put your back into it

a dirty song becomes applicable.  while on call for family medicine, i spent a decent amount of time hanging out with my former senior surgical resident.  while i didn’t enjoy most of surgery, the one area i did truly appreciate was vascular surgery.  i don’t know what it is about it.  regardless, the resident mentions that there is a ruptured, descending aortic dissection.  this is pretty much a big deal.  conveniently, sophie, one of my best friends is on call for surgery, and i meet her down there. 

quick aside to explain aortic dissections. 

  • the aorta is the biggest artery in your body.  most peeps know this. 
  • blood pressure is determined by the pressure in the aorta when the heart is pumping into it, and when the heart is closed – hence 120/80.
  • when you have high blood pressure or hypertension or htn – you can damage basically everything in your body, but in this guy’s case, you can get an aortic dissection
  • an artery is composed of three layers.  in a dissection, you have a separation of these layers forming a flap.  you end up having two lumens. 
  • it’s a big deal when 1 ruptures

normally a descending dissection is treated medically – you just control their blood pressure to keep it from worsening.  so what if it ruptures?  emergent surgery fool! that means blood is emptying into your body at a pretty fast rate because the aorta is packed with pressure.  and boy they don’t fool around.   they made a huge “L” cut into his sternum and along his ribs and opened his chest.  and there it is…you couldn’t miss it.  the aorta was humongous and bruised…just plain old ugly. 

they put the guy on bypass – from his left atrium to his common femoral artery – also nuts to see.  regular bypass consists of vena cava to aorta.  then i actually get to see the aorta cut open.  unfortunately the surgery didn’t get to far because the guy ended up dying on the table because of a complication (the dissection started to ascend – about the worst thing possible).  it was an amazing surgery nevertheless.  it’s not often you get to see the chest wide open with a clear view of the aorta in your chest…abdominal aorta? maybe, but in the chest?  very rare.

if it weren’t for general surgery being a 5 year bane to get to vascular surgery, i might actually consider it.  but gen surg is just too boring and painful. 


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