By Santosh Karmarkar
A heart-warming account by a doctor, an anecdotal story which tells us not to dismiss the heart as a weakling, the power of the heart is infinite….
THE heart has different powers.
The word “heart” is more than just a word. The mere utterance of the word HEART – unlike say uttering the word hand – evokes feelings, brings memories, and generates a strange comfort. This is because of the heart’s spiritual, metaphorical and metaphysical powers. The spiritual heart has no physical form. This heart has limitless powers. It’s our connection with the Divine and is like an inner sun, that shines forth. The heart also plays a metaphorical role in emotions.
Rumi lays out his metaphysical teachings concerning the “heart” (lubb, qalb in Arabic; dil in Persian), which is a key concept in Sufi literature. For the Sufis it is not the eye, but the heart that “perceives.”
But as doctors we deal more with the physical heart – an organ that pumps blood to different areas of the body to survive. My moment of reckoning with the power of this physical heart came when I was working as a trauma registrar in the Cooper Hospital in a western Mumbai suburb many years ago. I was on night duty in the busy Emergency ward. Those were the days when gang wars were commonplace in Mumbai. In the poorer central Mumbai, emergency wards received a least a couple of cases of stab wounds and sword injuries each day, whilst in the more affluent western Mumbai it was bullet and stab injuries.
That day, I had had a late dinner and after checking all the patients in the ward, was sitting in the doctor’s duty room, when I heard the usual commotion and cranking of the trolley wheels outside the ward, heralding the arrival of a patient. On the blood splattered trolley lay a gasping hefty Sardarji in a blood-soaked lungi and banyan. I rushed to receive him and checked his pulse. The pulse was very feeble, and the patient was deathly pale – due to having lost a lot of blood. As I spoke with his relatives, the staff nurse took an IV line, started fluids and sent blood for cross-matching, so as to be able to give him a blood transfusion immediately,. He had been stabbed with long pointed knife in the left upper abdomen. On enquiry I gathered that the direction of the stab was upwards towards the left chest.
His BP was sinking, and the heartbeats were muffled indicting pressure on the heart. A quick Xray confirmed the same. Unless the tamponade on the heart was relieved immediately it would be fatal. We wheeled him into the OT. He had already been intubated so the anesthesia could be given quickly. The OT sister was ready with the instruments trolley in a jiffy. I too scrubbed and donned the sterile gown and gloves in a flash.
There was no time to be lost, and thus I swiftly made a large abdomino-thoracic (on the abdomen and chest) incision and deepened the wound post-haste. The track of the stab was seen traversing through the diaphragm and entering the pericardium. The pericardial cavity was full and tensely ballooned with blood. This was causing pressure on the heart and severely restricting its movement.
I cut open the pericardium turning a blind eye to the large amount of blood that gushed out. This instantly relieved the compression on the heart, and I could see how the feeble and almost immobile heart now leapt back into action.
And as this happened, came my moment of realising how powerful the heart is! As the heart pumped with its full force, with every contraction a jet of blood squirted out and hit the ceiling of the Operating Room – which was more than 10 feet in height. I was in awe of the power and strength of this small fist-sized organ. I could see the small wound in the heart from which the blood was squirting out. On pressing my finger-tip on the wound the jet would stop…and on removing it – another powerful jet made a mark on the ceiling. But this was not the time for any amusement, I quickly called for a suture and put two good absorbable stitches to close the stab wound on the heart.
Luckily, the stab had not caused any other major injuries in the abdomen or chest. And as we began to close the surgical wound, the blood pressure of the patient became normal. We had already transfused 3 units of blood and so he was not looking as pale as he had been. All his other systems were normal and thus he made a swift recovery and walked out of the ward after two days.
Over the next several days, the exciting story of how the OT ceiling came to be marked with blood splashes did its rounds in surgical department. As I was narrating this awesome incident to one of my colleagues in the cardiovascular surgery department, he told me about a similar incident.
He mentioned how a flamboyant cardiac surgeon would purposely puncture the heart while operating on the heart to show how the powerful jet of blood would hit the ceiling. He apparently did this usually when there were young medical students in the OT.
Though I am sure this added to his flamboyant image and made him a hero in the eyes of the medical students, I was aghast on hearing this. While my experience had made me realise the physical power of the heart, the flamboyant surgeon’s deed made me wonder whether his heart was in the right place.
I also wondered which power of the heart was more important, the spiritual one or the physical one.
(Courtesy The Checkup)