The Surgeon places hands on belly and the diagnosis is clear

The call comes in at 9pm or so.  The patient sounds sick as all hell.  The Surgeon listens to the random assortment of numbers and vitals the nurse provides and clicks off his cell.  He finishes reading a boring Berenstain Bear story to his daughter and tucks her into bed.  He looks at the clock and runs some mental numbers.  By the time he arrives at Hospital, close to ten.  See the patient, talk to family, dictate notes, write all the orders and it’s getting close to 11.  Then the wait for the call team to arrive, the inevitable waiting around of anesthesia.  The family questions.  The delay in transport getting patient from ICU to OR and now we’re talking well after midnight.  Before he even cuts.

The lady is in extremis.  Family is pacing in the hallway.  The Surgeon places hands on belly and the diagnosis is clear.  She is on pressors already and her lower legs seem mottled.  Fluids are running wide open.  The urine in the foley bag looks like bourbon.  After the usual back and forth with family— surgery or no surgery, high risk, but what else can you do, she may make it /she may not, the only hope is to operate, but it could be futile and thus an operation would cause her unnecessary pain and suffering, etc etc—the decision is made to proceed to OR.  The abdomen is exposed, prepped, ready for scalpel five after one.  The arithmetic is just a little off.

It’s a dead cecum with necrosis of a length of terminal ileum as well.  He works quickly; mobilize, resect, wash out.  She’s too unstable for anastomosis.  The stomas are brought out.  He closes the wound and rushes to speak with the family.  Not so bad, all things considered.  Could have been worse.  She hung in there.  We will have to see.  There are hugs and the earnest shaking of hands.

He gets outside and his car won’t open.  The key fob is dead.  Battery?  Who the hell knows.  It takes the Surgeon twenty minutes by the light of a streetlamp to figure out how to get the emergency key out of the fob.  Then he has to read the goddam owners manual of the vehicle to figure out the magic trick of making the fob turn on the car when the battery has died.  This is an opportunity to manifest patience and forebearance.  Another 45 minutes lost.  He gets home and lies staring at ceiling for a half hour.  It is close to four in the morning.   He drifts off.  The alarm shrieks, a cattle prod in his amygdala.  He wakes.  It can’t possibly be time.

He has four cases, starting at 7:30.  Shower and coffee are like sucking moisture out of a cactus in the desert.  The Surgeon trudges though the darkened hospital parking lot to the locker room.  He gazes at his hollowed out visage staring back at him in the mirror.  The day stretches out interminably.  Good natured, well rested colleagues pass by as he stands looking in the mirror.  Time to light the fires again.  Time to start.  He splashes cold water over his face.  The OR is paging him.

The first case is a tough colostomy reversal.  Stapler issues necessitate a hand sewn mid-rectal anastomosis.  He breezes through a breast biopsy and a routine gallbladder.  Another gallbladder is tougher, acutely inflamed, common bile duct stones on cholangiogram.  It’s 2pm when he takes off gown and gloves.  There are 17 patients waiting for him in the office upstairs.  The thought of it makes him gasp and want to cry.  He writes orders, speaks with family and changes into regular clothes.  As he slips in the side door he can see the office teeming with patients.  Some have to stand because there are no more chairs.  The women always complain about the lack of reading materials in the waiting area.  The Surgeon has been meaning to mix in a few Ladies Home Journals or Cosmos or whatever the hell it is old ladies read these days.  His office manager scowls at him as he heads back to his desk.

He sits.  He hasn’t been able to just sit in 36 hours.  His head is buzzing with fatigue.  He clutches his forehead, elbows splayed on the table.  Listen to them, he thinks.  Listen to them all.  One at a time.  Take a deep breath and look them all in the eye and listen to them.  Take your time.  Don’t rush.  Don’t be impatient.  It will end.   You have done this before, he thinks.  This is not heroism.  This is called doing your job.  The office workers start filling rooms with patients.  The names on the computer screen in front of him ring familiar.  There are new ones too.  He will listen to them all.  He stands and grabs a chart.

That night he gets home around eight.  His little boy is crawling across the floor and when Daddy appears he smiles broad and innocent and starts power crawling toward him.  The Surgeon drops to the carpet and plays with his boy.  They wrestle and play and laugh.  He holds him tight.   He is happy.

Jeffrey Parks is a general surgeon who blogs at Buckeye Surgeon.

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  • NormRx

    The only way this story could be more sad is if when got home the sheriff was waiting with divorce papers. The sheriff told him he had thirty minutes to pack his bag and move to a hotel because his wife feels threatened by his presence. After a brief reconciliation, he managed to talk to his wife and he ask why? She reply’s, “I don’t love you anymore, you are never home, I never see you, you care about everyone else but your family. I want a divorce, full custody of the children and $8,000/month alimony.” By the way, I found another man, he bags groceries at the local market, but he will be home every night.

  • samantha

    Wow. Thank you for your honest story. This is what is wrong with this whole medical system we have, that creates situations like this. And wondering what the takeaway is. The “Surgeon”, capital “S” seems more involved with his car’s key system than with his patients. OK. As a doctor, the challenges of patients is the job. Being locked out of the car, I can understand that frustration. I know the stress of running a business, and having things not go your way when all you want to do is get home. If your office manager is scowling, fire her. If you have too many patients that it makes you gasp and cry, cut down on your appointments. It’s in your power. Doctors are such smart people — you wouldn’t have gotten through med school and residency if you weren’t.And you are expected to be everything: the bedside manner of Dr. Welby, the never-erring practitioner, the savvy business man, and perfect parent and spouse. But take inventory of why you went into med school, and what you are offering your patients, and get beyond your ego and the money and figure out how you can make a change in this bad system we have in this country.

    • azmd

      You know, I think you may have missed the point of this story, which was that it’s very stressful to do an already difficult job when you have been up working all night the night before. And if we all decide that we’re not going to take call so that we can be sure that we will go to work rested in the morning, who do you think will operate on your family member with a bowel infarct in the middle of the night?

      I think one thing we can all agree upon is that we have a flawed medical system in this country. But making changes in it is far beyond the scope of those of us who went to medical school so we could help people. Decisions about our careers and your medical care are made by powerful insurance company lobbists and by your legislators, not by us doctors. Blaming us for a flawed system is futile, because we don’t have the power to change it.

      • http://journaltowellness.com Kathleen (Kathie) Clohessy

        A more important point that others seem to have missed is this-Do you want a man or a woman who has been up all night to operate on YOU? I don’t. Any more that I want the guy driving me to the airport in a limo to have had zero sleep, or the pilot flying my plane to whatever destination I choose.

        Medical mistakes kill thousands of Americans every year. I cannot quote statistics off the top of my head but I read some terrifying ones recently about ICU deaths. This surgeon is not just “cutting” and seeing patient’s in his office. He is also managing the care of his most critical post-op patients in Intensive Care. Even if his patients manage to make it off the table, a lapse in judgement by an exhausted doctor there can send any one of them to an early and avoidable grave.

        I am a retired medical professional; I have the utmost respect for most doctors. But I am also a person who suffered a terrible outcome-one that profoundly affected me for the rest of my life- due to a “mishap” during a routine surgical procedure when I was 25 years old. Was my doctor tired? I’ll never know. What I do know is that as a result of what happened that day my life was never the same.

        The medical profession is being suffocated..slowly strangled to death by a system of reimbursement that demands superhuman efficiency from these very HUMAN beings. It is easy to blame the insurance industry.. and they certainly deserve a good portion of the blame. But as long as physicians as a group refuse to stand up to them; as long as doctors continue allowing themselves to be forced into virtual servitude while closing their eyes to the very real dangers to their patients that doing so entails they share it, too.

        Doctors are not gods. It is time they admitted that and fought back against a system that demands they behave as if they were.

        • buzzkillersmith

          So you’re saying Dr. Parks should have let that patient die so he could have had a good night’s rest. That’s your solution?!
          Do yourself a favor and read about how residency positions have been capped by Congress and then quit picking on people who are working in a system they did not create and have no power to change.
          It’s the patients who should stand up to Congress. There are a hell of lot more of them than there are of us.

        • azmd

          I think until you have done the kind of work that doctors do it is hard to appreciate how draining it is, and how little time and energy doctors have left over to involve themselves in organized medicine and the political fray. I sit on the board of the state medical association and it is really all I can do just to get to meetings and maybe create some talking points for lobbyists and attend a few meetings with legislators.

          You are right that we are being suffocated to death. I fear that we have reached a point where that suffocation is so advanced that as a profession we simply do not have the means to fight back. In my experience, doctors are not fighting back because of some misguided belief that they are gods. They are not fighting back because they are demoralized.

          In order for change to occur, everyone who has a stake in the game needs to get involved. And that includes patients, who must realize that the enemy here is not their doctor.

    • kjindal

      entitled American, with zero sympathy for the very typical story of a general surgeon, or even an on-call primary care MD (pediatrician, internist, family practice MD, ob-gyn, etc.)
      Dr.Parks, keep doing a great job at something that 99% of people could not do even in the best of circumstances. Your patients are being trained by gov’t payers, insurers, and the media to expect perfection, service with a smile, and “free” care at all hours of the night, and will never truly appreciate the sacrifices you make (as exemplified by samantha). So please remember that one day your kids will grow up – enjoy them and take good care of yourself first. Nobody ever laid on their death bed saying “geez I wish I worked more”.

    • buzzkillersmith

      You’re right, doctors are such smart people. Business owners, not so much. Come back and talk to us when you start saving lives in the middle of the night.

  • http://www.facebook.com/rjulun Rodney Julun

    That is one hell of a 36 hour period. Serving the public is usually a thankless job…But, every now and then, you get to take great pride in what you do. I feel your pain…..at least for the next 17 months…..

  • http://www.facebook.com/david.gelber David Gelber

    I think it’s time that the government passed a law that allows patients to become seriously ill only between the hours of 8:00 am and 5:00 pm. Of course, such a law may be buried somewhere inside the Affordable Care Act.
    I’ve lived through this scenario hundreds of times. The thing that keeps me going is the seeing a sick patient who had been at deaths door walk out of the hospital completely well. Even more gratifying is when they come back to see you two years later for a completely different problem.