Vascular OR and the bad kidney

Yesterday my day started at 3:30 am and  I did not get out of the OR until 10:00 pm. We a couple of major surgeries, 1 lasted 14 hours straight without any breaks. It was insane. The first surgery was a 54 year old man that had a renal cell carcinoma that grew so large it had worked its way up the inferior vena cava into the superior vena cava and then into the right atrium of the heart. We had a bunch of surgeons in there. Urology was there to disconnect the tumor which included taking the kidney out. Cardiovascular surgeons were there to remove the tumor from the vena cava and the heart. My team was the vascular surgery team lead by our attending physician who is well known in the vascular field. The vascular surgery team was there to repair all of the damaged vessels and make sure that the blood flow was restored and not bleeding anywhere. You should have seen all the bloated egos as the different surgeons had to work together. It was palpable. 

At one point the patient was put on cardiopulmonary bypass which is a machine that takes over the function of the heart. Technically the patient was dead for several minutes as the tumor was removed from the heart and the repair was completed. It was great to get to see all of this and help with this procedure. I got to do some minor cutting and some suturing. It was an intense case. I have included some pictures of the kidney which was nearly the size of a basketball because of the cancer. I also included a picture of the bypass machine. The cool part about this is that the patient survived and is doing well, although he is not out of the woods yet and is still in risk of dying. I think we went through 20 units of blood during the surgery and we had to shock his heart a couple of times.

It was a long, long day but it was also very rewarding. I was tired but totally charged up after the surgeries. The lifestyle may take away from other areas in life. Certainly these kinds of things have to be taken into account as I try to figure out my pathway in medicine. In surgery everyone has loots of long days. All the attendings were there as long as the residents and the students. When we finished the surgery at 9:30 we still had to round on other patients and we had to be back at the hospital at 4:30 am the next day (today). At least I was done today by 7:00 pm.