Two heart caths and a book by it's cover

Got off work, where today I had the opportunity to observe two cardiac catheterizations. I was considering only observing one, but I'm so glad I stayed and watched two; the two cases were as different as night and day, just going to show you that something simple and routine can be very different the second time, because each patient is different.

The first patient was a man, mid forties, clearly a little jumpy, but in control of himself, nervously cracking jokes. He was a little spazzy and needed to be reminded to lie flat after the procedure (any lifting of the head or bending of the leg immediately afterward causes increased pressure in the groin, threatening to dislodge the collagen plug inserted into the femoral artery to block the hole made by the catheter) - but on the whole, he was great. His cath was negative, as well, meaning there were no occlusions or problematic narrowings of the coronary arteries. The answer to what's causing his intermittent chest pain must be sought elsewhere.

The second patient was a different story. Her family sat surrounding her in the preoperative room, and when we came to take her into the cath lab, she began loudly insisting "No! You're going to put me out, right? I don't want to leave this room conscious!" She was 79, one of those ladies who screams in protest if you so much as press on her firmly (feeling for her femoral pulse was a trip). She didn't want to see anything in the procedure room, so we covered her eyes with a towel. The doctor also had an unusually difficult time finding the artery with his needle, which he puts into the artery in order to place the guide wire, and then advance the catheter. He ended up needing to use what is called a "smart needle" - it uses doppler to give the physician an audible idea of where the needle is in relation to the rhythmic swooshing of blood through the artery, helping him locate it more easily. Even with the aid of the smart needle, the woman's vasculature was located so deep that he had to probe quite a bit. The complicating factor here, I believe, was that she was quite a bit overweight. The doppler made sounds like the doc was navigating a windswept, frozen mountain peak in Greenland or something. Anyway, eventually he got to where he was going. This patient's heart cath revealed a partially occluded right descending coronary artery.

It was a nice plus that I was with some OR nurses who really liked to teach, and were great about it. Especially Brice. At first impression, I was like, greeeaaat....this guy won't even make eye contact with me, I know I'm a lowly student, but you don't have to be such a stiff about it...lol my preceptor dubbed him "Mr. Evil Hottness" because he is really quite good-looking, and young. BUT, hooray, he ended up explaining like EVERYTHING about the heart cath to me of his own accord, and really involving me in what was going on. So it was sweet. The end.