I've gotten some great feedback this week about update preferences. I will continue sending out email updates (probably weekly) and I've set up a blog. The blog link is: http://kristenfrey.
The case of the week goes to a lady with lung cancer in the middle lobe of her right lung. She is fortunate in that she was able to just have that lobe removed, rather than the entire lung. What makes her the case of the week is that during her surgery, one of the branches that comes off the right pulmonary artery tore 2/3 of the way through surgery (it was going to be taken anyway, but it prematurely came loose from the main line). "Oh boy that can't be good", you may be thinking... And you would be right. Before I continue with my story I want us to all be on the same page. The pulmonary vascular system is special: it's tubing and contents are opposite to that of the rest of the body. Normally arteries have thick walls and carry oxygen rich (red) blood to the body. While veins have thin walls and bring oxygen poor (blue) blood back to the heart and lungs. Since the pulmonary system is opposite of that it means, the pulmonary arteries are thin and contain blue blood (to go into the lungs and get fresh oxygen), while the pulmonary veins are thicker and contain red blood (to go to the heart and get pumped to the rest of the body). Why is that so important you may ask? It means that the pulmonary arteries are flimsy and prone to tearing, but carry a very large volume of blood in them. You know that saying from "Finding Nemo," that "all drains lead to the ocean"? Well, all veins lead to the heart, and then lungs... So if there is an unintentional, uncontrolled tear in a pulmonary vessel, someone can bleed to death very quickly. Ok, back to the story. Her operation was video assisted up to this point. When the small vessel partially tore, it was like the dam had broken loose. I've never seen that much blood come out of such a small hole before. Dr. Facktor and Luiz (the resident on our service this month), were calm as they found the leak and controlled it with gauze clamped in the end of an instrument. Dr. Facktor had the staff page Dr. Friscia to the OR stat! as Luiz enlarged the small VATS incision to become an open thoracotomy incision. The two surgeons then worked together to repair the hole as quickly and carefully as possible. It took them just a few minutes to repair. In that time however, even with good control, the patient lost about 900mL of blood, which is just under 1/4 of her total blood volume. She didn't require an intra-operative blood transfusion, though I think she got one afterward in her hospital room.
Geisinger is very much on the "healthy living to prevent diseases" bandwagon. As such, they provide free pedometers to employees who request one. I walk all over the hospital every day and curiosity has gotten the better of me. I received my pedometer last week and have logged a few days already. So far, I've walked 4-5 miles a day at work! That does include my walk to and from work, but the vast majority of it comes from walking the hospital. Add that with the hours spent standing during surgeries, plus the Calories burned for thinking/learning. That all means I get voraciously hungry for lunch and dinner. In order to prevent myself from being featured on one of those Snickers commercials, I've taken almonds and granola bars to work to hold me over if I feel myself getting too hungry. Maybe I should just buy a Snickers instead...
I went horse-back riding again yesterday. The horses are up to pasture at Laurie's brother's. So rather than having a harrowing adventure up an old logging road, we did a mellow 1.5 hour loop on rural dirt roads. It was a lot of fun, and I'm not nearly as sore as I was after the last ride. I'm going to end here for tonight because I need to get to bed. I will blog about Warren's barbershop experience and the Old Forge Brewery this week. So stay tuned to that link :-)
I hope you are all doing well,
Kristen
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