The Heart of the matter

Second procedure

Meredith had just had a second open heart surgery. "Are you sure she is stable enough to be discharged?" Ellis asked, sounding scared. "Yeah. We've been monitoring her progress very closely and for now, she is doing good, considering the defects she was born with and the fact that she was rushed into surgery after her ductus closed." The paediatric surgeon smiled at her, whose lips formed to a happy smile. The scar was there, red and going through the middle of her sternum. They had divided it. They had stopped her heart in order to repair it. For Ellis Grey that seemed unimaginable. She still couldn't think about what would have been if this had ended differently ... because it could have. Meredith not being able to come off bypass 'cause her heart is too weak to take up its function ... Then she would have been on ECMO. And that would not have been very good, was it her fault or what it just gods way of giving her karma for the affair.

"Dr. Grey?" The doctor asked as Ellis didn't react right away "Dr. Grey?" She has seemingly spaced out, apparently. "Umm, what were you saying?" She asked. The doctor cleared his throat, then he repeated the sentence. "We just need to confirm that everything is looking good with a post-op ECHO and of course electrocardiogram. She will have to take certain medication. She'll tire more easily than other babies her age. Meredith will need a lot of attention, a lot of help." The doctor said as he started listening to Meredith's heartbeat. "I am aware of that. This isn't the first time I have seen such a condition, I am an award winning surgeon" Ellis replied to his question with an eye roll . "What meds will she have to take?" She then asked. "I can tell you more about that after the ECHO. But for now, I think it's safe to remove the external pacer leads." The paediatric surgeon said. A lot of people have cared for Meredith during her stay at Seattle Grace. She was now a lot stronger than before the surgery. But there was still a significant difference between her and a child born with a healthy heart. "Okay, let's do it." Ellis said decisively as she cradled her daughter on her arm. Even though Meredith was now in a regular patient room, she was still attached to a portable heart monitor that was beeping rhythmically. "Ok, follow me." A nurse came and carried the monitor while Ellis carried her baby. They entered exam 5. Ellis saw the machine used to perform an echocardiography. Child-friendly figures could be seen on the walls in a lot of colours. "I will start by listening to the heart sounds." He explained. "i know. Just ... do it, please. I know how this works. So do whatever's necessary." The general surgeon advised him. He only nodded. Meredith, who was still in her mother's arms, squirmed when he came nearer with that thing. "Sh, it's okay." Ellis murmured, noticing her child's discomfort. "It will be over before you know it." Upon hearing her mother's voice, Meredith was more willing to let the doctor do what he needed to do. "Can I?" He asked in a soft voice he only used with children. With the heart patients he worked with ... and now it was Meredith Grey. He had warmed the stethoscope before putting it on Meredith's chest. Apparently, Meredith appreciated the warmth coming from it and her little skinny arms were soon reaching for it. The paediatric surgeon started the exam with listening to Meredith's heart. Of course, there was a heart murmur since they haven't corrected every anomaly they found. They would have to do second surgery to take care of that. There was a sound coming from the ventricular septal defect and the atrial defect as well as the common AV valve. "Yeah, I know you wanna try it out, huh, you want to be a doctor like mummy?" The doctor chuckled as he interacted with Meredith. Meredith gargled and blew a bubble in response. For once she was stronger than she was before surgery. Ellis Grey only nodded and smiled, knowing the impact the doctors words had to her, made her think more positively. Seeing the red and pink line across Meredith's chest, bisecting it ... She had a feeling that this wouldn't be all, that scar would be there for the rest of her life, she was worried about bullying at school especially in PE (physical education) and throughout life. That there would be a lot of more hurdles to go through ... But it's better not to know everything ... if you did, when would you find time to enjoy life? Then the doctor began with the ECHO. He felt Ellis staring at him as he evaluated the pictures. He turned the screen away from her so that she wouldn't see what the pictures showed. "Hey, what the hell are you doing?" Ellis exclaimed as she lost view of the screen. "I was just ..." He stuttered, knowing himself that it wasn't very professional but he just couldn't help it. "It's better if you don't have to see this, especially when you know how to read an ultrasound." He said, "Whatever, turn it back." Ellis said slowly. She was very insistent. "Please." She added as he sighed in a slightly vulnerable voice for Ellis grey and he reluctantly pushed the screen back to where it was. "Good." She only said in reply. But he didn't think that Ellis would make him turn the monitor so that she can see what the screen was showing, what her daughter's little heart looked like. She saw the common AV valve, the multiple defects in the ventricular septum as well as in the atrial septum, the great arteries – both supplying the right ventricle, meaning the blood was mixed, resulting in cyanosis.

There was a high shunt volume. She saw that. Meanwhile, the doctor was quantifying the shunt. But as the doctor pressed the transducer a little harder onto Meredith's chest, she started crying. "Shh, it will be over soon" Ellis murmured. It wasn't unusual for babies to do so when performing such a procedure. He knew a lot of babies did that. Shed seen a lot of baby hearts. Shed seen a lot of responses like that. After completing the exam, having looked at her heart in all the different modes such as four-chamber view, five-chamber view, parasternal view, M-Mode ... the doctor put the transducer away and turned to Ellis who was still focused on the monitor. Meredith's heart was still on screen, frozen. "So, everything looks as expected after this type of surgery. There is less pulmonary flooding due to the pulmonary banding but there is still a significant shunt. You will have to come to a repeat ECHO every two weeks until definite surgical palliation can be performed."

"Isn't there any chance that the next surgery can be a corrective procedure?" Ellis asked.

But the doctor shook his head resignedly. "Sadly, there isn't. But there are other options. From what I have seen your daughter looks like a good candidate for an atrial switch surgery also known as ..." "... Senning procedure." Ellis interrupted him. "You know about those things?" The paediatric surgeon asked surprised. He didn't know that. Ellis looked at him, sending daggers at him with her eyes before saying: "I'm a third year surgical resident at Seattle Grace Hospital, I've already won Harper Avery's, where did you go to med school, the Antarctic?. You bet I do, I know about those things!" Ellis glared at him. The paediatric surgeon smiled lightly. "So I guess, I don't have to explain how this works?" He said sarcastically "I'm not in the mood of hearing medical terms and processing what they mean. So just talk to me as if I were any other parent with no medical knowledge." Ellis just said, breathing in tersely. The paediatric surgeon turned to Ellis, clearing his throat before starting to speak. "Uh, right." The doctor started. "An atrial switch operation is a surgery in which we create a conduit within the atria that reroutes the oxygen-poor blood. The anatomic left ventricle continues to pump into the pulmonary circulation and the anatomic right ventricle will work as the systemic pump, in other words the ventriculo-arterial mismatch is left unrepaired." He explained.  "So in other other words The left ventricle will pump the blood to the lungs while the right ventricle is working as the systemic pump?" Her voice shook. "Yes." The surgeon said deadpan.

"Oh my ..." Ellis said out loud worried about her daughter and overwhelmed by everything that was happening.  "Do you need a minute to regain your senses?" The surgeon asked, trying to offer comfort, knowing that there wasn't much comfort that could be offered in such a situation. "I'll send the nurse with discharge papers." He said. "This first two surgeries have been successful." He continued.  "I know. If it hadn't been, she wouldn't be alive." She sighed before asking a question she needed to ask, needed to know the answers for: "Is there anything I need to look for? Symptoms that indicate that she's getting worse? What kind of things do I need to look for?" Ellis asked, realistically as a doctor she knew this stuff, but she wasn't a doctor she was a patient. The doctor explained "she's at risk of endocarditis, symptoms such as a fever, chills, loss of appetite, headaches, muscles and joint pain, night sweats, short breath and a persistent cough" the doctor started Ellis had wrote all this down and nodded for him to continue , "respiratory tract infections, such as pneumonia, the symptoms include coughing with the production of mucus or phlegm, wheezing, rapid breathing and chest tightness,  and pulmonary hypertension which may be harder to see in a baby as they can't describe how they are feeling for example, shortness of breath, extreme tiredness, dizziness, feeling faint,  a rapid heartbeat and chest pain" the doctor concluded, Ellis nodded, "thank you doctor Thomas I really appreciate it, so I can take Meredith home now till her next surgery?" Ellis asked, dr Thomas nodded "of course, don't be afraid to bring her in if something doesn't seem right" explained, Ellis nodded before wrapping Meredith up warm ready to take home.