Thursday, September 1, 2016

Clean Kill

Many cardiovascular surgeons are dedicated reasonably balanced humans. Some, are not. For those that are not it seems that if one is willing to do a prolonged residency in order to learn how to operate on a muscle slightly bigger than your fist, that it somehow separates them from mere mortal to better than - precisely the reason, at least to a great extent, they became CT surgeons in the first place. Driven by severe psychopathology, fueled by deep insecurity, all expressed as over-achievement and entitlement, they possess a seething rage rooted in self-loathing. These are the ones that give their profession a very bad name, indeed. Add in short stature and a fragile male ego and you've got a real nincompoop on your hands. Abusive to all - colleagues, nurses, students, wife, girlfriends. Here is a tale of one such surgeon.

                                  The Miniature CT Surgeon and the Mitral Valve

One day, a wee little surgeon, while standing on a riser, watched as a heart fell apart that he had just tried to put a new mitral valve in. Now rupture of the left ventricle along the atrio-ventricular groove during mitral valve surgery does not a good day make as it carries at least a 75% mortality. It results almost always as a result of poor surgical 'technique' and/or by a stretch injury due to the untethering of the left ventricle through removal of the posterior leaflet of the mitral valve. Oops.

The little guy new immediately what he had done. He acted quickly to try to stitch together what was a very friable heart not to save the patient but to save face - sort of like putting duct tape over the hole in the dike one had just created and then walking away trying to whistle innocently. He got his patient to the ICU and then quickly left.

Dedicated nurses and the ICU doctors struggled for three hours with massive blood loss as the heart came apart along his suture line, as he knew it would, working with all they had to save him. Just as the patient died the little surgeon popped his head back into the room and said to the nurses - " clean kill" - blaming them. Two of the nurses cried. Two more had visions of a gruesome homicide – for quite some time after. But be clear everyone in that room was deeply traumatized by this event and by the mean little surgeon for something he and he alone had done.

What became of it all? After all a person had died and nurses were publicly blamed. Well, nothing. Quality review failed with their job, again. Nursing administration failed to defend innocent, dedicated, hard working nurses, again. The department chair of surgery failed to admit to the pathology in his midst, again. The chief of the ICU too frightened by surgeons to care. And life just went on – for everyone - but the patient. After all miniature CT surgeons make lots of money for the hospital.

And the wee little surgeon? Well he went about his business hating himself just that much more, now even more likely to inflict harm on others – physically or emotionally – as he blundered on. Some say he got even shorter that day, his own heart colder, his sense of personal failure, while denied except late at night or in his urge to exercise incessantly, grew and solidified – etched permanently in his face. There is a special place for people like this. It is of their own making – and it is hell on earth. He suffers more than he will ever cause those around him to suffer. Warms my heart. A heart he will never operate on.

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