Week 7: Loss

The procedure, an angiography/angioplasty for occlusions in the superficial femoral artery, was progressing slowly but steadily. This particular patient had a massive calcium deposit, and even the attending surgeon was having trouble navigating the multiple occlusions with a thin, flexible guide wire. As the surgeons struggled with this patient's arteries, a phone call interrupted their efforts: the attending surgeon listened to the call and wordlessly walked out of the OR. After several attempts by the fellow to navigate the patient's arteries, she elected to wait for the attending to return. Waiting with a patient on the table was strange: 5 minutes turned into 10 minutes, which progressed past half an hour. After waiting about half an hour, a nurse informed us that the situation in the other OR was critical, and that the patient had been coded. After some encouragement, I walked over to observe how the surgical staff respond to an emergency in the OR. From the OR control-room, I observed a scene of frantic effort: the room was packed with physicians, nurses and techs all attempting to save the patient. Despite their efforts, it was not meant to be. Later the next day, I got the full story. This person had very diseased iliac arteries, and the removal of the arterial sheath imposed shear stress that ultimately tore the iliac artery. The resulting blood loss led to a loss of circulatory volume, the development of thrombi, and eventually a pulmonary embolism. Overall, the cause of death was exsanguination, or severe blood loss. I was surprised to learn that even in optimal conditions, such as being in an OR surrounded by skilled physicians, death can be implacable.