Matters of the Heart: A Tale of a Broken Heart on the Last Day of Work – David W. Holt, MA CCT

David Holt M CCT

So, my tell-tale story is about a personal experience that I could never have anticipated would happen to me.

My name is David Holt.  I am currently the Program Director at the University of Nebraska Medical Center’s Clinical Perfusion Education program.  I am an Ohio State University Circulation Technology graduate from 1979.  I took my first perfusionist job at Ohio State University Hospitals right after graduation and worked there just shy of two years.  I left Ohio State to go to a nearby private institution, Riverside Methodist Hospital in Columbus, Ohio.  In so very many ways there is no doubt Riverside made me the perfusionist that I am to which I am forever grateful.  Riverside gave me opportunity, autonomy, technology, independence and structure. Additionally, from the very beginnings of my career, I had the privilege to work with Circulation Technology students from Ohio State University.  Being a clinical instructor only complimented my professional growth.  I firmly believe giving back to our profession is something incredibly important and something that I live by to this day.

I worked at Riverside about 17 years and had given my resignation to leave the field for full-time teaching for the Circulation Technology program at Ohio State.  My resignation was to be completed the last day of the pay period in November of 1997. As it happened, that period was a call weekend for me.  Call at Riverside was always an incredibly busy responsibility. We stayed in-house 24/7 and we worked a lot of that.  Being an institution where angioplasty, stents, thrombolytics and other cardiology techniques were born, tremendous surgical techniques had to match, which turned out to be a round the clock experience and opportunity.

So much to cue, that final weekend was no different.  It was Sunday and I just had to make it to 0700 Monday, the day I would leave that institution to end one chapter of my life and begin another as a faculty member for Circulation Technology.  I was looking forward to transitioning and being part of the development supporting perfusion education and perfusion research!

True to form, we got the call for an emergency mitral/CAB that Sunday for a young lady in her 50s maybe 60s, young today by my standards at my age!  This person had been flown in from a regional referral center and had an acute MI and blown mitral valve.  I was called to put a balloon pump in the cath lab and we were to go to the operating room ASAP. It promised to be a complicated case and with a challenging surgeon and it was just THE event which just seem to bring my full time clinical perfusionist responsibility to a close.  I could not have anticipated the case as it happened as one so full of emotion for me!

We finished the cath and had taken the patient back to the coronary care unit to wait for the operating room as it was Sunday and the operating room staff was called in and those preparatory things were underway.  The patient’s family was in the CCU room and was waiting for the case to begin with their loved one.  Of course, the emotion in the room was very high for everybody.  I, being a typical health care worker, recognized we must keep those emotions in check and distance ourselves from being involved. Personally, for me that has always been a hard thing to do! The patient was in the room and the balloon pump was diligently supporting 1:1, though the patient was having some arrhythmias and chest pain and remained a clinical challenge.  I left the room to set up final touches on my OR system.

The operating room was ready and called for the patient and I knew it was time to return to the CCU to transport the patient with the IAB to the OR.  When I arrived in the patient’s room, there was an emotional exchange between the nurse and the patient about her wedding band.  This lady had just lost her husband to a cardiac event not long before her event.  Her wedding band was her emotional tie to her husband and she simply couldn’t bear the thought of enduring this event without him.  I walked into her room and being a male, large stature person, somewhat authoritative – not intentionally but certainly something that I’m sure I projected. I then and now, certainly want to project confidence and give the family a feeling that their loved one is in good hands.

So, this discussion was ensuing between the nurse and the patient and the nurse had asked the patient to remove the wedding band because of standard operating procedure.  We all know that jewelry in the operating room increases risks arising from edema, cautery burns, infection, and all those sorts of things.  Well I had heard this discussion and we were somewhat delayed now by this whole process getting to the operating room and underway.  I just tried to help with the process and spoke calmly and confidently that it was important that she removed her wedding band because of possible harm if they left it on. She tearfully countered to me (my heart breaks seeing those tears to this very day) and the others in the room that this was the only thing that she had left between her husband and her and the promise they made to never part.  She said she hadn’t had the wedding band off for over 40 years and it was a promise and something that she just couldn’t do. I continued and said it was important to take it off so that her family could hold it in safekeeping so that she would be able to have it back on the soon as possible and I had said to her that if she doesn’t take it off, I was quite confident they would remove it in the operating room and quite possibly they might have to cut it off if it became an issue to get it off.

With encouragement from her family she gave up the fight.  The instant that she pulled her wedding band off, she went into ventricular fibrillation not a doubt to me from a broken heart.  Right away this marginally stable patient on a balloon pump became a cardiac emergency.

She had CPR all the way to the rush on bypass and we all recognize the challenges with that. The case was otherwise a textbook case as I like to pride myself in the vast majority of my cases, but I sensed that there remained a mystery in what had transpired.

In spite of a new St Jude and CAB times a bunch, we couldn’t get her off bypass.  She never recovered from her broken heart. We ended up calling the case in the operating room.  I went with the surgeon as he told the family.  I asked for and received forgiveness in that I pushed the issue with her wedding band.  I cried with the family that day as if were my own mother.

To this day, I regret that I played my unexpected role in breaking her heart.  However, as a person of faith, I recognized this was my last day at this job, my last call responsibility and my last patient at this institution.  Most certainly, this was a sign from above for me to remember my humanity and convey this in how I teach perfusion.

May God bless her soul, her husband, and her family.

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Perfusion Theory is an educational platform for the Oxygen Pressure Field Theory (OPFT). August Krogh’s theoretical concept of the oxygen pressure field is explained and then applied to clinical applications in perfusion practice.