Monday: I'm sitting around with nothing to do when my pager goes off. It's Zach. We medical students take care of each other. "Scott just got out of the triple-A repair," he says. "They lost rhythm as they were closing, been coding him in the OR, he's going to the floor for a bit, they may do some more resuscitating there. If you want a little excitement." I went.
He had an abdominal aortic aneurysm, a 6x6 cm defect about 10 cm long, which fits the criteria for having it repaired. It's a 5% per year chance of rupture at 5cm, with a >50% mortality for rupture. The risk of death in surgery is 2-5%, as high as 10% by some retrospective studies. He elected repair. He had a brief run of V-tach (ventricular tachycardia, when the bottom of the heart controls the beat and makes it too fast) mid-surgery, then it was okay. And then, as Scott was stapling the skin closed, he went into V-tach again. They did CPR, shocked him twice, got him into a weird rhythm and then back to V-tach. Sustained V-tach is a dead man's heart rhythm - it has a tendency to degenerate into VF, which is when the heart just twitches a lot.
Cardiology's verdict: he had a heart attack during surgery.
They brought him up to the ICU, 40 minutes later, after getting him as stable as they could. We were all hanging around to see what would happen. They brought him up to the ICU, O Best Beloved, so his family could say goodbye to him. He was on all the medications known to support blood pressure, intubated, run by machines and drugs. He was grey and pale, and I wanted to touch him to see if he was cold. But when he got here they had him in some kind of rational tachycardia and they slowly started to wean the pressors. They were going to take him off life support last night or today.
This morning he was still there. This morning he was bucking the vent, off half his meds, supporting his own blood pressure. ICU staff said they were going to lessen sedation, take him off the vent.
This afternoon, O Best Beloved, we went in to see him on rounds. He was lying in bed, arguing with the nurses, on just a face mask for oxygen. He has a morphine PCA pump that he's only used once - no pain, really, he says, just where we made the incision. He says. We're taking the NG tube off tomorrow. EH says "He's just going to pick up his IV pole and walk out of here."
We stood outside his room, four medical students with eyes like saucers, and all we could say was "Wow." He was a dead man yesterday.
Miracles happen, O Best Beloved. And sometimes - sometimes, we're lucky enough to see them happen.