What is Vascular surgery? Easy answer is surgery on the blood vessels, the arteries and veins of the body. A seemingly invisible roadmap that runs throughout our bodies, avenues, highways and byways that allow blood, carrying oxygen, from our tiptoes to our nose. And in so doing, allows life to persistent, for as I explain to so many patients, oxygen means life, without blood there is no oxygen, so without blood there is no life. A Vascular Surgeon's job is to ensure that blood continues to perfuse all the way from those tiptoes to that nose and everywhere in between. When our own roadmap gets potholes, downed telephone wires or perhaps herds of sheep clogging the way, blood flow becomes disrupted, tissues downstream become starved of oxygen and start to die. The Vascular surgeon must fix the potholes, move the telephone poles or find and/or create a way around, and get the sheep off the road before the ischemia down-stream becomes irreversible.
It can be incredibly rewarding to finish a case, do a pulse check and find a fat bounding pulse where there wasn't one before. It can be incredibly elegant, cleaning an artery and then patching it back together, the finest suture placed technically perfectly. It can also be defeating, mentally, emotionally and physically.
There's a joke that a vascular surgeon really only needs a few patients to stay in business. And that's a funny joke, because it's so true. These patient's that I've been seeing over the past weeks have known my attendings for 20+ years. So many of their faces I recognize from my own past experiences on the vascular service, only last time they had more of their toes, or they still had both limbs back then, etc.
The other week we had a new patient, not your typical vascular patient (elderly individual with multiple co-morbidities). In fact the opposite, young and relatively healthy except for her odd history of strokes and blood disorder causing hypercoagulability. She had gone to other hospitals complaining that her toe hurt multiple times and been sent home each time. By the time she got to us, not much blood was making it to her foot anymore. Over the course of two days, I spent a total of 15 hours (8hrs + 7hrs) in the OR working on her leg. We got it to her foot at one point, but it didn't last. Kept trying old tricks and new techniques, I actually learned a lot in the process, but nothing could get the blood down to her foot. Flow stopped at her ankle. At the end of those 15 hours, I sat exhausted with my attending, both of us trying to smile but it coming out more as a sad pathetic chuckle. Tough defeat to swallow. We didn't do the amputation until almost a week later. The delay wasn't a patient factor, she was mentally prepared and ready sooner than we were. It was surgeon factor.
That's the thing with Vascular surgery. It is fighting a loosing war. There may be intermittent successes, but the question is always, how long. How long will it last? Because it will eventually fail. Despite maybe two or three or even four battles fought and won, there will always come the final battle where all will be lost.
Much love and prayer!
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