart is made visible and ready for cannulation, the surgeon asks the anesthesiologist to give heparin systemically. This is done so as to make the atraumatic insertion of the cannula to the patient’s heart possible. During cannulation, the perfusionist collects the blood in the operative field through his green suction and into the reservoir of the oxygenator (the lung substitute). With all safety parameters checked (gas source, ACT count, occlusion check, power supply secured) the surgeon then commands the perfusionist to go on bypass. The roller pump (heart substitute) is slowly turned on up until it reaches an acceptable flow based on the patient’s temperature.

At the initiation of bypass, the anesthesiologist hands over the support lines (a set of sterile, thin lines from which medications pass through). These support lines deliver the agents that will make sure the patient is relieved from pain and memory. In the particular operative case I am writing about, the doctor did a new manner of handing over the support lines: by THROWING it - right in front of me.

I was taken by surprise. For the life of me I was not able to see the need for the support lines to be thrown towards me. The patient was stable. There was also no toxicity that may cause pressure to act eccentrically. So why throw the lines? Can it not be handed over nicely?

The support line skidded down to the floor. My mind struggled between the choice of keeping mum about the rude behavior and/or voicing my thoughts about it. In the splittest of seconds, I opted to go for the second choice. I called the attention of the doctor and said:

“Doctor, unsterile po yung support line. Hindi niyo po kasi inabot ng maayos” (the support line is unsterile. For you did not give it to me properly.)

“Hindi unsterile yan!” (that is not unsterile!) the reply of the doctor to me.

“Tignan ninyo nga ho. Nasa sahig yung dulo ng line” (Look at the line. The tip touches the floor)

The doctor shot a slashing look at me. If only looks can really slash, my face would have been hacked in two instantly at that time. I guess my reaction and confidence to stand up against the rude behavior caught the doctor by surprise.

The doctor opened the push cart to get a new line to replace the unsterile one. After the sterile line was connected, the doctor got the dirty line. Since it was already a trash, I was expecting the doctor to throw it to the trash can which was just nearby the push cart. The doctor did throw the dirty line. Where? In front of me. Yup. In front of me, on top of my oxygenator. What a professional and ethical act! :-).

My mind processed the newest stimulus. Will I flee or fight? Again, I chose the second option. I got the unsterile line. What did i do? I threw it back to the doctor . Then I shot the doctor the “my-area-is-not-a-trash-bag” menacing look. The doctor just needed to make a half turn to face the trash can, but that is not what the doctor did. The doctor bent down to pick up the unsterile line, then faced me and threw the unsterile line back again to me. Amazing isn’t it? We were like in a playing ground! Hehehe. It was at that time when I realized the doctor is playing badminton with me. "And so shall you see my badminton skills", i thought. I got the unsterile line shuttle cock. And with much gusto (as if playing in an international meet), I served the unsterile line shuttle cock back to the doctor cross over the transducer cables. The unsterile line landed on the doctor’s feet.

The doctor was taken aback. The doctor paused as if to decide what next move to do. Then the doctor asked me:

“Wala na bang ibang perfusionist?” (Is there another perfusionist?)

“Wala ho” (There is none) I answered.

“So ikaw ang hahawak ng kasong ito”(So you will handle this case?) the doctor asked again.

“Yes. And I will finish this case” I replied.

For some reason, the other members of the surgical team seemed not to mind us. Although each of us are just an arm’s length from each other, my exchanges with the doctor seemed unheard and the flying in the air support line seemed invisible.

The surgery went on. The surgeon applied the cross clamp. The heart was arrested. And while all of those were happening, the doctor nonchalantly stood on top of the foot stool while observing the events happening in the operating field. After I gave the cardioplegia, I updated my patient data sheet. The doctor was still on the foot stool I observed. When I was about to finish writing on the PDS, I saw in the corner of my eye the doctor got off from the foot stool. The doctor approached the monitor screen and calibrated some parameters. Then the doctor went down again to pick up the unsterile line. And for the nth time, the doctor again threw the unsterile line towards me! It was already becoming irritatingly comical I thought. We were like preparatory kids playing during recess. To again reiterate my stand that the proper place to put the line is in the trash can just nearby to the doctor, I picked up the line and thew it back to the doctor. Twice the force. The doctor quick as lightning picked up again the line and threw it. Only at that time farther than I could reach.

Then the doctor looked at me fiercely in the eye and said:
“Bastos ka!” (You are rude!)

I was stupefied. “Bastos ako?” (I am rude?) Then if I am and was rude, what does that make the doctor then? Uber bastos? Unethical is a better word i think.

Upon the advise of my colleague wyner (who came in to circulate for me), I did not answer the doctor back. I sat on my chair for i know i need to relax. I took deep breaths and concentrated on relaxing thoughts like the beach, my latest Baguio trip, the Christmas season etc.

At the end of that day, I realized two things:

1. The doctor is just like me - a perfectly imperfect person.

I too have my own share of weaknesses and deficiencies. I also commit misjudgments and lapses. So why did I blew my top and showed unkindness to the doctor in return? Why did I not extend my patience further? I could have just opted to talk to the doctor after the operation when emotions are not heightened anymore but I did not. I chose to feed my ego and act solely on what is pleasing to my logic.

2. The doctor is just like me – a work under progress.

I am still continuously being molded by God to become the updated version of me. Things are not yet finished for and within me. So much of me is yet to happen and so much of me is yet to become.. and so is with the doctor! Maybe the doctor hasn’t gotten over a hurtful past or a traumatic issue. Maybe the doctor is carrying a heavy load.. And if ever the thought that I am progressing faster than the doctor holds a grain of truth, who am I to act superiorly?

Before retiring to sleep, and after saying my prayers, i became aware of the fact that the doctor is a part of my world. The doctor is one of the many colors in my world. And these colors collectively make up the spectrum of light that illuminates my world. In a way, the doctor is a part of the light in my life.

Come to think of it, the doctor was instrumental for me to become enlightened on an area where I am blinded. So wherever you are doctor, thanks to you.