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Healing After Surgery: Why Early Follow-Up Matters
Why do some breast reductions look square and others round? Dr. Luis Villar shares the first lesson he learned as a resident at Mass General. Read the story.
I had just come down from Boston to Nassau County Medical Center on Long Island, New York. I did not yet have a dorm room assigned, so I slept in empty hospital beds of opportunity. I had to go back to Boston in two days to pick up and move my belongings down. The medical intensive care unit (MICU), was adjacent to the surgical intensive care unit (SICU), separated by an open through passage. I was wandering about, getting the lay of the land and checking out the nurses, when I noticed the medical team resuscitating a patient in the late afternoon. He would arrest and they would get him back. This occurred numerous times over a few hours. Then they posted a chest X-ray on the backlit frosted glass x-ray reading boxes along the wall across from the patient cubicles filled with blinking and beeping machines punctuated by the slow crescendo swish of ventilators, separated by curtains.
As a Junior Surgical Resident at Massachusetts General Hospital we had a rotation through Lynn Hospital. I had just come up from my Shock Trauma Internship at the University of Maryland. A 55 year old male presented to the Emergency Room with a severe heart attack. Back in the early 70s, people routinely died from heart attacks in community hospitals. There were no cardiac catheterization services, CAT scans, MRIs, sonograms. There was only one trauma center in the entire country! I just came from it, at the University of Maryland. Open heart surgery was in its infancy. During my rotation in open heart at University of Maryland in 1973, mortality was 80% and worse at other times!
How I learned NOT ALL DOCTORS ARE CREATED EQUAL. Case #1 Two Minute ballet During my first week as Intern at St Frances hospital in Baltimore a 50 year old male presented to the emergency room with a gunshot to the heart. He was leaving a restaurant with his wife. A man demanded his wallet. He gave it without resistance and was shot through the heart. His pupils were fixed and dilated, but his heart was still fibrillating. I intubated him and started large bore IVs with fluid resuscitation. But what next? I called the Chief Resident. “I have a gun shot to the heart, fixed a dilated. Can you show me what to do if he came in still salvageable?” “Keep resuscitating”, he commanded. “On my way”. I feigned resuscitation on his brain dead body until the Chief Resident arrived.