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Cancer in Your Corner: Fragile heartbeats — handle with care

Submitted by Clayton Hess MD, MPH

I had not been asleep long when the sound of rapid buzzing entered my dream and called me to attention. It was my call pager buzzing. Little sleep was part of life on the trauma surgery team at the University of Texas in downtown Austin. We wore two pagers – one with a long, sustained buzz to alert us of normal urgencies and one with rapid pulses, nicknamed the drop-everything-pager. Adrenaline flooded the dreamscape. Half awake, my arm searched my hip, my fingers clenched and raised the buzzing pager to eyelevel, and my lashes blinked repeatedly at its green message screen set my face aglow: HELICOPTER ARRIVAL – 5 MINUTES. CODE RED. GUNSHOT WOUND. I wrenched the remainder of myself from sleep and raced from the closet-sized sleep room – my shoes untied and white coat swinging from one arm. Drop-everything meant that life hung in the balance and seconds mattered.

Our team converged at the emergency room trauma bay and echoed patient details around as they arrived – “57-year-old male found down – bullet to the upper chest – cause unknown – possible firearm accident – not responsive.” We quickly donned plastic knee-high blue boots, body gowns and gloves, and full-length face shields – this was going to be bloody. Suddenly, we heard chopper blades whipped loudly, pulsing though the air from glass doors that had slid open from the nearby helicopter pad as a gurney raced towards us. A bloodied man was immediately transferred to the trauma table. We punctured him with large-bore intra-venous needles and hung pressurized fluid bags – racing to replenish the blood being lost. “Blood pressure critically low – pressors in – no traceable heart rhythm,” I heard. To my right, the head surgeon assessed the situation and called for a “clamshell” – the rapid opening of the chest to manually find and stop a punctured blood vessel. In under a minute, the man’s ribs were opened with bone cutters that resembled hedge clippers – an emergency thoracotomy – and a bullet hole was found in the left pulmonary artery. This was the source of his bleeding. “Cardiac massage, more packed red cells, and hemostat with 3-0 polypropelene,” he said. He was calling for a needle with thick suture material to stitch repair the blood vessel wall. But first, he clamped off bloodflow just upstream to the hole, grabbed my hand, and plunged it into the patient’s chest, wrapping my fingers around the man’s heart, and ordered me: “squeeze while we sew.” Soaked in blood, adrenaline, and disbelief, I obeyed, pumping his heart manually, watching each stitch as it was placed, and hoping his blood pressure still rose each time I clenched my fist.

I often think of that now-distant day, vividly etched in memory. More than any other professional experience, that night humbled me. Beating another man’s heart in the palm of my hand was an unforgettable lesson that life is fragile. While I later chose a career treating cancer rather than trauma, the same lesson applies. Protecting life from trauma or cancer is worth all the resources we dedicate to it.

As Nevada County residents, are we sufficiently aware of the harm that surrounds us? Only when aware of danger we can protect ourselves. Regarding trauma – yes – we can protect against firearm accidents – gun safety is critical and well known. Cancer safety, however, is less well known and risk is harder to avoid. We can educate ourselves about carcinogens. A carcinogen is anything that interacts with the cells of your body that could cause DNA mutations during the cell copying process, which can then lead to cancer. Chief among carcinogens is the sun. High-energy ultraviolet light from the sun is why the skin develops more cancer than any other organ. Breathing ash or smoke – from chimneys, wildfires, car exhaust, or tobacco products – can cause DNA mutations in our mouth, neck, lung, bowel, and bladder. Chemicals of many types can harm as well. Proposition 65 now informs Californians about carcinogen risks in consumer products – we can look for these labels and reduce how often and how much we are exposed. Reading these signs – this product contains chemicals known to the State of California to cause cancer – can be overwhelming. Be more aware than alarmed since exposure is often – like the sun – unavoidable and since cancer can still occur despite risk reduction.

How much to avoid exposure to carcinogens is an individual choice. The more exposure the higher the chances of future cancer but also the more life interruption. Moderation is key to sustainably reducing risk. We can enjoy the sun, but wear sun protection. We can relish the crackle of a warm fireplace in winter but avoid direct smoke inhalation or prolonged contact with ash or charred materials. We can be industrious and work the land but use personal protective equipment (PPE) with mask and eyewear for projects with airborne dust, building materials, or chemicals. We can enjoy the conveniences of modern life but choose for ourselves how to reduce carcinogen exposures in consumer products, balancing the higher costs of organic products with the burden of chemical avoidance on our individual lives.

You are more fragile than you may realize, so be informed about carcinogen risk and handle yourself with care.

Cancer in Your Corner aims to advance public health, bolster community trust, and enhance readership understanding through medical storytelling. Dr. Hess is the Director of Radiation Oncology at Sierra Nevada Memorial Hospital. His views do not reflect official positions of CommonSpirit Health, Dignity Health, or Sierra Nevada Memorial Hospital. Some aspects of this article are fictionalized history but are based on a true story. Names are fictitious to protect confidentiality.


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