My son always asks, “What did you do today mom?” Unlike my daughter who decided a few years ago that she wants to be an obstetrics and gynecologist, my son doesn’t seem to want to do anything in medicine; but he is always curious to what it is I do on a daily basis and if I had to ‘stare death in the face’ (his words). I remember having an unhealthy fascination with death when I was his age, I would walk around in cemeteries reading tombstones and wondering the lives of the people that were long buried there. Strange, I know….
Yesterday was a typical day. My team and I started rounds at 6am and around 705am there was an overhead trauma activation. We split up the team, half went to the trauma and I continued rounds. Shortly after finishing rounds two back to back traumas were called. I was supposed to be in the operating room at 730 and had a full day but had to find someone to cover my first case because I was the most senior person available to run the traumas. It was after 9 that everything was settled and I ran the list with the attendings on our service and then planned out the day with our team before I went to the OR. I had two laparoscopic cholecystectomies (gallbladder surgery) and two hernias one open and the other laparoscopic. I missed lunch and by the time I was done it was almost 4pm. Afternoon rounds were completed without incidence and loose ends were tied before my work day was over at 6pm. Its a great day when I am operating all day, but contrary to popular belief, surgeons are not just technicians, we are well rounded physicians who take care of our patients as a whole. Elective surgeries are very nice because you have generally healthy patients coming in for outpatient surgery and going home the same day. Emergency operations on the other hand are challenging, not only in the complexity of the operation, but also in the postop care.
Our patients don’t come to us with just their surgical pathology, the body reacts in different ways to that dysfunction especially in older people who can not handle fluid shifts well. Patients who come in septic shock, for instance a patient I had the other day with perforated bowel in his late 80s who was severely acidotic and in acute renal failure prior to his operation would have a much longer and complicated recovery than a 35 year old with no other medical problems with the same pathology. Post op in our elderly patients its not uncommon for them to end up with arrhythmias or renal insufficiency or respiratory failure. Its important to keep on top of things and make sure we get them over that hump. Our goal is to get them back to their preop level of function. Sometimes this is not possible, the body is beyond repair and we have to make sure our patients die with dignity. It is very difficult for me as a physician to discuss death because it’s contrary to what I went into medicine for. It’s as though I am giving up on the fight and I am losing. But it is my responsibility as a physician to realize when care is futile and we have done all we can. Death is a painful part of life that we have to deal with this side of heaven, but for those who believe in God, we know our loved ones are only sleeping, waiting for Jesus’ return. What a comfort we have, knowing that we will reunite with them soon.
