A Note to My Future Self

This past weekend, I supervised a non-surgical trainee in the CVICU placing a thoracostomy pigtail catheter in a 6.8kg infant for pneumothorax. The patient was levocardic and the pneumo right-sided, large but without significant untoward hemodynamic or respiratory effect. With 10,000 hours under my belt, this was a chip shot situation. For the trainee, this was a first opportunity, the first hour. So we went through all the motions; the ultrasound guidance, the heavy sedation to near-intubation, the sterile draping with towels galore, the thorough time-out, and the multiple tentative passes of the introducer needle through the rib space, timed perfectly with the unnerving movements of the baby’s arms and legs. And the thoughts I’m sure! Self-consciousness from the perceived staring and judgment of the supervising intensivist and surgeon that had done the same procedure effortlessly many times before, the dreaded sense that one was doing more harm than good, ultimately replaced by the triumph of a new procedure attempted and accomplished.

As a young attending, I pass very little judgment. All of those motions and thoughts are magnified in the operating room. My first hour at the helm was a 2.1kg D-transposition, normal coronaries and well-aligned commissures thankfully. Paired with an experienced assistant. Aligned with the chiefs of cardiac anesthesia, perfusion, and nursing, all of whom had made a conscious effort to swap shifts and support my nascent career by participating. Greeted in the CVICU afterwards by a seasoned intensivist for the critical first post-operative hours and the director of the unit himself. A Heart Center with the interests of its providers and its patients thoroughly in mind.

As much as this is written for others, this is a note for me. One day, I will hopefully have accrued 10,000 mostly successful hours that will make baby heart operations feel more like chip shots than self-conscious beginnings. And when that day comes, I hope that I remember my first hour well. No one was staring or passing judgment.

A heartfelt thanks to the many people that have sustained me in my career so far.