3. Angels in the Operating Theatre!

“Imagine a highway that’s completely jammed—that was the condition of your lungs.
So we cleared a path through it.”
That’s the graphic picture painted by one of the doctors who performed the first procedure on me—an Angiojet Thrombectomy. This uses jet pump mechanics to break apart and remove harmful blood clots in the arteries.

The medical team had discussed and dismissed the immediate use of thrombolytic drugs to break up the clots that were disrupting blood flow to my heart. Reason? Very heavy menses indicate a propensity to bleed, and a blast of “clot-busters” might lead to risky complications like a brain haemorrhage. If not for that, option 1 was usually strong thrombolytics, according to friendly Dr Chatty. Option 2 was a thrombectomy to try to suck out as much of the clots as possible. And option 3—the last choice—would involve cracking open the ribs and attempting to catch the clots―a tricky affair as the jelly-like masses would be shifting around in the vital organs!

sgh_ctscan

And so it was that I found myself wheeled from the Cardiothoracic ICU to an Operating Theatre. Before that, I had undergone a CT chest scan known as a Pulmonary Angiography that requires the injection of a special contrast dye into my circulatory system via a catheter. This allows the blood vessels in the lungs to be seen clearly so that blood flow can be assessed. Among the possible minor complications listed, I felt only a warm sensation. According to the Patient Information leaflet, more serious complications include convulsion, heart failure and a very low risk of death.

Angiojet Thrombectomy
A minimally-invasive image-guided catheter-based procedure used for Thrombolysis.
Thrombi—blood clots; Lysis—break up, dissolve, loosen. (Word Origin: new Latin, from Greek). If I recall correctly, the risks spelled out to me included the potential puncture of a vessel or an organ as the catheter (tube) travels through the body.

“Have faith, it’ll be alright,” calls out an unknown nurse along the corridor.
Father God speaks to His children in so many ways—direct and indirect. Thank you, Lord.
An oxygen suppy is my constant companion wherever I go, along with attached drips and a monitor.

The doors open and giant monitors with an imaging system catch my eye. The efficient pull of bedsheets to transfer a patient from one bed to another; this time the target is the surgical bed—one, two three!
New faces and efficient voices. Soon I’m prepped and it’s all systems go.

“Carol, are you alright?” Yes, I am, doctor.
Two doctors, I believe. Lying there, I can hear more than I can see.
There’s a discussion on the diameter of the catheters available.
Final decision—call the rep. and ask for a specific diameter.
“She’ll probably have to go to her office to get it.”
“We’ll wait”
Docs and all retire to an inner room.

Alone and I focus on talking to my God. I’m very tired, Father.
A summary of His reply, “It’s not time for you to go. You still have things to accomplish for Me here.”
Alright, LORD. You are with me always. I trust You. Guide my doctors.

Voices and faces advance towards me.
The rep’s here. I hear a whooshing sound.
Okay, start. That’s good. Again. A test run?
Kinda surreal—do they remember that I’m here listening to everything?
🙂

Here’s a picture taken off the internet showing an Interventional Radiology Suite.
thCAQMKQZ3

I’m fully conscious throughout.
A catheter is inserted into the large femoral artery in the groin where the thigh joins the abdomen. It has a tiny Angiojet attached to it. The doctor watches the monitor as he advances it to my lungs. The pump’s activated and it sends saline jets to create a powerful vacuum within the blocked arteries. This breaks up the clots and pieces pass through the catheter into the pump—like a vaccuum cleaner, as one doc describes. The catheter’s removed and pressure is applied to stop the bleeding at the entry point. No stitching required. It’s no wonder that some call Interventional Radiology the surgery of the new millennium.

Back in the ICU.
Someone tells me that 30-40% of the clots were sucked out.
What about the rest? We’ll have to let your body do the work.
I learn later that the Angiojet attached to the catheter can only be in the body for a maximum of 4 minutes.
And when both lungs have blockages, that’ll mean only about 2 minutes on each side.

celect_side

Another day, another scan.
There are many clots in both your legs. We have to prevent them from travelling up.
We’ll insert an IVC Filter. It’s like an umbrella that’ll trap the clots that try to move up.

IVC: Inferior Vena Cava. Large vein that carries de-oxygenated blood from the lower body into the right atrium of the heart. IVC filters were once placed in the body permanently but now there are retrievable ones. We may remove yours in 3-6 months.

cookmedical.com has this interesting instruction: Supplied sterile in peel-open packages. Intended for one-time use. I should hope so! I’m all for recycling but surely this is stating the obvious? Small digression here—one of the nights that I was in the ICU, I was looking out and saw a nurse drop a glove that she had just taken from a box. She bent down to pick it up then moved out of my line of vision. I really hope that she threw it away and didn’t try to salvage it!

IVC Filter Scare Factor according to several websites:
#Effectiveness and safety profile not well established but generally recommended in some high-risk scenarios. #Filter migrates to the heart or pulmonary artery. #Parts of the filter breaks off. #Perforation into the duodenum. Reassuring, no?

I believe the Standard Operating Procedure is that medical personnel need to inform patients of the potential complications arising from any operation, procedure or test. And for me throughout my long stay, that meant hearing about a gamut of possibilities including blood-borne infections arising from blood transfusion, strain on kidneys resulting in potential life-long dialysis and liver damage.

“You will guard him and keep him in perfect and constant peace whose mind is stayed on You
because he commits himself to You, leans on You, and hopes confidently in You.” –Isaiah 26:3
“For God did not give us a spirit of fear (timidity)
but rather a spirit of power and of love and of a sound mind (self-control).” 2 Timothy 1:7

*

Did I hear someone asking, “Where’s the bit about angels? Get to that already!”
I hear you! I’m a woman of her word and I deliver what I promise.

Day 2 in ICU
Visitors in the evening, including an elderly lady in her 70s.
Nurse: Sorry, she needs to go for her procedure.
How long will it take? About an hour. We’ll wait.

Wheeled back to ICU.
Nurse: Your visitors had to leave. The procedure took much longer than usual.
Why?

thCA9GCE7G

Action inside the Operating Theatre:
IVC filters are compressed into catheters and inserted via the groin, neck or arm veins.
The entry point for mine was the groin, the same as a day earlier. Implant successful.
Doc to another: “It’s touching the wall. Let’s ask Prof.”
There’s a kind of screen above me that blocks my view.
But I can hear them going to the inner room on my left.
Prof comes out. Presumably he looks at the images.
“Carol, we’re going to have to pierce your neck.”

Note: The following is non-verbatim, from memory

“I’ll try to catch hold of it from here, see if you can move it.”
“No, that’s not it. Try again.” And again. Still trying. More attempts.

“Father, I don’t want the filter to be off-kilter.
It’s going to be in me and I want it to be exactly where it should be.
Please guide the hands of my doctors and send Your angels to help position it perfectly.”

Voice of first doc: “It’s in place! Don’t know how that happened but it’s done!”
Prof’s presence near my neck disappears, his work is completed.
Me speaking up, “I don’t know if you believe it, but I just asked God to guide the hands of my doctors and send His angels to help position the filter.”
Thank you, everyone! Partners with God, whether they know it or not.

Angels. Throughout the Bible, they play a variety of roles—divine messengers, protectors, guides, warriors and law givers—executing God’s will on earth and in the heavenlies. How little we know of the vast Creation of the Almighty. How scanty our understanding of His eternal perspective and plan. No wonder the Lord tells us in His Word: “For as the heavens are higher than the earth, so are My ways higher than your ways and My thoughts than your thoughts.” Isaiah 55:9

Aside:
I didn’t know about the role of the Interventional Radiologists (IR) until I asked a nurse who “Prof” was.
My request for more information about the IVC filter was conveyed by the Cardiothoracic ward to “Prof”.
And that led to an IR doctor taking the time to drive back to SGH after his meeting in another hospital.
I was touched by the trouble that he’d taken and by his patient and detailed explanation.
Doctor Eloquent solved two mysteries for me. (Will he allow me to name him?)
Why was there a need to wait for the rep to bring a specific catheter?
Because Angiojet Thrombectomies aren’t so common that the hospital would stock a full range of diameters all the time.
Why did the initial adjustment of my IVC filter need adjustment?
Because my IVC isn’t straight; it tilts to the right.

Dr Eloquent shared that when he was practising medicine in Australia, a substantial number of people suffering a Pulmonary Embolism didn’t get to a hospital in time, due to the longer travel time.

God’s promise for His children: “For He will give His angels charge over you to accompany and defend and preserve you in all your ways (of obedience and service).” Psalm 91:11

~

How Great Is Our God– Louie Giglio
An image-rich journey through the cosmos that lets us peer into God’s universe to discover the amazing magnitude of His greatness.

我神真伟大 (How Great Is Our God) – 约书亚乐团 (Joshua)
Translated from “How Great Is Our God” by Chris Tomlin, Jesse Reeves, Ed Cash

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