Admit the Heart

I was engaged in a conversation with someone in my office when I had to excuse myself so I could “admit the heart”. They were curious about what that meant.

When a patient comes out of the operating room after open heart surgery, there is a whole team assembled in the Intensive Care Unit to “admit” them. We receive information from the OR team and the heart surgeon’s team about their past medical history and what led up to the events that required surgery. We learn about the procedure that was performed and the kind of medications they needed in the operating room. And we discuss the ICU plan for the ventilator, monitoring parameters and our overall game plan for what we’ll do if we encounter certain challenges in those first several hours.

At the same time, our “pit crew” is attaching the patient to monitors (so we can see their heart rate, respiratory rate, continuous blood pressure and heart pressures), connecting suction lines to the chest tubes, performing a measurement of their cardiac output, securing the breathing machine, placing a warming blanket, taping an oxygen monitor, drawing lab work and viewing the chest x-ray. Someone once described it as watching an orchestra with each person playing their part.

You know, when I get my car serviced, I hear explanations for what they think is going on and how the various tubes and pumps and valves work. I compare this to my knowledge of the human body with its various tubes and pumps and valves. Unfortunately, unlike cars or air conditioners or washing machines, we can’t unplug the human body, unscrew the cover and take a look inside when everything is “turned off”. We can’t take the body apart and place the pieces on a table and then replace the damaged parts and put everything back together. We have to run a series of diagnostics, similar to the auto shop or the maintenance workers, and test our theories of what could be causing the various symptoms…with the body still “on”.

During open heart surgery though, we do divert all the work of the heart and lungs to a “bypass machine” while the heart is stopped and the surgeon can repair the heart. After surgery, the heart and lungs are started again and they are brought to ICU for recovery.

“Admitting the heart” is a generic ICU term for our orchestrated focused efforts at settling the patient into our care. Then comes the actual personalized way we get to know the patient when the family comes in and when the patient starts to wake up from surgery and the breathing tube comes out. Our medical lingo may sound foreign or lacking in personal TLC, but I assure you, we have your heart at the core of what we do.

“Courage, dear heart.”
– C.S. Lewis

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