September 29 is World Heart Day. Newborns who have fallen to the ground, pillars of work, and elderly people with progressive heart failure… Cardiovascular disease has become the number one “killer” that threatens the health of people of all ages.
In the Department of Cardiovascular Surgery of Zhujiang Hospital of Southern Medical University, there are a group of “heart guards” who care for everyone and work day and night on the front line of fighting cardiovascular disease. How does their day go? On the eve of World Heart Day, we stay on duty and record the “twelve hours” of cardiovascular surgery.
In the operating room, Mingming (pseudonym), who was less than 3 months old and weighed less than 4.3 kg, received endotracheal intubation and general anesthesia.
Because of the surgery, he had not been breastfed since the night before, and he cried for a long time on his father’s shoulder before entering the operating room in the morning. Obviously suffering from a complex congenital heart disease – pulmonary atresia, after crying, his face immediately turned cyanotic, which made him feel distressed.
Mingming and her parents are waiting for surgery, South + Xu Hao photo
Li Yaling, the head of the cardiopulmonary bypass group and the attending physician, arrived in the operating room very early, and started working around the cardiopulmonary bypass machine with the cardiopulmonary bypass perfusionist Dong Yunhao.
The heart is an organ that is always beating. Before the doctor operates on the heart, it is necessary to stop the heart, which requires “driving” an extracorporeal circulation machine and an artificial oxygenator to replace the heart. The work of pumping blood and exchanging gas in the lungs.
A few hours after the heart stops beating, the cardiopulmonary bypass machine plays a role in maintaining vital signs, ensuring blood supply to important organs, and assisting cardiovascular surgeons to successfully complete heart operations.
The control panel of the extracorporeal circulation machine Nanfang + Xu Hao photo
Li Yaling and Dong Yunhao opened a bag of pipes of different sizes and shapes, trimmed them, connected them in sequence and connected them to the cardiopulmonary bypass machine. Under normal circumstances, there will be at least 4 pipelines in the cardiopulmonary bypass machine, and there should be no air bubbles in the pipelines. Dong Yunhao poured saline into the pipelines and oxygenator, and kept beating to push the gas out…
While the cardiopulmonary bypass group was preparing in an orderly and rapid manner under the stage, the work of the surgeons was also unfolding simultaneously.
Heart ultrasound team leader and attending physician Zhang Xuehua pushed a professional ultrasound machine to the operating room. With the cooperation of her colleagues, she put the probe into Mingming’s esophagus, turned her head and began to check the ultrasound image.
Cardiac ultrasound is known as the “eye” or “scout” of cardiovascular surgery, and the vast majority of heart disease diagnoses require echocardiography. Before the operation, the sonographer should re-evaluate the degree of disease of each chamber and valve of the patient’s heart, so as to provide the surgeon with real and accurate indicators; Provide postoperative guidance to surgeons.
Zhang Xuehua (left) looking at the echocardiographic image of the heart Nanfang + Xu Hao photo
After ultrasound examination to further clarify the condition, the surgical team lays out the sterile surgical drape, revealing the small chest. Attending physicians Yang Bo and Yang Dongpeng came to power to perform thoracotomy and the establishment of cardiopulmonary bypass for Mingming.
Not long after, Director of Cardiovascular Surgery Wang Xiaowu walked into the operating room fully armed – wearing a surgical light with camera function, a surgical magnifying glass, and complex equipment pipelines interlaced, extending to On the video streaming machine on the back – it looks like you’ve just stepped out of some sci-fi movie.
Wang Xiaowu in the operation Nanfang + Xu Hao photo
“I’ll try the pressure… it’s okay.”
According to Wang Xiaowu’s instructions, Li Yaling adjusted the knob skillfully. Starting the cardiopulmonary bypass machine (also known as turnaround) requires the cooperation of two people, one person is responsible for adjusting the machine, and the other person is responsible for keeping an eye on the dials of various instruments and making records. “It is necessary to gradually cool down and adjust the patient’s circulatory indicators to a scientific and appropriate stable state, and closely observe blood oxygenation and blood recovery. During this period, no mistakes can be made.”
Mingming’s heart stopped beating, and this complicated operation for infant congenital heart disease officially started and continued until 13:00.
Around 12 noon is supposed to be lunch time for ICU nurses, but they rarely eat on time.
In the intensive care unit (ICU) of cardiovascular surgery, head nurse Zhang Yinhong, nursing team leader Yu Zhili and colleagues are constantly patrolling the bedside of each postoperative patient, observing the patient’s heart rate and blood pressure , urine volume, ventilator auxiliary parameters, drug dose application and other indicators, record various vital signs every hour, turn over, pat back, suck sputum, squeeze chest tube, blood test and other operations…
This is a modern professional cardiovascular surgery ICU with first-class instruments and equipment that has just been put into use. It has a total of 12 beds and receives all perioperative critically ill patients, most of whom are To use advanced equipment to maintain life stability, this puts forward extremely high requirements on the comprehensive technical ability of ICU nurses, even more than junior doctors.
Medical team in the ICU South China + Xu Hao filming
When the patient returns to the ICU from the operating room, the nurse must first connect the ventilator, chest drainage tube, gastric tube, urinary tube, etc.; secondly, check various special vasoactive drugs and drugs blood test to check the internal environment, electrolytes and other conditions; turn over to check the general condition of the skin, hand over shifts, and hand over various intraoperative and postoperative conditions… When the patient is truly stabilized, it may have passed a couple of times. Hours.
In order to quickly transfer the patient out of the ICU, after the patient is stabilized and the ventilator is removed, the medical team will plan an early cardiac rehabilitation exercise for the patient.
“I remember an uncle who had a heart valve operation. His mentality was very good. When we were busy with work, he would take the initiative to lead the patients in the next bed to do rehabilitation exercises together.” Yu Zhili recalled that the uncle’s preoperative condition was relatively poor, unable to lie flat and breathless, but he recovered quickly after the operation and was discharged home a week later.
In the echocardiography room, Dr. Zhang Xuehua is conducting scans for patients in an orderly manner. They include both post-operative patients in recovery and new patients from outpatient clinics.
This ultrasound room dedicated to cardiovascular surgery is equipped with multiple advanced ultrasound instruments, which can meet the inspection needs of adults and infants of different ages and different ultrasound sites, and is also equipped with portable ultrasound The instrument can reach the bedside consultation at any time.
Patient undergoing ultrasound examination in cardiac ultrasound room Nanfang + Xu Hao photo
One afternoon a week ago, after finishing the work at hand, Zhang Xuehua saw her daughter in the hospital with a fever of 40 degrees Celsius. Even in her own hospital, Zhang Xuehua was unable to take her daughter to see a doctor in person. Instead, her husband asked for leave to do it for her.
“My daughter asked, can my mother accompany me today? I said that I’m too busy today, so I can’t accompany you until Saturday.” What made Zhang Xuehua feel guilty was that the Her daughter was sick and her hair was messed up, but her mind was still tightly entangled in her work, and she couldn’t even worry about it. “Then on Saturday, Corey had something to do, and his promise to accompany his daughter was not fulfilled.”
15:00—17:00 Application time
Hu Ping, the nursing team leader of the general ward, is explaining to the patient how to record the urine output in the ward. The amount of fluid intake and output is an important indicator for measuring heart and kidney function. It is monitored by special pipes and instruments in the ICU, but after being transferred to a common ward, it must be recorded by the patient consciously.
Some patients and their families do not understand the importance of urine output, or cannot learn how to operate. Zhang Yinhong, Hu Ping and their colleagues will organize missionary meetings from time to time, setting up explanation and answering sessions. Small gifts such as detergent and paper towels will also be prepared to increase the enthusiasm of the participants.
Zhang Yinhong and nurses in the ward round South + Xu Hao filmed
“Occasionally cured, often helped, and always comforted.” The family members of patients in cardiovascular surgery are often in a state of anxiety and tension, and nurses have to play the role of clinical psychologists, so as to reassure the family members for their cooperation. Medical care work.
After a patient passed away, the family found Hu Ping with a letter of thanks, saying that she felt warm because of the nurse and was very grateful.Hu Ping said: “My small contribution can be exchanged for the sincere recognition of patients and family members, and it is the strength that supports my work in cardiovascular surgery.”
In the general ward, Didi (pseudonym), who has just received atrial septal defect and ventricular septal defect repair surgery, is watching a cartoon.
Didi is the third child of her mother, Xiao Jing, who is 2 years old this year. He needed to be in an incubator after birth and was soon diagnosed with a congenital heart disease. At that time, the doctor suggested conservative treatment to observe whether the defect could grow back on its own, but as Didi grew up, the defect became larger and larger, which also affected his growth and development. A small cold could easily develop into Pneumonia, and is always ill for a long time.
The nurses used small toys to comfort the child before surgery. Nanfang+ Photo by Xu Hao
Two months ago, the cardiovascular surgery team of Zhujiang Hospital held a free clinic in Shanwei. Xiao Jing, who heard the news, carried Didi to the scene for consultation. The doctor who received the consultation was Wang Xiaowu. After learning about the condition, Wang Xiaowu told Xiaojing that Didi’s illness could be cured with just one operation.
In order to facilitate communication, Wang Xiaowu also gave Xiaojing his personal WeChat. Under the remote guidance of Wang Xiaowu, Xiaojing spent more than a month to adjust Didi’s physical condition to a state that can be operated, and then decisively came to Zhujiang Hospital for surgery. The operation went well and Didi is expected to grow up healthy like a normal child.
“I hope that after overcoming this difficulty, Didi can grow into a useful person to society and repay everyone’s kindness.” Xiaojing said that her family is not wealthy, and she has undergone cardiovascular surgery. The high cost had made her hesitate. Fortunately, Pearl River Hospital has continued in-depth cooperation with a number of charitable foundations. With the dual help of charitable funds and medical insurance, Didi’s surgery has become affordable.
Doctor Chen Hongyan is on duty in the ICU. “In the beginning, I came for Director Wang’s charisma. After I arrived in the team, I found that everyone was equally rigorous and positive. I liked this kind of atmosphere very much.” Chen Hongyan said that when she was studying in the cardiovascular surgery department, she once watched There was a large ulcer on Wang Xiaowu’s hand, and it was later learned that it was pulled out by forceps after three consecutive operations.
Now, Chen Hongyan has been working in cardiovascular surgery for more than 3 months, mainly in the ICU. She needs to work night shifts every 5 days. 36 hours without rest is the “normal”. A full book. “This kind of intensity gives me the motivation to keep learning.” Chen Hongyan said that she set herself the goal of mastering the conventional techniques of extracardiac monitoring skillfully and flexibly within 2 years, and hopes to make achievements in scientific research in the future.
The most exhausting ICU night shift has begun. The night shift time is generally from 22:00 to 7:30 the next day. In addition to monitoring the patient’s condition at any time as in the daytime, doctors and nurses on the night shift must also be prepared to deal with the challenges of the emergency department.
Cardiovascular Surgery ICU Nanfang + Photo by Xu Hao
“After the night shift, I have to sleep all day, and I can’t do anything.” Yu Zhili said with a smile, “My family is used to my rhythm. My temper is not particularly good, it can be said that The best temper is for work, and the worst is for family.”
Leaving the small family and taking care of everyone is the tacit understanding of the cardiovascular surgeons.
Zero has just passed, and the intense work continues in the operating room.
With the increasing number of hypertensive patients, patients with aortic dissection are more common than ever, and sometimes “cluster” in the emergency department of Pearl River Hospital. This is an extremely dangerous disease, with 50% of patients dying within 48 hours. To this end, Zhujiang Hospital has set up a “green channel” for patients with aortic dissection, and critically ill patients can be treated directly from the emergency department to the operating room.
Wang Xiaowu (right) and Bi Shenghui during the operation, photographed by Nanfang + Xu Hao
This night, Wang Xiaowu, the head of the Vascular Surgery Group and the Deputy Chief Physician Bi Shenghui were all performing operations in series, and the medical staff in the ICU were also connected in two shifts. Although everyone worked hard, Tired, but not complaining.
1:00—3:00 Ugly Time
At 1:00 am, Wang Xiaowu received a WeChat message from his daughter: Dad, I just finished the experiment and I am going to rest. The tiger father has no dog daughter, and his daughter is now studying for graduate school and medicine in the north.
Cultivate oneHow long does a cardiovascular surgeon take? There is a saying that cardiovascular surgeons must be at least 56 years old to be mature and competent.
Wang Xiaowu said: “In foreign countries, a doctor must be trained and studied in general surgery, intensive care, thoracic surgery and other disciplines before he can become a qualified cardiovascular surgeon. We dance on the tip of a knife, saving and losing lives are often in an instant, which requires a good psychological quality.”
Cardiovascular surgery team during operation Nanfang + Xu Hao photo
Wang Xiaowu’s wife is an ICU nurse and fully understands the hard work of a cardiovascular surgeon. When it comes to family, Wang Xiaowu is both proud and self-conscious. “We must let the family understand that although cardiovascular surgeons are hard work, they are life-saving and a very honorable profession. They rely on this positive energy to make up for their regrets for the family. My daughter wants to study medicine, and she has suffered from this since she was a child. inspiration.”
At four o’clock, Li Yaling and her colleagues were still undergoing surgery.
One early morning last fall, Li Yaling, who was more than 8 months pregnant at the time, was still on duty overnight. An emergency patient, who had just undergone a successful operation, suffered a sudden protamine allergy after the cardiopulmonary bypass was shut down and nearly went into shock. Fortunately, Li Yaling was on duty throughout the whole process, and immediately re-exhausted and turned around, saving the patient’s life at the front line of life and death.
Li Yaling is operating the cardiopulmonary bypass machine, photographed by Nanfang + Xu Hao
“After it was done, I felt that the baby was moving all the time in my belly. At that time, I was thinking, although it is very hard, it is a good thing that saving people can accumulate virtue and blessings for the baby.” Until delivery. The day before, Li Yaling, who felt a change in her stomach, applied for a leave of absence from the director and wholeheartedly welcomed the arrival of her new life.
After the maternity leave ended, Li Yaling still worked the night shift as usual, and ran home to breastfeed her baby between shifts and operations. “Since I have chosen this profession, I still want to do a better job and let the children understand the greatness of mothers.” Li Yaling said that now the baby is one year old and has begun to get used to the “absence” of mothers.
Wang Xiaowu had just completed an aortic dissection operation overnight, when Wang Xiaowu returned to his office and ate a cold takeaway. After simply filling his stomach, he prepared to squint on the cot to save enough energy for the next operation in two hours.
Wang Xiaowu eating takeaway in the office South + Xu Hao photo
“One of the characteristics of cardiovascular surgery is that it works all night. I work about 12 hours a day, and team members often exceed 10 hours.” Wang Xiaowu said that medical staff in cardiac surgery must love the profession , be conscientious, and be not afraid of hard work and support each other.
In business exchanges, he often cheers for the team: “my country’s cardiac surgery is trying to catch up with developed countries in Europe and America, and there is still a lot of room for development.”
With such a rush and a sense of professional honor to save lives and help the wounded, this group, which has been officially established only more than 2 years ago and whose members are only over 30 years old on average, is full of vigor, working day and night.
“Although the sparrow is small and complete, the Cardiovascular Surgery Department of Pearl River Hospital is a young team, but we are backed by the hospital, and have already experienced in neonatal congenital heart disease, aortic dissection, valvuloplasty, etc. The field has made its own unique advantages.” Wang Xiaowu said that he hopes to double the number of cardiovascular surgery operations from the current 400 to more than 800 in five years, and enter the ranks of the top 100 domestic operations.
[Written by] Zhong Zhe and Wu Xiaodan
【Photography】Xu Hao Jin Dy
【Author】Zhong Zhe;Xu Hao