OF A FAILING HEART...

So the other day we admitted a patient with a severe heart condition at 26 weeks gestation. She had rheumatic heart disease...(that one caused by untreated throat infections that then spread and cause your heart untold grief....). She had severe Mitral  valve stenosis with elevated pulmonary pressures. Now pregnancy as much as it produces a smile and a bouncing bundle of joy also wrecks alot of havoc on a woman's body (Now this is one reason why every woman should be respected....especially after she has carried a baby to term.....)One of the systems that is badly battered is usually the heart. So the patient is admitted because the pregnancy was taking a toll on her weak heart for intervention.

Now in this part of the world, resources are limited and scarce (ahsanteni AKUH for the brand new cardiac unit.....). A cardiologist reviewed the patient and he suggested they could do a minimally invasive procedure where they pass a catheter from the patients thigh to her heart through a blood vessel and try and open up the blockage. Well that was welcome news..wow...a solution! Damn problem, The Cath Lab that does all those procedures has been accumulating serious dust and all those funny creatures! It has been out of order for...eh....ah.....DOG YEARS! Now as much as it can be done in other units, the operation costs two arms and six feet! And my patient didn't have such resources sadly.

The other option we offered was terminate the pregnancy, save her ailing heart then plan for the operation later. Only problem was,the pregnancy was quite advanced, terminating it would cause more harm than good the seniors shuddered at that option. I had a chat with her and offered the options, we were stuck. Her husband was even more lost (aren't men always lost on such issues??)

Then along came our knight in shining armour... Cardiothoracic team. They said they could try open heart surgery and replace her valve with one of those brand new shiny ones(I think they're cool....you can hear every heart beat as a click!!! ) OK, we were stuck really, and there was no way we would keep her in the ward and just watch her waste away, something had to be done. We prepared her for theatre, haggled and begged for an ICU bed post op and finally she was taken to theatre.

She managed almost 2hours on the fancy heart lung bypass, another two hours of....... (Honestly I don't know what they do, but I really admire their skill, holding the heart in ones fingers and feeling it stop beating and after all that, feel it beat all over again once the whole operation is done... I think it must feel exhilarating!) So she pulled through it and she awoke in ICU. She was even breathing on her own, without all those tubes down her throat....until some 24hours later, complications arose, she threw a clot and in a matter of minutes....she was gone.

We lost them both. Could we have lost her if we did nothing? Very likely. But we still lost them when we did something.

Such is the life we live day in, day out :-(