Books of N.M.Amosov
Diary. Saturday, February, 14
The whole week has been wasted, so to say. Three days in Moscow, a conference on cybernetics in physiology, my report. On Thursday I rushed from the train straight to the clinic. Three operations — all of them mitral prosthetics and very risky.
A boy of fourteen. You can expect any complications with children. The left atrium in the second patient was packed with thrombi — I extracted a whole glass of them. If you leave even small bits that will be the end of it — cerebral embolism will inevitably result. The third patient, a boy, had a very big heart. This is always too bad — extreme hypertrophy, very often accompanied by arrhythmia and even infarctions.
He showed us where to get off...
I left the operating theatre rather early — it was still light outside, around five o'clock. Two of my patients had already awakened and were breathing independently. I asked for the tubes to be removed. I waited until they rolled out the last patient. He awakened in the post-op room and followed all instructions. There was no reason to worry. At seven, I talked with Lida over the phone and said that I'd be home soon.
Nothing doing. When I entered the intensive care unit, Vitya Kozlovsky was leaning over the patient, staring at the oscillograph. A frightening ECG, known as ventricular tachyarrhythmia. Fibrillation might occur at any moment. Vitya was waiting: his hand poised over the heart, ready to begin massage. The necessary drugs had already been injected, artificial respiration had been resumed.
"There you are! It has begun!"
Fibrillation.
Then everything happened the way it had the week before. Massage went on for forty minutes, stimulants and inhibitors were infused; defibrillation was used every two-three minutes until the heart finally began to beat on its own...
Analyses showed pronounced hypoxia. We realized that we had put him on independent respiration too early. In this case, my experiment turned out to be harmful. I would have to correct my attitude towards artificial respiration, since such bad hearts apparently needed it for at least several hours...
It was not yet nine when I left for home. The heart was satisfactory, although the patient had not regained consciousness. There was no reason to stay any longer. He would have to be kept on artificial respiration. The situation would become clear only by morning... I began to feel better after a call at eleven. Sveta reported that there were signs of awakening, although very slight.
With this I went to sleep. I awoke with the same feeling at five and could not fall back to sleep. While I was running and having breakfast, I could not stop thinking about the boy.
They had good news for me at the clinic — the patient was fully conscious, and the tube had been removed. I could not believe our luck!
I thanked the others for their confidence in me at the previous day's conference. I promised to be as objective as possible and not to insult anyone's sense of dignity.
This time reports were made by chiefs of departments for children with congenital defects. Nothing in particular to write about. Our goal is to reduce by half this year the child mortality rate after operations with the AIK machine. I'll do my utmost. (And I mean what I say.) The round went without a hitch. The boy from the day before who had given us such a scare was quite normal.
My A. has already been moved to her ward in the Bendet's department. When I came up to her, she got up and gave me a kiss on both cheeks... I was embarrassed. Complications are still possible.
When I was leaving for home last Friday, her husband also embraced me, deeply moved. I excused his angry looks on the eve of the operation when there was almost no hope. It's too difficult for the relatives; we have to understand them.