When the Air Hits Your Brain: Tales from Neurosurgery by Jr. Frank Vertosick Page B

the heart-transplantation waiting list.
    Baby girl McKenna had entered the world with a small right ventricle. This pumping chamber receives depleted venous blood from the body and flushes it into the lungs, where it is replenished with oxygen. A month premature, she had arrived before her parents could agree upon a name. Her condition had deteriorated rapidly after birth, and she was sent to our pediatric heart service during one of my nights off. When I arrived in the pediatric ICU to make rounds at 5 A.M., little B.G. McKenna, a blue blob on maximal life support, awaited the next operating-room slot. Maggie sat in her surgical scrubs and rocked slowly in a large wooden rocking chair—known as the chair by cardiac interns.
    “I don’t know what we can do for this munchkin,” she said, sipping from a vending machine cup. “Hartley and I are doing her as soon as they finish the trauma patient that’s in the heart room.” Hartley was the chief of pediatric cardiac surgery.
    That’s great, I thought. I was on call for the night. B.G. and I were sure to have a fun time together. Babies this small can’t tolerate the heart-lung machine, and are done instead under “profound hypothermia.” Packed in ice until suspendedanimation occurs, the infant’s heart is stopped and repaired as quickly as possible.
    Certain species of frogs and fish can be frozen solid and rethawed with no apparent injury. But babies are neither frog nor fish. Without the protein antifreezes that circulate in those animals, they emerge from profound hypothermia near death, their blood-clotting mechanisms deranged, their livers reeling, their brains dysfunctional. I looked at the chair, now occupied by Maggie—the command seat for the pediatric heart patients in the children’s ICU. We spent many nights in it, wrapped in an afghan and rocking nervously, watching patients too unstable to be unattended.
    B.G.’s surgery commenced later that morning and finished around five o’clock. Having scrubbed on cabbages until about eight, I finally wandered down to the pediatric ICU for signout at nine. Maggie awaited me, anxious to sign out B.G. before leaving. The service was quiet…except for B.G. As I expected, the problem for the night.
    Surgical soap stained her scrawny little body orange from her neck to feet. Heating lamps dangled above the bed, to restore warmth to her frigid body. She looked like a little cornish hen roasting under the heat lamps of a delicatessen.
    Maggie handed me an index card. “Here, I’ve calculated the doses of the resuscitation drugs for her weight. I think everything is there—epi, bicarb, bretylium…The nurses know the defib settings, they’ll help you with that. You’ve taken infant CPR? Good. You’ll need it. She’s going to have a rough night, but if she makes it twelve or twenty-four hours, she has a shot. The parents have just left…We’re all counting on you. I want her alive tomorrow morning. You know how to reach me if you get up to your ass in alligators…So long.”
    Maggie left. I dragged the heavy rocking chair beside therotisserie bed and plopped myself in for the night. Gazing at the monitor, I watched the little squiggles that B.G.’s damaged heart traced across the fluorescent screen. So far, so good.
    I dozed for a short time. A nurse shook me awake. “Her pressure’s falling,” she whispered.
    I cleared the cobwebs from my head and ordered an infusion of albumin and an increase in her dopamine, an intravenous drug which stimulates the failing heart muscle. (The drug dopamine is the same as the brain chemical dopamine which is deranged in schizophrenics. The human body uses many chemicals in multiple roles.) B.G. stabilized for an hour before her blood pressure dipped precipitously again. Despite more albumin, the pressure bottomed out completely and her heart fibrillated wildly.
    I jumped from the chair and started cardiac compressions on her tiny chest with my index and middle fingers. I