Five Little Stitches

Cruz had been dropping off a friend at a Skytrain station after a long day of painting when they came across a young woman being assaulted by a man. Cruz, father of two young children, had stepped out of his vehicle and yelled at the man to stop. For that, he was stabbed once directly in the heart. The assailant left, along with the woman Cruz was trying to help.

For his actions, Cruz would later be described by RCMP as a ‘good Samaritan’. But in the moments after he arrived in Emergency, he was unconscious and in critical condition. His chest cavity was filling with blood.

Emergency physician Dr. Craig Murray was the first to see Cruz. He made a quick decision to call me in while he, the nurses and other members of the team in the ED attempted to stabilize Cruz. Immediately they placed a chest tube into his left chest but soon stopped draining when it soon became plugged with clotted blood. He needed immediate surgery.

While I was enroute, the surgical department was preparing the operating room for me while also dealing with a gunshot victim who had been brought in for emergency surgery. The efforts of my colleagues in coordinating all this could not have been executed any better.

By the time I arrived – about 10 minutes after waking up to the sound of my telephone – the patient had already been given about a litre of blood. He would need another litre before the end of the night.

I would rely on Drs. Nigel Findlay-Shirras, Dick Lee, and Lori Fuller as well as a whole team from the OR for help. Operating room nurses Lydia Kendrick, Debbie Fraser and Heather Ballantyne, along with Anaesthetic Assistant Penny Polischuk were all involved as we attempted to save the man’s life.

Normally, as a thoracic surgeon, I would not do open heart surgery – the scheduled kind anyway. That would normally be done at Royal Columbian Hospital, the Fraser Health cardiac centre. However, thoracic surgeons at other hospitals will do emergency trauma surgery that might involve the heart, or the sac and great vessels around the heart. We are trained to perform open heart surgery so as to be comfortable around the heart... particularly for traumas.

But emergency trauma cases always cause a bit more of an adrenaline rush than scheduled cases. So when I walked into the Operating Room I was primed for action and totally alert. After opening Cruz’s chest and reaching his heart, I found a one-inch laceration in the top of it and a chest full of blood. In a trauma scenario such as this we would not stop the heart and go onto bypass. Instead we would do the repair while the heart was beating. We are trained to that but are rarely called upon to do so.

As I placed my finger on the hole to stem the loss of blood and allow the OR team and Dr. Lee to continue to stabilize the patient, I noticed a police officer sitting in the corner of the room, as they often do in cases like this.

Very carefully, I put five sutures – placed with small pieces of surgical felt to prevent the sutures from tearing through fragile muscle tissue – in Cruz’s heart. I had to time each suture with each beat of his heart to avoid tearing the tissue and making the hole even bigger.  Once that was complete, I closed his chest. He was stable now, and I knew he would survive. It is in this kind of moment that I relish being a surgeon and a member of the Surrey Memorial Hospital team.