Deciding on a career in surgery was very difficult for me. I went into medical school believing I would become a family medicine physician or a pediatrician. I wanted that patient-physician relationship, and that was one of the hardest aspects of falling in love with surgery: I thought I would never develop those relationships. How wrong I was.
Even as a resident, where patient continuity doesn’t exist as you rotate to new hospitals or services every 4 – 8 weeks, there are several patients I will never forget.
The first was a young man who came to the ED with symptoms of a large bowel obstruction. He had undiagnosed Stage IV colon cancer with tumors throughout his liver. As the third-year surgical resident on call, I had to tell this patient and his lovely wife that he had metastatic cancer, and that was causing the blockage in his colon. We took him for a laparoscopic transverse colostomy and port placement the next morning. In the recovery time, he spent a few extra days in the hospital learning colostomy care, consulting with oncology, and working with our social workers. I lingered longer in their room every day than I really had time for, counseled him about possible genetic syndromes and that his family needed early colon cancer screening. But we didn’t just talk about medicine; we discussed our favorite graphic novels and board games. He told me about a board game, where you acquire gems to buy cards with different points. It was near Christmas, so I bought the game for my husband as a gift. We still play it regularly; and every time we do, I think of this patient and his family.
As a chief on our Acute Care Surgery team, I admitted an elderly previously healthy woman who swam regularly who also presented with an obstructing colon cancer. She didn’t want any surgery, but I educated her that since she did not appear to have any metastases this was a very curable process. I convinced her to have surgery. Given the obstruction, we did an open left hemicolectomy. The surgery went well and only took 2.5 hours. However, in recovery her blood pressure dropped and with fluid resuscitation she went into right heart failure. She was transferred to the ICU and required pressors. Her heart never recovered and she died 2 days later. I had never cried in front of a family before, but I sobbed with them as they hugged me and they said goodbye to their wife, mother, and sister. I was devastated and lost confidence in my abilities.
However, about 3 weeks later, I received a letter from her husband explaining how in his opinion she died with dignity and that he couldn’t have asked for any better care than what I provided. I was shocked that was his perspective. That letter still sits on my desk to remind me that how we handle complications and loss is just as important as how we handle success. Patients truly respond to compassion.
As a current surgical fellow, I have had similar encounters with families. I have learned the names of their children, joked with them as they recover, and delivered new devastating diagnoses. I have finally gotten a glimpse of patient care continuity, and it is so rewarding. In the age of EMR overload and burnout, never forget what brought us to medicine in the first place: to care for our patients.
One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.- Dr. Francis W. Peabody
Sabrina Drexel, MD, is a minimally invasive surgery and flexible endoscopy fellow at University Hospitals Case Western Reserve in Cleveland, OH. She attended the University of Rochester for medical school, and completed her surgical residency at Oregon Health & Science University in Portland, OR. She will be returning to Portland after completion of her fellowship in Minimally Invasive Surgery to surgeon in private practice. She can be reached on Twitter @SabrinaDrexelMD.
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