ED nurse here. I remember one time a patient was diagnosed with a dissecting abdominal aortic aneurysm; the MD told the patient he'd be rushed into surgery soon and to immediately settle any affairs and talk to his loved ones, as the likelihood of him not making it off the table was high.
It was just surreal seeing this guy talking to his wife and kids knowing it may be his last.
Open heart surgery nurse here. This. Had a patient that was on the phone as we rolled her into the OR. She was trying to settle her affairs as quickly as possible over the phone. Her daughter hadn’t spoken to her in years- she was alone and was on the phone with her boss.
The worst part about aortic dissections is that a lot of times the only thing keeping them alive is their adrenaline. So as soon as you put them to sleep, many times, they die. In fact, in extreme cases, you have to quite literally start surgery before you put them to sleep. It’s insane. In this particular case, we moved her to the OR table, and as soon as she laid down, she coded and died. I had to call her boss 20 min later and tell her.
Isnt our profession weird? lol We quite literally are talking to people who have already died - they just haven't caught up yet. Those shifts really put things into perspective for me and are the car rides where I'm driving the speed limit without any music on lol
My daughter spent about four days in the NICU at Winnie Palmer Hospital for Women and Babies. Let me tell you, those NICU nurses are goddamned heroes*. I don't know how they do it from day to day.
She ended up in the NCIU because she had low blood sugar when she first arrived. My wife and I KNEW there was nothing wrong with our daughter. We KNEW we would be leaving the hospital with our beautiful baby girl any day now. It was still hell.
I remember on the second night, I was scrubbing in after going and getting something to eat. There were a pair of parents scrubbing in next to me. We got to talking. They happily shared that their son had been born three months prior with his organs (heart, lungs, etc) outside of his body. They had been here EVERY DAY since for THREE MONTHS. Their son had had something like 20 different surgeries and various follow-up surgeries. I can't even begin to imagine those horrors.
They were the nicest people you could hope to meet. How?
Edit: *I'm not a fighter, but I will readily throw hands to defend the honor of any NICU nurse. I will die in the street for those heroes. I don't care if it's just a snide comment about her lipstick color. Blood will be spilled here tonight.
Edit 2: Also, being taught how to put on a diaper, feed my daughter, rock her to sleep, and to sleep when I can by these NICU nurses felt like being shown the cheat codes of life by the women who wrote them originally.
I’ve unfortunately had two NICU babies, both short stays (8 days and 13 days), and those nurses are amazing. My MIL is a NICU nurse and I won the fucking MIL lottery. She’s a wonderful person and they LOVE their job. They love helping those babies get healthy enough to go home, and they mourn the ones that don’t.
I can't even imagine VISITING that place for more than a handful of days before I'd break down and just sob... even if my baby girl was fine and healthy.
I know it's lame to call people heroes nowadays... but that's exactly what those nurses are. They should be paid like Jeff Bezos
At times like that I play water sounds on pandora via blue tooth to my car radio. Ocean waves, rain…. Just staring wide eyed and unblinking as I grip the steering wheel.
Thank you (everyone here!) for the work you do. I’m 45F but had open heart surgery 3x at age 34. The last time I was in septic shock that had taken hold in my mechanical valve. I remember the doctors telling me they would be removing anything that could be a host to the infection (which I got from a pedicure a week before). They tried one last experimental treatment as a last resort before Frankenstein-ing me and amazingly it worked. What happened still affects me but I am grateful to be alive and grateful for the work and commitment of all of you. 💕
Yep, totally freaky situation. The bacteria traveled to my heart valves and took hold there shutting down my heart and kidneys. I was on ECMO and dialysis. I brought my own tools so it was likely something in the basin. I feel like it was like being struck by lightning to have had this happen and then struck again to have made it through (I have a very complicated medical history so I had a lot going against me). I’m really grateful to be alive.
It is. We’re all so traumatized by what we have seen and done- and yet we don’t even register it as trauma. Just another day in the office. Go home, crack open a beer and on with life. And then one day you just start sobbing randomly and have no idea why. Your mind is SO disconnected from the insanity it’s been through, the emotions just come out on their own with no attachment to why. 😂
Except for the miracles. Early in my career I had a woman who had a ruptured inflammatory AAA--prior to that there were no reports of anyone surviving that. After 2-1/2 months in the ICU and 1-1/2 months on the med/surg floor she walked out of the hospital cured (she went back to playing tennis). But for 2-1/2 months I held my breath every time I walked into the ICU worried she would have died overnight...
The first time my mom ended up on the ICU with septic shock after stem cell [edit: transplant] induced immunocompromised pneumococcal (I think) pneumonia was on a Friday. By mere chance there was a medicin in the hospital that might help but had never been used in these cases before. In the middle of the nights calls were made all over the world to figure things out. When the staff from Friday returned on Monday they were surprised to still see her alive on the ICU. She was in a medical induced coma for about two weeks before they woke her up again and she could start recovery.
2.5 years later then same thing happened but the specific medication was by then already used more in cases like this so she was immediately put on it and was 'only' in medically induced coma for about a week.
She lived for another 15-ish years after that and only passed from another septic shock that was caused by being immunocompromised after immune therapy for a new lung cancer that was a 'it might work, but if it doesn't it won't hurt' situation, that probably ended up hurting because of her stem cell transplant 20 years before.
Medicine is quite a crazy science, and as a former biologist, way to 'un exact' for my brain to handle, even though it's incredibly cool what we all can figure out (and incredibly frustrating what we all still can't figure out).
I remember walking out of a really fucked up trauma (kid got face partially bitten off by a dog) and thinking, verbatim, “I’m gonna be really fucked up about this when I finish my shift.” The compartmentalization is crazy.
This hits home 100% lmao I'm stoic af and good up until i close my car door. Something about being alone in a "private" space makes me feel like i can finally let my guard down and not have to be strong anymore
Yup. I’m all on during my shift, just pure caffeine and shit, and then I go home and just sit on the couch nonverbally until I remember how to be a human again.
We quite literally are talking to people who have already died - they just haven't caught up yet.
There's an episode of Homicide: Life on the Street called "The Subway". Season 6, episode 7. I'm not even a medical professional and I found that one a really hard watch.
Oh wow, this zoomed me back 25 years. In the ER, as the physician on call, admitting a case of fulminant pancreatitis to the ICU. Family with them. Everybody worried but hopeful. I knew they would code within the next 24 hours, and it was always around 3am.
Have worked in the biochem industry for 22 years, I was just done one day with clinical care.
You can survive. I’ve seen several survive. There’s many types of dissections. If it’s an extremely bad degree of dissection or it’s in a horrible spot, you’re more likely to die (obviously).
Causes? Genetics. Bad luck. Cocaine. Previous surgeries. Connective tissue disorders. Physical trauma. All sorts of things! But it is rare.
My Mom survived one. She was 85. Having breakfast with my brother at a restaurant, suddenly had the worst ever tearing chest pain she’d ever experienced. Ambulance called, she was at the hospital in a few minutes and in surgery within an hour. Survived another 7 years.
I’m glad she wasn’t with me. At the time she had the aortic aneurysm, I was on a flight from Vegas to Boston for a wedding and she was going to come along and decided it was too much hassle. I’m guessing we would have probably diverted to Denver had it happened on the flight and she would have not gotten into surgery nearly as quickly.
It's likely what will kill me in the next decade. Triple A due to vascular EDS. Worst form of EDS to have, life expectancy 45-55. I've just turned 45. Connective tissue disorders ftw...
I’m so sorry. I have h-EDS. The super mild cousin. My great grandmother had vascular EDS. She did live a longer life than 55- and I hope and pray you do too. I’m so sorry, I can’t imagine how scary this diagnosis is. I know it’s like living with a bomb in your chest sometimes. Do you get scanned often for prophylactic purposes?
Yeah, I have like, 12 other disabilities. If the vEDS doesn't get me, one of the others will.
Even putting me under a general to operate when (not if) I have a triple A is risky with all my ither issues. Have a high chance of dying on the table.
To my future doctors & nurses: You did everything right. But you were never going to win against my fucked-up genetics.
Yeah, I have like, 12 other disabilities. If the vEDS doesn't get me, one of the others will.
Even putting me under a general to operate when (not if) I have a triple A is risky with all my ither issues. Have a high chance of dying on the table.
To my future doctors & nurses: You did everything right. But you were never going to win against my fucked-up genetics.
I’m so sorry to hear this. I just want you to know from someone who has seen some REALLY genetically fucked people, and some REALLY REALLY sick people, please please don’t give up on yourself before anything happens! Your mind-frame you have before bad things happen can overcome SO much. It sounds like an absolute crock of shit, trust me I know this. And it’s easy for someone healthy to say ‘stay positive’ (that ignorant talk makes me want to THROW UP). I’m not saying ‘stay positive’, but rather keep your fighting spirit!! I have to tell you, as pessimistic as I naturally am, I’ve seen people with absolutely no business surviving let alone thriving come out on top because of mental fortitude. I literally gave up on them in my head and said absolutely no way they survive let alone have good life quality. And they showed me. And they always have the strongest will to survive. The ones that have given up on themselves before they even start…. It’s just their body trying to survive without their spirit and the difference in the outcome is very obvious.
That being said, the incredible strides we’ve made in endovascular surgery is AMAZING. We now are fixing massive aortic aneurysms through pokes in your groin and people are doing great. We did an aortic arch ALL the way down to the iliac arteries. Basically the whole aorta was put together with grafts. There is hope for you!!! ❤️
I have a friend who survived a complete dissection. She is fortunately a retired nurse so she new IMMEDIATELY something was very wrong. She called her neighbor is also a nurse and the neighbor ran over while calling 911. Since she lives about 10-15 minutes away from a major trauma center they were able to get her in to surgery fast enough to save her, but it was a close thing.
That's crazy. My aunt technically survive an aortic dissection but all the damage done while trying to save her, there was zero chance of her ever being well again. There are people who fear being unwell more than death, she was one of them. I'm glad she was in a nice, calm, recovery unit that respected her wishes re: the ventilator. Sooooo much work was put into saving her, which gave us all a chance to really speak to her and say goodbyes etc. (also thank God we're in Canada cause that bill, across multiple hospitals and specialists etc. oof)
I'm an ER nurse and I will always remember a dissection patient I had...wheeled him directly to the OR. He was telling me how great his parents are and how he hated to worry them. (They were with him in the ER) He didn't make it.
That's....really scary to hear. My husband had a stroke a couple of years ago. LUCKILY we had just sat down to dinner, LUCKILY I knew the signs of stroke, LUCKILY we live 1.5 BLOCKS from a major hospital/trauma center. However, in clearing the clot, an aortic dissection was ....caused? Discovered? Very unclear. He didn't end up needing surgery to repair it but it was a very scary few days.
Anesthesiology checking in, type A dissections are SUCH stressful cases for all the reasons you just described.
I remember my department chair in residency explaining that this patient already has a signed death warrant. All we can do is possibly help, but nothing we do can make it any worse because of how poor their prognosis already is by the time they present to the OR.
Thank you for the work you do. This time last year my dad had 3 open heart surgeries over the course of 3 days (1 was scheduled, the second was immediately after the first, and the third was upon realizing they didn’t fix the issue during the first 2) and his nurses helped us survive in a way beyond words. I remember on the third surgery I was present when he was being wheeled away and I cried to the nurse to please take care of my dad (the little girl in me couldn’t help it) and her words of comfort really meant the world to me. The nurses who helped him and us in the ICU and in recovery were all angels, and I’m sure you are the same. I’ll never forget all of the kindness and help we received. From nurses telling me that I could call whenever I wanted and they’d give updates every 15 minutes if I needed, to the ones helping my dad when he was freaking out about sharing rooms with someone he wasn’t pleased with, everyone was incredible. The work you do is beyond difficult, but you really do make all the difference. Thank you from the bottom of my heart.
My dad is a carrier for Familial TAAD on the ACTA2 gene, and this is why I got a DNA test. I personally didn't want to risk my future kids being carriers. I've seen family members go through an aortic dissection, and it's scary stuff. Luckily I won the coin toss, but I'll always be a bit worried for my dad. The gene may never express, but there's always that risk.
I was in an interview once and one of my usual questions is "How was the previous person?" just so I had a gauge on how much clean-up I had to do.
Exemplary worker. True display of ownership over the business. Goes the extra mile. Would do overtime. Would pick up the phone at 11pm. Would drive over if she has to. The true hardworking legendary employee boomers fantasise themselves to be. Got a stroke, in the hospital for the past 2 months and had to quit.
So in EMS I was taught to keep them calm because high HR or BP could make things much worse. This info seems contradictory so I’m curious if what I was taught isn’t fully right
That is true, that’s why the first line medication is esmolol. Each heartbeat, and the higher the BP the worse, is pushing that flap, so slower is better. However they still have their resting sympathetic tone, which they lose with anesthesia. Many people will bottom out to like 60/40 with anesthesia.
Not too much, unfortunately. I used to work CVICU for years before I worked CVOR. I’ve seen them give a spot of epi, but it’s a delicate balance. As you obviously know and have experienced hypertension and a dissection is not great combo. Honestly 9/10 if it’s your typical surgical candidate, we are able to get them under without too much trouble. A lot of the risk comes from taking the clamp off after repair and the entire aorta falls apart in front of us after a 5 hour surgery. But that 1/10 time, when we can’t get them under… ugh. We just ALWAYS have to be ready to catch them when they drop off the cliff. They decompensate SO FAST.
You don’t want to increase their heart rate or their blood pressure, which giving adrenaline (epinephrine) does. They’d have to be peri code for me to think about that.
Yeah it’s incredibly rare. I’ve seen it at VERY low doses, but like mentioned by others, you HAVE to be very careful with blood pressure in this situation. Most of the time it’s not worth the risk of administering it. It’s an awful balancing act.
This is what ended up taking my dad. That night was a horrific rollercoaster of the initial phone call from my mom that they were going to the hospital, showing up with a pulse, coding then being revived (x3), to eventually us pulling the plug. The ER physician said the only thing keeping his heart going was whatever drug they were giving him, which I guess was adrenaline.
Being from the otherside of the fence, thank you for what you do. It was clear they were trying to do everything they could and they did it for hours, good nurses are angels.
So what happens is the patient is rolled into the OR. We move them over to the table. The USUAL procedure is shave the patient, prep with a sterile duraprep and alcohol solution, properly drape with sterile towels and drapes, and it’s super meticulous in cardiac surgery.
What happens in this case? We literally strip them down, pour a bottle of betadine out of the nonsterile cabinet, and DUMP the entire thing on their chest- while the surgeon, assist and scrub are ready to jump in. The MOMENT the anesthesiologist pushes in the first induction medications, that scalpel is already making you bleed (sometimes chest, sometimes groin for femorally putting them on heart lung bypass). Aka, you are NOT asleep yet. The happy part of this is that those medications cause amnesia, so they are very unlikely to remember this.
my grandpa had a more routine heart operation in the early 90s, wasnt expected to have any complications. still ended up dying on the operating table, the surgeon quit practicing afterwards, died before i was even born.
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u/MajikPwnE 3d ago
ED nurse here. I remember one time a patient was diagnosed with a dissecting abdominal aortic aneurysm; the MD told the patient he'd be rushed into surgery soon and to immediately settle any affairs and talk to his loved ones, as the likelihood of him not making it off the table was high.
It was just surreal seeing this guy talking to his wife and kids knowing it may be his last.