vascular surgery

The blood saturates the bandage, soaks into the bedsheets, keeps spilling out under my fingers each time I lift them from the gauze.  The gentleman is easygoing, and his niece (?) pays no attention as the intern reassures her that some bleeding is normal given the patient's blood-thinning medications.

Her brief smile as she excuses herself gives lie to those reassurances.  In fact, we are rather worried that the man continues to bleed.  What she doesn't say to the patient is that she is quietly going to consult a more senior resident about what to do.

We debrided his ulcers in the operating room in the morning, and unfortunately, the coin-sized holes concealed large areas of necrotized tendon and muscle, mushy to the touch.  One of the orthopedics residents on the service

Prior to my surgical clerkship, I had imagined surgery as being a bloody mess, but in reality, most of what I saw was fairly clean, sanitized, and concealed by sterile blue drapes that showed only a small rectangle of the abdomen or other body part in question.  Rarely did I on the operating table see an entire body part attached to a person I had spoken to a few minutes before anesthesia.

"It's always the patients we like!" the intern complained.  "They always do poorly."

I never have felt even mildly nauseated in the operating room, not even when assisting with a below-knee amputation, but watching the attending vascular surgeon snip out bloody bits of once-upon-a-time Achilles tendon was somewhat close.

* * *

Our triple-A referral from the night before was in his 80's, with what seemed like a melon-sized capsule of blood extravasating from his aorta, the major artery in the body.  He would likely die on the operating table if we attempted to repair it, but without surgery, he would certainly die.

"I'm old, and I've had a good life," he told the residents.  "I don't need anything done.  Keep me comfortable."

They agreed with him.  Also, it was a mercy for our team.  It would have been really hard to have him die on the table.

* * *
I spent two hours on the phone today with a Shanghainese-speaking patient and his wife who were worried about his arterial bypass in his leg.  His feet were still cold and hurt, he kept complaining.  The residents kept explaining that our surgery wasn't perfect, but they were tired and impatient with the Mandarin-speaking translator.

I lucked out today and by chance got a Mandarin translator that also spoke Shanghainese.  The patient connected with the translator, and the translator also explained to me a little about how the system worked.

I was tired, but it was clear that the wife was coming every day and was very worried that her husband wouldn't eat, had no appetite, and had skin color changes from poor circulation.  After seeing this every day, it is easy to forget that most normal people do not see sick people each day.

What she needed was a little bit of information, a lot of assurance, and a chance to feel cared for.  I could almost hear my medicine preceptor reminding me, "Now is the time to practicing doctoring."

By the end, she looked much less anxious and scared.  She didn't quite remind me of my mother so much as the parents one of my friends from Shanghai.  I wouldn't want them to be scared or so worried.  All of my personal plans for the evening had already fallen through, so I had nothing but time.

* * *
I would never be a vascular surgeon, but I like my team a lot.  We have a lot of down time, but I think they are essentially very kind, decent people, albeit who get tired sometimes.  We work together.  I would hang out with them outside work.  We are all in the trenches together, working with patients, getting our hands dirty, being tired together, and dealing with emergencies together. 

The one thing I never had in my research was teamwork.  Sometimes it is hard if your team is not good, but when things mesh, it can be a beautiful thing.