Sure Surgery

December 6, 2010

Long time no surgical updates. There have been some wonderful, sad, or at least interesting stories. Sorry for holding out.

In medicine there are two stories happening simultaneously.

1) The story of the patient

2) The story of the body

I’ve tried to understand both; here are three patients, or 6 stories.

First, Ms.X. I met her the moment before she underwent anesthesia. Unfortunately I didn’t get to learn much about her, other than she was a caribbean lady with heart failure who had fainting spells. My mentor from the medicine rotations – a Polish Electrophysiology Cardiologist – was nice enough to let me scrub into the case. We put in a loop recorder to figure out why she was fainting. For those out of the loop (sorry,couldn’t resist that one. forgive me.) it’s an electrical device you place above the muscle of the chest. The incision isn’t too deep. Then, it records the heart rhythm. Imagine a tiny flash drive. It was a fast procedure, but, lucky student that I am, I was allowed to rinse out the incision site, tie knots, even check to make sure the stitches were closed propoerly. Clearly, an excitinjg afternoon.

The next day – patient number two, a 22 month old boy with a ton of energy and a tumor the size of a tennis ball (hepatoblastoma) in the right lobe of his liver. I had the priviledge  to hang out with him before surgery. Clearly a bright little guy, instantly drawn to my surgical mask that was hanging around my neck. I think he’s going to be a doctor.  I wish I could describe the feeling you get seeing a pacifier and a blood pressure cuff on the same patient. Or, later, when such a tiny patient is lying on a giant surgical table with a mask the no bigger than an espresso cup on his face. It was a big case.The chief of transplant was there, and 4 other surgeons. The resection lasted 4 hours.  I saw him today got to do a quick physical exam. Good news: clear lungs and a strong heartbeat.

Last but not least, a patient I have been voyeuristically following since I got here. Mr. I – 54 years old, from Pakistan. He has a disease called Alport’s syndrome, which required a kidney transplant over 20 years ago. Alport’s is a defect in collagen, which also effects the patient’s vision and hearing. The way to remember this- if you ever have a quiz, is to scream “ALPORT’S” (so people with alport’s can hear you). Mr. I’s case is tricky, he also has hepatitis C, and came to the hospital with pancreatitis caused by a gallstone. Yep… a kidney-liver-pancreas-gallbladder problem. Oy vey. He was scheduled to have his gallbladder removed today. I was scheduled to scrub into the case. Which brings me to why I have so much time to write about patient’s this morning. The case was cancelled. During the pre-op assessment, his risk for liver failure was too high. Instead of surgery, he’s been recommended for a liver transplant. Plus a new kidney since the older one isn’t working well anymore. More to follow for those interested.

On that note, back to the floors.

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