Acute Abdomen, Farewell

I finished my last day of general surgery yesterday. Kind of sad to say goodbye to Dr. Gourlay and Julie, his secretary. Gourlay has a great way of putting people at ease and anticipating questions. Key takeaways:

- Always maintain a sense of humor, even if you're about to drain someone's abscess by sticking a knife in 'em.
- Talk kindly of other docs, even if you don't agree with their decisions. This is a Gourlayism, and I like it.
- Lead the conversation and don't let the patient lead you, such as if they're about to tell you a story about being in the roller derby.
- Say yes to anything a preceptor asks you to do even if you don't want to.
- Know more about the patient than the preceptor knows.
- Follow your attending's lead
- Stay human, even if that means you gotta cry every once in a while.
- People are tough. Take the 49-year old obese male who had perianal abscess. When the doctor said, "I'm just gonna knife you and drain it" the patient replied, "did you say knife me, Doc?" To which the doctor said with a smile, "Yes, because I think a local would be just as painful as just sticking a knife in it," the patient said, "OK. Do it doc." The knife went in, pus and blood emerged, and it was done that fast. The patient left smiling and thanking the doctor. What!? Like I said, people are tough.

In the last two weeks, I scrubbed in to see:
- 1 partial mastectomy
- 1 lumpectomy and sentinel node biopsy
- 2 ventral hernia repairs
- a few more cholecystectomies
- 2 colonectomies

I also saw several hemorrhoid cases, 1 abscess drainage, generalized lymphadenopathy, sebaceous cyst, inguinal hernia, and lots of post-op follow-ups.

I'm constantly learning about the doctor-patient relationship, how bad docs can make a patient feel like a specimen, and how good docs can make her feel like a human again. For example, I helped one of the ICU doctors put in a central line (on the same patient I helped put in a trachea tube). The doctor didn't explain shit. He didn't consider any opioid until the nurse suggested it. I felt sick for the patient who took the procedure without any conception of what was happening.

Mr. Aldea, an 81-year old Asian man, underwent a colonectomy for stage III colon cancer. The surgery went successfully but the patient slipped into SIRS (systemic inflammatory response syndrome). He already suffered from kidney failure and several other complications. After 7 days in the ICU and many docs trying to figure out how to treat him, his end prognosis didn't look good.

Then there was the 82-year old man with parkinson's, CABG, and a large inguinal hernia. His wife, a recovered colon cancer patient, was his sole support and only learned of his growing testicle a few days ago.

Those patients and all the interactions did me in. I had a good cry and felt human again. It's easy to forget that the patients in the hospital and in the clinics are suffering human beings, scared and desparate for life. I hope I never forget.