I haven't had much to blog about recently. Mostly because my days are long and I try to avoid my house and computer as much as I can so that I can get some work done before passing out in bed. Also, I actually have had little to say, recently --which, for those of you who know me, is rather rare. It's not that I'm bored or that interesting things don't happen to me everyday, but I think that part of being immersed in the surgery culture involves acquiring a certain efficiency of not overprocessing everything. Plus, my days start at 5am, my hospital work ends around 6pm, and between 6pm and 10pm, I am usually being overwhelmed by everything that I don't know that I should know as soon as possible.

Today, as I was falling asleep over one of my casebooks at starbucks, I was reading about diagnosis , staging and surgical treatment of lung cancer. Our school is a fairly progressive school and we've had it pounded into our heads more than once that we should never say to a patient "there is nothing more I/we can do for you." Yet this is a term I have heard doctors and medical students around me use all the time, often unconsciously, and I can understand how, if you are an oncologist or a surgeon, you feel that there is nothing wrong or dishonest about that statement. Yet today, in my half-dream "studying" state, I suddenly fully felt the loneliness and abandonment that one would feel if, after months of "fighting the cancer" with tests, surgery, radiation, chemo, etc, these people who had become so integral to my existance all suddenly told me that in effect, it was time for me to terminate this period of my life with them and go off and die. Anyway, it was a strange, half-dream/awake experience, this sudden flood of empathy, and quite disturbing.


***heads up, if you get easily queasy, you may not want to read the next paragraph***

Since I'm on the cancer topic...this morning, I scrubbed in on a palliative surgery of a 80+ year old man with metastatic rectal cancer. He had been having obstruction and bleeding per rectum, so we were going to go in and chop the mass out. He didn't look 80, maybe late 60s (which probably means that, unlike almost everyone else at the VA, he wasn't a smoker). He had turned 18 soon after the start of WWII, so I'm guessing he was a veteran of that war. When I walked into the OR, he was already unconscious under anesthesia, sprawled on the operating table, his arms strapped out, crusified-style (as most people are during surgery) and his legs spread apart in stirrups. He was naked except for socks and compression stockings, and a urologist stood between his legs with a scope, trying to jam a catheter through his narrowed urethra. I spent the time looking at the man's CT scans, which showed a hideously large metastatic tumor growing in his liver. After about half an hour of blood and urine, the catheter finally made it to the bladder, and we started to get ready for the surgery. My attending called me over and asked me to put my finger in the man's rectum and locate his tumor, and as I did, chunks of the tumor and blood came spilling out of the anus. I had my second serious bout of nausea in the OR (the first time was when an anesthesiologist pulled the nasogastric tube out of a patient's nose and then proceed to suck the stomach contents and snot witih a suction in the man's nostril). More than that, I felt a certain awe at feeling these bits of tumor below my finger tips - friable and fragile, I could scrape a lot of them out of the anus, and yet, they would very likely be responsible for ending this man's life.