It was one of those intensely dark, deep December nights, at least a decade ago, back in my heart surgery days, when we went to my wife’s “Ladies Night Out” Christmas party. The location, a block from the hospital, was most convenient for my on-call status, but said status left me somewhat resentful and abstemious among the other spouses. I could certainly eat, however, but just before dinner the ER called.
Some guy, only blocks away, had been stabbed in the chest in some chemically fueled conflict and was on his way in with barely detectable vital signs.
He and I arrived at the same time. His breathing was agonal, which is that of a dying person resembling a fish out of water. No longer responsive and his face blue, he was quickly intubated by the ER physician to secure the airway. Blood pressure was unobtainable, and his heart rate was now 160. Drifting through the corner of my vision, I briefly thought I saw Tami MacDonald, one of the cardiac surgery charge nurses.
The guy’s only hope was to get him to the OR immediately and relieve what appeared to be cardiac tamponade, which is when a hole in the heart leads to bleeding in the sac around the heart. The heart is compressed by the blood around it and can’t fill or squeeze. That option evaporated when the distressed heart fibrillated, going from a wildly contracting muscle to a quivering and ineffectual organ in the chest of a man now dead.
We washed his chest in betadine, an antiseptic, as it became apparent we would have to open him there in the ER. I took off my new Christmas sweater, a rich emerald and black, so it wouldn’t be ruined in the coming tumult. I put on a blue paper gown, despairing that I would have to try to cut between the ribs to get to the heart, because I had none of my regular tools.
I’d often wondered how those shepherds felt, on the first Christmas, keeping watch over their flocks by night, when suddenly an angel of the Lord appeared in the sky.
Whoa. Now I know, because as I reluctantly picked up the scalpel, Tami appeared with Kathy Kennedy, one of my cardiac scrub technicians, and they had brought all my toys from the OR — a sternal saw, a retractor, every present you can put under the tree. One vertical slice to the bone, a quick run up the sternum with the saw, open up the pericardium with the Mayo scissors, and we were there.
His heart, blue and distended, undulated weakly but defiantly as it died. There was a short, clean rent in the right ventricle where the knife had entered, and black, desaturated blood oozed.
Kathy gave me just the stitch I wanted, a 3-0 Prolene on an SH needle, a bright blue, Christmas ornament-looking stitch with a white felt pledget on the thread so it wouldn’t pull through the almost gelatinous heart muscle.
One stitch closed the hole. The heart was repaired but not beating, and I thought desperately if only I had internal defibrillator paddles, which Tami promptly produced in another miracle. One shock and that moribund heart leapt joyously back to life.
The heart blasted liters of blood to the oxygen-starved brain, which then snapped out of it and ordered a round of breathing. The man’s large chest then violently contracted, and all the blood pooled in his chest from the stab wound was expelled in a mighty gush into my face and onto my paper gown, which promptly dissolved.
Soaked in blood and now bare chested, I watched in horror as he then sat bolt upright, his heart swinging wildly out of his chest, and I mused that things were getting a little weird.
The alert ER physician quickly anesthetized the guy, and we scooted up to the OR and washed him out and closed him.
Afterward, I stood in the shower in the OR locker room, the hot water loosening the clotted blood from my body hair and sworling crimson around the drain, and I reflected on what had happened. All those people in the ER, my trusty OR crew with whom I have shared thousands of cases, the people in central processing who get all the tools together and clean, everyone at that moment in time came together, read the situation perfectly, and had executed the ultimate two-minute drill.
I went back to the ER, found my new sweater tucked gently in a corner, and went back to the party.
Two days later, it was like nothing had ever happened to the guy. He was fine. I sat at his bedside, preparing him for discharge, and told him that a lot of people had done an incredible job to save him, that I felt his survival was as close to miraculous as it could be.
“Whatever,” he said, “that’s a nice story but let’s make sure I get plenty of Percocet, OK?”
I just lost it at that point, and unleashed a thoroughly unprofessional sermon right from the fourth chapter of the Gospel of Dirty Harry: “Listen, punk, you’re just another piece of garbage I stepped in while I was on call. You’re like the sixth idiot I’ve fixed with a stab to the heart, and the first five were just as useless as you.”
I stomped out, discharged him and wrote a prescription for ibuprofen. You and your posse party down on that.
Eight months later, I was chilling in my office when some guy strode in, walked right by reception and up to my desk. He emphatically slapped down two pieces of paper in front of me and delivered a challenging glare.
One of the documents was a culinary certificate from a local technology college, and the other was a pay stub from a restaurant. He then delivered on sentence, each word laden with fervor “I … am not … a piece … of garbage.”
He then dramatically exposed his now healed sternotomy scar.
When the night is cold and dark and deep, and it seems that our lives are predictable and even grinding at times, there always exists the possibility that a bright light, even a star, will appear and change everything.
Christmas is ultimately about a light in the darkness, the belief that redemption is always possible. It is also a challenge to each of us to live our lives, as seemingly as ordinary as they are, with an attitude of excellence, so that when the moment arrives that we transform the mundane into magic, we might hear the angels sing.
Dr. Alan Muskett is a board-certified plastic surgeon at Billings Plastic Surgery.