Hearts

In honor of Valentine's Day, I played heart surgeon.  When I was on call last night a young man came in with abdominal pain. My intern evaluated him in the ER, noted his abdominal tenderness and some difficulty breathing. Then he did an ultrasound and reported to me, "His abdomen is tender and. I think he has a pericardial effusion ["fluid around the heart"]...but I can't be sure."  I'm proud of him for doing the ultrasound and looking at the heart- its not something a surgeon always looks at when consulted for abdominal pain!

I took the ultrasound to the ER to evaluate the patient. He couldn't breathe well while lying down, his liver was enlarged and tender...then on ultrasound I saw a HUGE pericardial effusion. Biggest I've ever seen  It was like the heart was a tiny, quivering ball surrounded with fluid.

A picture of a small pericardial effusion from the internet. Probably measuring about a centimeter.  Now imagine the fluid space to be wider than the heart...that's what I saw

I measured the distance from the heart muscle to the sac: over 9 cm! Usually pericardial effusions are graded as small (less than 1cm), moderate (1-2 cm), and large (>2cm). This effusion was off the charts. We also got a chest x-ray:

a normal chest x-ray (thanks Wikipedia)

His chest x-ray...his heart shadow took up half of his chest!

Amazingly, his heart rate was only a little bit fast and his blood pressure was normal. Obviously he had had the fluid for a very long time. Months probably (likely from tuberculosis). His liver had been hurting for three weeks because of the pressure build-up. After seeing an effusion that big, I wanted to rush him straight to the operating room to get the fluid off.   But it was the middle of the night, he was stable, and the effusion had been there a long time. So, we took him this morning. I opened the heart sac, put a drain in it, and got over 1 1/2 liters of fluid out! It was a pretty satisfying operation and I got to literally touch someone's heart on Valentine's Day. :)

Yesterday, we got a package from my mom with some amazing Valentine's treats (just in time!). She included some heart-shaped sprinkles. I happened to have a box of cake mix and some frosting and was inspired to make a last-minute Valentine's cake to bring for the OR staff.

The power went out, so I ended up baking the cake mostly in the dark ...but it still turned out.

When I gave it to the OR supervisor, he was a confused when I said "Happy Valentine's Day." It took a few minutes to explain why I brought a cake because I didn't know the French word for Valentine's Day and its not really celebrated holiday around here. Most of the OR staff didn't even know it was Valentine's Day, but now they do and they were very happy to eat some cake! :)

I also made some Valentine cookies last weekend...

The cookie press was left here by a missionary several decades ago. Still works fine!

Usually I would make Spritz  wreaths for Christmas....but the Christmas red hots came in January this year. So I made the Valentine version of Spritz...What do you think? Perhaps a new Valentine's tradition has been started.

Happy Valentine's Day!!!