Early morning calls from the ER are usually for patients who have been in an accident and for most of the times our emergency department team is excellent in managing chest trauma. So most of the times I am informed about the patient but they have invariably done whatever is needed to sort out the patient. So when the phone rang at 3.00 am I was half asleep expecting the usual conversation with the ER, but 30 seconds later in the talk I was wide awake…I was being asked to see a young lady in her late 40’s with a condition involving tear in the main artery in the body. This is a condition which is lethal and almost 50 percent people who develop it die on the spot and are unable to seek any help.. Those who survive also die at almost 1% per hour. So practically everyone is dead in 48 hours.
Anyhow this was not the story with our lady…As I stepped out of the bed and got ready to go to the hospital there were thoughts already racing through my mind trying to foresee various possibilities and what could be done to save her. By the time I reached the ER they had already done the CT scan and Echo and I had all the information needed to guide the further treatment.
A review of the CT scan showed that the aorta had a tear from inside beginning at the very beginning of the main vessel of the body which carries all the blood namely the aorta and going across the arch of aorta and had involved the blood vessels in the neck which supply blood to the brain also. The distal part of the aorta appeared normal. Surprisingly she did not have a stroke yet although she did complain of mild dizziness when she had initial symptoms.. But obviously looking at the scan it was clear that she was sitting on the edge of her deathbed and needed to be in OT urgently.
Relatives were counseled and explained the grievous nature of the condition and the option available. It was already morning by that time and I suggested we take her once thing were ready in OT. Unfortunately only one team was available in morning and they very occupied with a elective surgery so we had to wait till they became free from the surgery and..that meant delaying surgery for another 5 hours…this was a tense time for everyone involved as anything could have happened during this time. Also as these surgeries take 10 -12 hours I wanted to finish in reasonable time
Anyhow by god’s grace we were in OT eventually without any disasters…During the surgery, the findings were same as what we saw on the CT scan and we ended up replacing the entire ascending aorta, arch and its three branches with artificial grafts…to my utter dismay, I landed up ligating the right side neck vessel supplying the brain (carotid artery) as it was badly damaged and there was no conceivable way to salvage it.
After a grueling 12 hour surgery she was finally out of the theatre.. I had to clearly inform the relatives that we had to ligate the right carotid artery and we should be prepared for the worst, as there was a 99% chance that she would develop massive stroke on left side.
Waiting again for next 12 hours for her to start waking was very agonizing ..,not knowing whether we had done any good for her or had added to her problems was exasperating. Overnight I could not sleep very well as it kept on playing on my mind if I could have offered or done anything better for her. Every time the answer was same there was simply no other conceivable way out.
Finally after 15 hours or so she started waking up with movements of all four limbs and she was clearly obeying all verbal commands. It was clear that we had not done any major damage. She subsequently got better and just before discharge we did a CT scan of the brain to see how much damage we had inflicted…Luckily for us and for her and her family there was miniscule changes on the scan and our neurologist was clear that this wouldn’t affect her in any way in leading a normal life.
It is a year since her surgery and she is doing well…Sometimes God is great ..Nature has given us so many inbuilt protective mechanisms that if one fails the system falls on to the back up setting and life continues undisturbed.. Truly human body is remarkably complex and certain things are beyond our understanding.. The only thing to do is to marvel at its way of working and be grateful for it every moment.
- Dr. Sandeep Agarwala
Sr. Consultant Cardio-thoracic Surgery