11 hours

On a Tuesday at the end of July ‘18 I was the on call cardiac surgeon. I had just come back from holiday a couple days earlier and was looking forward to a ‘quiet’ on call. My registrar called me at 19:00 and I heard the phrase dreaded by any on call cardiac surgeon: ‘We have a Type A dissection’.

This is a life threatening condition that carries a 1-2% per hour mortality ie. without an expeditious operation the patient will likely die within 24-48 hours. Even with an emergency operation the chances of losing one’s life or suffering a stroke are very high.

I reviewed the scan and realised that the extent of the problem was such that warranted more than one consultant cardiac surgeon. The patient already had a chronic type B dissection which had now progressed to type A including the aortic root, one of the coronary arteries and the aortic arch with involvement of the vessels providing blood to his brain.
I called in the anaesthetist and the on call theatre team.

I called my colleague Mr PK (who was not on call), explained the situation and asked for his help: ‘I am on my way’ he said and put the phone down.
We started the operation at 22:00 that night. We finished at 09:00 the next morning. Two anaesthetists, two perfusionists, two teams of theatre nurses (new shift came on at 07:30), two consultant surgeons and a trainee worked relentlessly and systematically for 11 hours. Our cardiac ICU and ward 16 nursing teams did the rest. The patient woke up neurologically intact the next day and went home two weeks later.

This kind of commitment and dedication is not unusual for cardiothoracic surgery. It echoes a mentality that transcends ‘contracted working hours’, ‘on call duty’, physical and mental fatigue.
That morning after we had finished the operation I was driving home looking forward to a ‘well deserved rest’ as they say. I couldn’t help but feel proud to be part of such a team. A team that had eloquently shouted: ‘This patient’s life is non-negotiable’

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