Things Fall Apart

The first time I met him was briefly outside the OR before his surgery, in the pre-op area. I introduced myself as the medical student on the team, and he pleasantly smiled back at me. He didn't seem too nervous. There could be a few reasons for that. He had gone through this before; he knew what to expect. He had also been in the navy, as I learned later, and had probably faced a lot of things worse than this surgery. Lastly, he had gone through extensive chemotherapy and radiation, which is difficulty for anyone. So, although he was undergoing a rare operation, one the chief resident had never seen and the surgeon, a leader in his field, had only done a handful of times, he was calm.

It was a long, complex surgery. First, one surgical specialty team did their part, and then, three hours later, my team came in to do ours. During the surgery, we kept getting positive margins, which means cancer cells are present, on the specimens we sent off to pathology, so we kept resecting until we could resect no more. Luckily, that last margin was negative. I remember feeling good. It was a really cool surgery and we seemed to have gotten our desired result. The other team then came in to finish their part. Twelve hours from first incision, it was done.

For the first few days after the operation, he seemed to do pretty well. He was sore, but recovering. I got to meet his family and learned a little more about him. We celebrated together when the final pathology came back negative.

Post-op day seven, things changed. He started spitting up what appeared to be bile. We tried to give him some medicine to help his intestines move things along, but it only made him severely anxious. We ended up scanning him. Something was wrong and his new intestinal conduit wasn't emptying properly. We presented him at tumor board that day. Tumor board is a meeting where all the specialists in that field get together and review cases. The decision was made to take him back to surgery that night. After 2 hours of making little adjustments, but not really finding the cause of the problem, we closed him up. He was in the ICU for a while after that.

The last day of my rotation, we were getting ready to transfer him out of the ICU to the regular floor. I remember reassuring his worried wife that he was on the road to recovery and didn't need to stay in the ICU anymore. I was wrong.

It is now a month and half later, and he is still in the hospital, in and out of the ICU, in and out of the operating room. To quote author, Chinua Achebe, "Things Fall Apart," and based on my medical school experience, it always seems to happen to the nicest patients.

The reason I like surgery is that it was one of the most concrete ways to help a patient. An appendix ruptures, you take it out. Problem solved. Unfortunately, it is not always that simple. Sometimes you end up hurting patients more than helping them although your intentions were otherwise.

Trauma Call

What I'm like on trauma call

"You just need a man to figure it out"

Setting: the female fellow and male attending are working to place a new dialysis graft in the patient's arm.

They are trying to figure out how to work with a different tunneler when the attending says, "You just need a man to figure it out."

At another point in the surgery when the fellow was questioning the position and number of the vessel clamps, he again responded, "You just need a man to figure it out."


In both these instances, the fellow half-heartedly laughed in response. Was the attending saying this in a joking manner? Yes. Does that make it ok? I say no.

Just some food for thought.

The Silver Lining

Some days it's difficult being the med student.

You put pressure on yourself to perform well, especially when you're in the specialty you want to pursue. In the process, your nerves are your undoing on something as simple as a patient presentation.

You try and take the initiative and remove a wound dressing, only to find out it wasn't supposed to be removed yet.

You know the answers to all the questions except the one you are asked by your resident.



The silver lining? When your patient tells you you're going to be a good doctor.

A Haiku: Gyn Surg

Uterus, pregnant?

No, big with fibroids, so large

Took out, now it's small

Hysterectomy

Alien head uterus

filled up with fibroids

Scraping uterus

 for too much bleeding, and so

biopsy will tell