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The Heart of the Matter

Dr Cynthia Chia

Cardiothoracic Surgery is a specialty often described as a calling, a field that requires tenacity and aptitude of its practitioners. The sheer amount of stamina needed to keep up with training, procedures, electives and emergencies is a daunting prospect for many. Not so for Dr Cynthia Chia, a Year 4 Cardiothoracic Surgery (CTS) Resident, who declares animatedly that she, is “pushing through it all”.

For doctors in CTS, the best and worst parts of the speciality often converge; even the most dire cases can turn out to be the most rewarding successes. Cynthia recounts a case involving a patient in his teens with chest discomfort and giddiness. The patient was on LVAD (Left Ventricular Assist Device) due to cardiomyopathy. The result of an Electrocardiogram (ECG) revealed that he was suffering from Ventricular Fibrillation, a life-threatening case of cardiac arrest. However, he was largely stable due to his LVAD. After he was brought to ICU and cardioverted, he regained sinus rhythm but was hypotensive. Despite following the proper procedures and resuscitation protocol, he remained hypotensive. “It was a huge shock. It just spiralled into an incredibly stressful situation! I did everything right and in the correct order, but my patient still collapsed. The right side of his heart was pumping erratically and he passed out. I knew I could not give up; I did not want to give up as he was so young and has everything going for him. He WALKED into the hospital, in fact. I started the whole treatment protocol again, praying hard the entire time. It was a relief when I managed to resuscitate him!” Only after the situation improved was the patient able to undergo surgery to receive an Implantable Cardioverter Defibrillator (ICD).

Cynthia is still hoping for the best outcome for this young patient. “He’s doing really well right now and waiting for a heart transplant. Although he cannot participate in strenuous activities like others his age, his positivity and optimism are inspiring.”

Another case that sticks in Cynthia’s memory is that of an elderly man who, after undergoing a bypass surgery, went on to run in the Veteran Athletics Meet at the age of more than 80! “Patients who come to us are occasionally on the brink of death. What we do sometimes is to give hope, when it seems that there is none. By instituting ECMO (Extracorporeal Membrane Oxygenation), sometimes, we can save a patient who has collapsed. It is very rewarding to see a patient being brought back to life when there is no hope”, she says.

Cynthia stresses that cardiothoracic surgeons have to be prepared for the worst possible situation while working precisely and decisively. Cynthia’s experience as a medical student at Singapore General Hospital (SGH), where she completed two electives, left her impressed by the structured program at SingHealth. She was convinced that this was the place for her Residency training.

“There are many opportunities for Residents here to practice on procedures under the Consultants’ mentorship. I got to work on proximal anastomosis from my third year onwards!” Cynthia also notes that Residents have the chance to choose and plan their own electives, making CTS training a customised ‘internship’ that helps them develop their specific interests.

When asked to give a tip for aspiring Cardiothoracic Surgery Residents, Cynthia laughs and simply says, “You have the power to make of life what you want. You can make it happen!”