Stories from My Years of Clinical Experience

A Man with a ‘Big’ Heart

In the year 1983, as a fresh-faced resident medical officer (RMO), I joined the Cardiovascular Thoracic Surgery [CVTS] department at B Y L Nair Hospital in Bombay Central, Mumbai. Excitement and nerves coursed through my veins as I embarked on a journey that would alter the lives of countless patients.

What I did as an RMO in CVTS

As an RMO, my primary responsibility was to prepare patients admitted for heart surgery for their designated procedures. Sometimes I was given the opportunity to open the chest at the start of the surgery and to close it after surgery was over.

Whether it was heart valve replacement surgery or coronary artery bypass surgery, I dedicated myself to ensuring each patient was mentally and physically ready for the challenges ahead.

And once the surgery was complete, I diligently took charge of their post-operative care in the Intensive Cardiac Care Unit (ICCU), along with my fellow resident.

Now, the real story

One day, a young man in his twenties from Ahmedabad, Gujarat, with a well-built physique, found himself on the operating table awaiting a heart valve replacement. He had been referred by a doctor to our hospital for surgery.

In spite of his heart condition, we found the patient to be very cheerful and full of life. An X-ray and Echocardiography showed that his heart was enlarged and dilated.

This young man had multi- valve disease, caused by a condition called Rheumatic Fever in his childhood. Rheumatic fever is caused by Haemolytic Streptococcus A bacteria.

Untreated, our body builds up antibodies that kill the bacteria, but the residual antibodies cause harm to our joints and heart. In the joints, it causes arthritis, and, in the heart, it damages the heart valves.

You can read all about rheumatic fever and how it affects our heart here-

As the years go by, the heart muscle compensates for the valve damage by enlarging or dilating and becomes huge. This young patient had a big heart, caused by damage to his aortic valve, a condition called aortic regurgitation.

The heart walls had become thin due to the constant backflow of blood into the ventricles of the heart, and it was working poorly, causing tiredness and fatigue to this patient.

The surgery

After preliminary examinations and investigation, this patient was posted for open heart surgery. This surgery involves putting the patient on a heart- lung machine and the heart is stopped for the whole period of surgery by immersing it in an ice pack.

This is how a heart lung machine looks like-

His heart, dilated and struggling to function properly, posed a considerable challenge for the skilled surgeons. The room buzzed with anticipation as the team prepared for what lay ahead.

I had already opened up the chest of the patient with the help of another RMO. Then the heart surgeon arrived for the valve replacement surgery.

The heart surgeon, a senior doctor and head of department, with unwavering confidence, initiated the intricate procedure. Every cut, every stitch, fuelled by years of expertise and a dedication to saving lives.

Time ticked away as the surgery progressed, each moment carrying the weight of hope and uncertainty.

Finally, after what seemed like an eternity, the surgery came to a close. The young man’s heart now carried a new lease on life, beating with renewed vigour. The team breathed a collective sigh of relief, knowing they had played a part in restoring hope to this young soul. If you had a chance to listen to the heartbeats with a stethoscope, you could hear a distinct click of the metallic valve placed in his heart!

Days turned into weeks, and the young man made a remarkable recovery. His gratitude poured out, painting a vivid picture of the second chance he had been granted.

With a grateful heart, he bid farewell to the hospital and ventured back into the world, ready to embrace life with newfound appreciation. We all wished him well for his future life.

A Sad Twist to this story

Four months down the lane, we got news that the young man with the big and operated heart suddenly collapsed in the bathroom and died while having a bath.

All of us from the CVTS department were saddened by this sudden turn of events leading to the end of a cheerful person. We then had a meeting in HOD’s office where we discussed the various causes of his death.

One prominent cause identified was the failure to take anticoagulant medicine-Warfarin- by the patient. I had written a similar story earlier- you can read it here-

Key Takeaways from this story

As we come to the end of this story, I am sure you must have guessed the key takeaways. Yes, you are right-

1. Never neglect your throat infections- this can prevent future heart diseases like the one described here.
2. If operated for any heart condition, never ever forget to take medicines on time.

I hope you enjoyed reading this short yet true story. My sincere thanks go to Dr John Frederick Rose who helped me publish my earlier story.

I also thank Dr Mehmet Yildiz, who has been instrumental in helping me publish on ILLUMINATION CURATED [IC] and whose articles have inspired me to write stories-thank you, Sir.

In my next story I will describe the plight of two patients who neglected their diabetes treatment.

Till then, adios.