Monday, October 16, 2006

An "Ah-Ha" moment


Allow me a brief diversion, not intended to delay the return to hernias. In my recent post, "Taking Trust," in which I tried to describe an aspect of the mysterious relationship between surgeon and patient -- being allowed, given the privelege, to reach inside another person -- my words "creeped out" a few people. Of course, that makes me feel bad, in that I'd like as a writer to be able to express my thoughts clearly enough that they aren't misinterpreted, and in that as a surgeon my relation to my patients is and was anything but creepy. In my ruminations and recriminations over the post, something just occurred to me: something I of course assumed, but which not everyone who read the post may know. Us older surgeons, who trained before CAT scans and laparoscopy, were taught (required!) to "explore" the abdomen as part of any abdominal surgery. Before attending to the problem at hand, in a systematic and thorough way, we felt every organ in order to be sure no other pathology was present, and to (in the case of cancers) look for signs of spread (you may be surprised to know that most intestinal cancers can, for instance, spread to ovaries). The exploration was expected to be done, and the results included in the reported operative findings. Far from "taking liberties," it was as important a part of the procedure as sewing up at the end. It didn't occur to me until now that my description of that -- poetic or not -- without explaining why I was doing it could be part of what some people found weird. Or not.

6 comments:

Empress Bee (of the High Sea) said...

in my wildest dreams i simply cannot fathom one word in that post "creeping out" anyone! it was one of the most beautiful things i have ever read... please do not apologize doc, or change one word. go with your heart, it will not lead you astray my friend... bee

Cathy said...

I agree with Bee...When I had my big surgery back in 95, I know I had ct scans before my surgery, but, my surgeon also told me that he would be checking every organ while he was inside my abdomen. Why would that have freaked me out? He was looking and feeling for abnormalities that might have indicated metastatic disease.


I think the entire post was beautiful. It was also written from your heart... Maybe it is the healthy, who have never faced big surgeries, who can't fathom what it is all about. For those of us who have been there, your words meant much more to us.

It was one of the best posts I have ever read. Thank you for writing it!

Jude said...

I read your blog because they give me a perspective I would otherwise never gain. The clarification is probably a good idea, though, because you are speaking to us from an alien perspective, so sometimes it might require more explication for the uninitiated.

emily said...

One of the most amazing moments in my life was to scrub into a thoracotomy as an NP student. This was a patient I had cared for over months as an RN in the Intensive Care Unit.

Your post brought me back to those moments when I caressed his lung and felt his ribs through my gloved hands.

It was incredible to realize that surgeons do feel that wonder although it is rarely mentioned in professional circles.

Alice said...

Your post described the secret glamor and thrill of surgery that I'm just starting to latch onto, and one of my reasons for choosing it as a profession. It probably scares some laypeople if they hear about it; but it's there. With great power comes great responsibility.

Alexandra Lynch said...

Thank you for the further explanation. It's something laypeople just don't know you surgeons do.

And given the way my lower gut reacts during my menstrual period, I am not at all surprised that the ovaries and intestines occasionally give each other cancer.