Friday, October 5, 2007

Matters of the Heart

I saw someone’s heart today, and not in the metaphorical sense. This past week I’ve been going to a hospital in Malad (W), a 20 minute rickshaw trip from home, where I’ve been shadowing a cardiologist Dr. Venkat Goyal who is a friend of Samir Mama’s. The hospital he works in is very impressive, the largest I’ve seen so far and the most high-tech, which makes sense since it’s a cardiac center. The main ICU has about 20 beds and a central station where the doctors can monitor every patient’s ECG, oxygen saturation, and blood pressure.

This past week I have gotten to see several angiograms, where the doctor inserts a catheter into the radial artery and threads it within the lumen of the arteries through the arm and across the chest until it reaches the aorta. Then while taking X-rays he injects a liquid that allows him to see the flow of blood through the coronary arteries that feed the heart. It’s pretty amazing to watch the doctor thread the catheter to the heart since he cannot see the vessel the wire is moving through, a bit like driving without being able to see the road.

If the angiogram shows major blockages in the coronary arteries, then the doctor can perform an angioplasty to remove the blockage. To do this, he uses the catheter as a guide to correctly place a balloon at the site of the blockage, and then inflates the balloon to make a whole through the plaque. To keep the vessel open, the doctors puts a stent over the balloon. The stent is a small cylinder of metal mesh that is often coated with a drug that keeps plaque from building up again. The whole procedure takes about 20-30 minutes and the patient can go home after a couple of hours.

When I arrived at the hospital today I was told that a bypass operation was in progress, so I quickly changed into scrubs and hurried into the OT. The doctors had already opened the chest and begun to graft the small sections of arteries taken from the thigh into the heart’s vascular system. It’s a bit of a surreal sight to actually see someone’s heart beating inside of their chest. It’s also not very common for bypass surgeries to be done on beating hearts, they usually put the patient on a heart-lung machine during the surgery so the doctors can work on a still heart. It makes it easier for the doctors to operate, but the damage the heart-lung machine can do to the patient’s blood can mean a longer recovery process. Operating with a beating heart requires much more skill and confidence on the doctors’ part, since much more can go wrong. But thankful everything went well today and after the three bypasses were completed, and the site checked for other bleeds, the doctors stitched up the patient, using stainless steel wire to suture the ribcage close.

As exciting as it was to watch the operation, I don’t know if I would have the confidence to literally hold someone’s heart in my hands as the doctors did while they grated the bypasses. Hats off to all the cardiac surgeons who do that on a regular basis, they’re an amazing group of people.

12 comments:

Anonymous said...

Wow,a beating heart! You are very luck to be able to see it. I don't think you would have that kind of chance here. I still remember Mrs. Matthews( your kindergarten teacher)
admiring your very long and thin fingers and mentioning that they would be ideal for being a Cardiologist.

Sapana said...

I'm more impressed that you managed to watch the whole thing with any degree of composure. I would have probably fainted (for real) in a couple of minutes. I don't like to see stuff like that when it's not moving, much less when it's moving...

Anonymous said...

Dr. Venkat Goyal is a cheapster thug & flesh market trader who is openly looting poor heart patients for lakhs of rupees. My close relative was forced to undergo heart angioplasty at this thug's hospital at Malad & he exhorbitantly charged 100% extra. At the end the patient did not survive, but this money eating monster businessman got lots of profits. This is what your Dr. Goyal is made about. I'll make sure I post my comments on each and every newspaper in Mumbai and on all possible website. People need to STOP going to this man-eater doctor for all reasons. There are many better options and sensible human doctors in India. Goyal is not the only option.

Anonymous said...

n........nice pictorial blog keep it up

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Unknown said...

If at all your review was genuine why did you choose to be anonymous. You're just another non medico who doesn't understand what a doctor goes through with each and every patient. Uneducated people like you dont even understand what is what and just know to spread negativity on anything and everything possible. People like you should be eradicated from this country to clear all the filth you people spread.