Give me one more Kiss & I will see you later …
For most of my perfusion career and the rest of various first-assisting O.R. positions I have held, I was always about the patient.
I don’t suggest that there were any lapses- since I was always very proactive in reassuring patients if I noticed that they were scared, smiling and chatting them up to take their mind off the operation that was coming up, in some cases an operation that could significantly change their lives.
This extended from days as an EMT in Pittsburgh, a Navy Corpsman in the Philippines, a first assistant scrubbing my way through college in southern Cal, and through quite a few hospitals as a perfusionist.
I don’t know why, but there was always a patient connection that went beyond the data entered on a perfusion chart.
So fast-forward …
to sometime recently, and enter into the pre-op holding room on a busy midweek morning.
A thick chart on the crowded desk in front of me, and a patient with 3 family members off to the side a bit.
As I reviewed the chart (there were two of them- so that fact alone sends it’s own particular message) I can always hear the conversation the family is having. Not eavesdropping, but not ignored either, in some cases the things they are talking about may prompt inspection to an area of clinical concern or so, that might otherwise have been missed.
It is atypical for me, but on this particular morning I wasn’t my usual gregarious outgoing self. I was in the “work mode” as this was the first of two hearts, and the second one was to follow at a different hospital. So it was all business. I even noted that to myself- as in “am I in a bad mood or something ?” .
So on this day, there was a reluctance to talk to the patient or the family, and I just finished my assessment, filled out that “precious” STS form, and went about my business. Not being rude, or dismissive, but casually indifferent, and well to put it bluntly- “opaquely clinical” and to the point.
As I was leaving the room, the last words I heard this patient say to her daughter as she was walking away, was “give me one more kiss, and I will see you later“.
And that’s what her daughter did. She turned and walked back, and gave her mother that “one more kiss”. But what was missed in that moment, was that the second part of that equation may have to wait until heaven opens it’s doors.
Sometimes, You can’t know …
To sum it up, the operation went fine until we came off bypass and our pressures took a nose dive. We recannulated redid a few grafts and tried once again to come off, to another rendition of the same. And two more times to follow that.
Thick myocardium, we were able to arrest the heart, but how well it was ultimately protected is a reasonable question. Moderate to severe MR without replacement was another consideration on the table of laid out questions you ask yourself after a patient unexpectedly dies on the operationg table.
Whatever damage had been done. it was pretty clear that it happened sometimes during the first run, which from my standpoint was relatively unremarkable except for the fact that it took a large initial dose of cardioplegia to finally arrest the heart. Blood gasses were fine, and no blood was required the first time around.
There wasn’t anything that stood out and yelled at you.
It doesn’t happen often, but it did happen on that day.
And there really aren’t any clear cut answers. Sometimes people are alot sicker than they look, and sometimes you don’t know how it’s going to turn out.
What I do know is that I cared, and I also remembered that at least her daughter gave her that “one more kiss”.
The rest of it is what it is. There is no finger to point. The die having been irrevocably cast.
I just remember the words and the odd way I hung on to them. I have no second guesses as to why they stuck out in the sea of conversations going on around me that morning.
And now they they live on in front of you, on this page, so in a sense her last words to her daughter did indeed have a life of their own.
They do remind me that sometimes, the little things we forget or don’t notice, are the biggest tiles on a street we walk- called life.
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