Just a heartbeat away

TickTOCK TickTOCKTickTOCK _________________

For 72 years Phil Turner’s heart performed soundly; idling at 59 bpm then revving up to 180 bpm when chasing after a ball or an opponent, or when tactically retreating from an imminent snake encounter. Now, 37 minutes into urgent abdominal surgery, Phil’s ticker failed.

Phil is a habitually fit human being. For longer than he can remember, he has been involved in strenuous sporting pursuits, playing competitive cricket until age 65 until Covid 19 shutdowns called an extended drinks break.

Phil plays social tennis on Saturday and walks the local golf courses mid-week. On Sunday you will catch Phil joyously toiling in their quarter-acre garden, with his loving wife, Fiona. He never shirks any task. Whether through pride or frugality, Phil climbs trees that need lopping, digs trenches and carts all manner of freight in his often overloaded 8x5 trailer.

His knees are a bit worn out, his back lets him know when he’s overdoing it, but Phil’s BMI is about right, and his endurance is high. With a sly wink towards Fiona, Phil proudly describes himself as “a lean, mean, loving machine.”

Phil lives what he describes as a balanced life, “Work hard and play hard.” is his motto. This has served him well for a very long time, so it was a hell of a shock when he met the dawn on this early spring morning with a fever and a gut ache that would kill a brown bear.

“Hi Phil, my name is Paul Riser, and I’m the surgeon who will be looking after you today.”

Phil looked up from the trolley he arrived in the Emergency Department on, clutching tenaciously to the magic green pipe the paramedics gifted him for his journey. With his free hand Phil desperately clutched Fiona’s warm, loving hand, creating a powerful connection that temporarily cleared the fog in his head and allowed him to focus on the intense bespectacled eyes above the blue mask that was calmly speaking to him.

Paul Riser is a 56 year-old, bald gentleman with intense brown eyes highlighted by steep crow’s feet and uncharacteristically bushy grey eyebrows separated by short vertical frown lines. The image reassuringly portrayed a learned professional with a comforting sense of humour.

Dr Paul is a renowned general surgeon specialising in the gastroenterological genre. He trained at Harvard University before spending 5 years with Médecins Sans Frontières, serving in Afghanistan and the Middle East. After 10 years in private practice and 5 years lecturing at the University of Toronto, Paul returned 7 years ago to his home town of Melbourne and to his life-long passion of emergency surgery, at the Alfred Hospital.

Dr Paul explained to Phil that he needed a CT scan to hopefully determine the cause for the pain and fever. A burly yet competent patient transporter cheerfully wheeled Phil out of the emergency ward, along a maze of corridors, through countless doorways until finally pausing at the Radiology department waiting room.

The professional scanner operator, with the assistance of the more than capable orderly helped Phil onto the CT chamber table and within minutes he was back on his faithful trolley for the return leg to ED.

“Welcome back, Phil”, greeted Dr Paul, with a thoughtful yet reassuring frown. “So, here’s the deal. You have a small perforation in your large bowel, caused by an inflamed diverticulum that has ruptured the wall of your colon. You are currently experiencing septicaemia from the infection, so we need to perform a Hartmann’s Procedure ASAP to repair the damaged section of bowel.”

Still dizzy from the recent trolley ride Phil looked to Fiona, who is a registered nurse but prefers to keep her little secret when visiting hospital environments. However, on this occasion she willingly offered her skills as an interpreter, putting both the medical staff and her discombobulated husband at ease.

“You have a hole in your bowel that’s leaking shit into your belly, and this is causing a major infection.” Fiona couldn’t see what was going on behind Dr Paul’s mask, but his frown disappeared as he nodded, confirming her translation into layman’s language.”

Phil nodded, “Got it. That makes sense to me. Sounds pretty urgent so let’s get on with it.”

While Fiona and Dr Paul were looking at each other anticipating their next move, Phil asked, “By the way, what’s this Hartmann’s thingy?”

Fiona motioned to Dr Paul to take over.

“First thing you need to know is that this is a major operation, in fact it’s considered the biggest abdominal surgery you can have. Typically, it takes around four hours to perform.” Dr Paul paused to allow Phil to digest the gravity of his situation.

“Yeah, go on…”

“What we do is make an incision from your sternum to your pelvis so we can access your entire intestinal tract.

Then we cut out the damaged section and sew up the remaining rectum known as the stump.

The live end of your colon is then brought out through your abdominal wall to create a new active rectum, known as a colostomy.

We attach a colostomy bag over your new rectum and that deals with the faeces.”

“Sounds wonderful.” Phil uttered with a tone of sarcastic resignation. Again, he looked to Fiona for reassurance. Fiona was quite familiar with the Hartmann’s procedure, a complex operation that is only performed by the most skilful surgeons. Feeling sure that Phil had the gist of the explanation, she attempted to lighten the mood by translating as, “Dr Paul is going to do what I have threatened to do often, rip you a new arsehole!”

The mask chuckled, Phil glared at Fiona and a nurse arrived with the inevitable paperwork.

An hour later,

“BP 60 over 40!”

“Weak pulse!”

“BP 40 over 20!!”

“No pulse!!”

“The patient has arrested!” announced the surgical registrar, attending his first Hartmann’s, an honour bestowed upon only the brightest surgical hopefuls.

“Should we administer adrenaline?” the registrar asked, eagerly awaiting confirmation of his brilliant diagnosis and recommended treatment.

The head nurse suggested activating the Defibrillator and another nurse queried whether CPR might be appropriate.

All the while Dr Paul gave no response, instead focusing all his attention on the rather gory cavity behind Phil’s rib cage.

“Please Dr Paul, what should we do?” demanded the anxious registrar, to which the experienced anaesthetist gently raised his forefinger in a gesture commanding silence.

Finally, Dr Paul calmly announced, “I have the situation in hand.”

Silence filled the theatre with the exception of the cardiac monitor that was only capable of playing one note, incessantly.

“Seriously, I literally have the patient’s heart in the palm of my hand.” Dr Paul explained to his stunned audience. “There’s not much room in the chest to witness this technique, but I suggest you watch the monitor closely.”

What Dr Paul did next was nothing short of amazing. With the palm of his hand firmly supporting Phil’s heart, he compressed the dormant organ against the robust flat sternum, simulating a normal heart beat.

With metronomic skill Dr Paul persisted with the heroic internal cardiac massage for 3 minutes until the cardiac monitor jumped back to life tracing a somewhat sinusoidal rhythm.

“BP 70 over 50.”

“Irregular pulse rate 50 bpm.”

“BP 90 over 70.”

“Pulse 72 bpm. Back in sinus rhythm!”

As the monitor told a story of strong improvement in Phil’s heart health, Dr Paul’s sense of humour returned and he announced, “Look, no hands!” Of course, the whole surgical team looked away from the monitor to see Dr Paul still up to his elbows in Phil’s chest cavity. He ordered a series of drug infusions to stabilize Phil’s cardiac function and after several minutes of good behaviour Dr Paul carefully withdrew from Phil’s chest cavity and picked up where he left off. He continued manipulating Phil’s large bowel, cutting and shutting as if nothing out of the ordinary had happened.

8 hours later, “Welcome back to the land of the living.” The mask exuded joy, satisfaction and an air of relief as Dr Paul stooped over Phil’s ICU bed, inconspicuously cradling his patient’s left wrist and surreptitiously glancing at the cardiac monitor.

“How did it go, Doc?” A washed out Phil enquired. It was clear from his shallow breathing and raspy voice that he wasn’t up for a detailed account of the afternoon’s events, just a comforting “all good” would suffice.

“The surgery went very well. We’re sure you’ll make a full recovery. Rest now and we’ll chat more tomorrow. No problem. Good night Phil.”

3 days later with his body temperature back to normal and his heart pumping powerfully in his unexpectedly sore chest, Phil was learning to deal with the intricacies and nuances of living with a colostomy bag.

Conveniently, Dr Paul and Fiona both visited Phil at the same time and Dr Paul made a point of taking time out to answer all their questions and even explain why Phil’s chest was so sore after abdominal surgery.

To enhance the relaxed atmosphere of the informal meeting, Dr Paul removed his mask, revealing a surprisingly distinguished white handlebar moustache that extended the curl of his lips making even the slightest smile appear as a mischievous grin.

Since the frantic morning of Phil’s admission and the urgency of the surgery, so many questions were left unasked. Apart from the questions of management and hygiene and cost, by far the most pressing and desperate question is, “Is this situation reversable?” In other words, will Phil be stuck wearing (and dealing with) a colostomy bag forever?

“First things first.” Dr Paul instructed with a wry smile, or a cheeky grin, depending on whether they were looking at his lips or his flourishing ‘stache.

“Let’s start with how you got here in the first place. Diverticulitis is almost entirely a disease of our Westernized diet, low in fibre and high in ultra-processed foods and saturated fat. So, it’s not your fault.” Another comforting smile. “All you did wrong is eat what was served up to you. I’ll refer you to a dietician if you like, so you can make any necessary modifications to your diet.”

“Now, let me tell you about a little adventure you didn’t even know you were the star of, during surgery.” Dr Paul leaned closer to the curious Phil, rubbed his hands together and winked at Fiona as if to say, “You’re going to love this.”

Dr Paul went on to recount the events leading up to Phil’s cardiac arrest and the technique he employed to correct the issue, trying to play it down as just part of a day’s work. He anticipated Phil’s and Fiona’s next question and explained the incident resulted from an allergic reaction to one of the anaesthetic drugs. “We reversed the reaction with another combination of drugs, and all went fine after that. You’ll be pleased to know we have documented your allergy, so you won’t repeat the performance if you ever need a general anaesthetic in the future.”

After clearing up some colostomy management questions which the stoma nurse had already drilled the couple about, Dr Paul moved on to the most pressing question that was hanging precariously from Phil’s lips. “Based on what I saw while I was swimming around in your gut, I am very confident that we will be able to successfully reverse the Hartmann’s procedure. Defying physics, with the massive load lifted from Phil’s shoulders he sank into his pillow, and although overjoyed at the news, a confused tear found itself wandering down Phil’s cheek.

As he got up to leave he turned to Fiona and handed her a curious stainless steel implement which she accepted with a knowing nod. “I counted 97 staples, so have fun with that.” He smiled to Fiona, then turning back to Phil he said, “I’ll see you in 9 months to plan this reversal thingy.”

10 months later, as the burley patient transporter safely delivered Phil to the hand-picked theatre team, Dr Paul’s eyes met Phil’s and he greeted him brightly, “Welcome back, Phil. Let’s see what adventures we can get up to today.” Even though Dr Paul was thoroughly masked Phil knew he was grinning confidently, with a hint of mischief in his twitching moustache.

“This time just play with the gut, hey…” Phil drifted off into a peaceful sleep knowing that when he wakes his life will return to something very close to normal, some amazing lessons learned and great stories to be told.