The Perfusionist’s Ballad by Steve Learn, CCP
It’s 4:30 AM and I hear my alarm clock ring,
“Time to make the donuts,” I think and see what the day will bring.
Twenty minutes in the car, I sip a hot cup of joe,
I think ahead through my day and how things should go.
Getting settled in the OR, I carefully read the patient’s chart,
then reach behind me selecting appropriate cannulas from my cart.
The patient is brought into the room, his face as white as a ghost,
We give words of reassurance that he’s with a competent host.
Methodically I prime my circuit removing the smallest bubbles of air,
then remove the pre-bypass filter and add the first of the meds with care.
When the team is ready, I give them the sterile pack of lines,
The heparin is administered and I check the clotting time.
It’s been twenty years of practice, I’m confident we’ll do just fine,
But still when we go on bypass my gut feels like butterflies.
The surgeon applies the cross clamp, with potassium I arrest the heart,
I watch flows and pressures carefully and mark the numbers on my chart.
The heart goes into V-fibrillation, it’s just what we expect,
then the ECG is flatlined- we’ll give the heart a rest.
Once the dust has settled, I check a set of labs,
Blood gases, ‘lytes, and hematocrit, it’s all within my grabs.
No RBCs need be given; I adjust the flows and gas rate,
then with my trusty iPhone, the DO2 I calculate.
The procedure moves along, many hands work with finesse,
The surgery tech hands up more ice slush for in the chest.
Today our lucky patient gets a new mitral valve,
Hopefully it will solve the problem that he had.
I drop the blood flows and the cross clamp is removed,
We all wait a long minute while the heart is reperfused.
Hold on, says Anesthesia, the right side “took a dump”
The circulating nurse asks if we need to get a balloon pump.
Anesthesia gives some dobutamine or perhaps milrinone,
Maybe that’s all we’ll need before we can all go home.
Fortunately for us, the patient’s strength returns
Things will often improve on their own if we just wait a turn.
The patient is warm, the repair is done, the surgeon asks “Are you good?”
Anesthesia and I concur we’re as ready as we could.
I clamp the venous line, just a little at a time,
And slowly refill the heart with its volume so sublime.
Once we have reached our optimal blood pressure,
I turn down the pump and clamp the lines the full measure.
Thank God! We’re off pump without any “OH NO”
We didn’t even say the dreaded word “ECMO”.
The PA and the surgeon close the chest with wire,
The nurse at the desk thinks, “How many years until I can retire?”
The sterile drapes are removed, this case has gone well
It’s a little late, but we can still hear the toll of the lunch bell.