Broken Hearts

Alexandra Adler, MD

Resident in Anesthesia at Massachusetts General Hospital

PGY-4

Broken Hearts

My second week in Vietnam is flying by.

We spent Monday and Tuesday at the Heart Institute, where they do two complex pediatric heart cases per day as well as several adults. I spent a lot of the first week teaching (or perhaps learning how to teach), but on Monday and Tuesday, I had the unique opportunity to be a learner in a totally new environment. As a resident, I’ve done adult cardiac cases but I’ve never done repairs for pediatric congenital malformations.

At 7.30am on Monday, I arrived at the Heart Institute just in time for the morning report of the cases. The team, led by Professor Quy, walked me through the physiology and then whisked me into the OR, where I had the rare opportunity to be the only learner in the room for such challenging cases. It is hard to put into words what a unique opportunity this was. There were a lot of firsts — my first arterial line in a neonate, my first central line in a neonate, and my first time going on and off bypass in a neonate. 

  

I did get to do a bit of teaching at the Heart Institute. The staff there has expertise in the placement of lines by landmark technique. But because they recently acquired an ultrasound machine, I thought it would be fun to teach ultrasound-guided placement of lines. And because children with congenital heart malformations may also have aberrant vasculature, this is a nice skill to have in your pocket for tough cases. It was intimidating to teach a group of highly-skilled attendings as a resident, but perhaps that’s the great thing about anesthesia — we do so many different things and work in so many places (OR, ICU, PACU, pain clinic) that there is always a new skill to share.