Friday, October 5, 2018

Surgery: The Flip Side (And Trump)


This is gonna be my last newspaper column for a while, but I'll still post stuff on my blog. Sorta tired of pissing into the wind.
Implicit in the ability of a surgeon to do good is the potential for harm. If dwelling on it can be paralyzing, ignoring it is dangerous...  
Imagine being parents of a perfect newborn. The joys and worries of pregnancy have resulted in a beautiful boy. He coos, wraps his hand around your finger as you feed him. You’ve never felt such love.

Then, at six weeks old, your baby begins vomiting, keeping almost nothing down, not gaining weight. Hypertrophic pyloric stenosis, the surgeon calls it, speaking Greek, or Martian, telling you an operation is needed. Like a raw doughnut tossed into a fryer, the circular muscle at the bottom of the stomach has grown, too fast, preventing the stomach from proper emptying. Pyloromyotomy is the curative operation. 
Think of a tight ring over a gloved finger. The aim is to cut and open the ring, but not the glove; to see the glove fabric bulge up through the ring, indicating it's free. But if the fabric itself is pierced, it’s a bad thing. The glove is the inner lining of the stomach, so a hole in it causes leaking stomach contents. 
It’s necessary to divide the entire muscle or the operation won't be effective; too deep, there’s the hole. The local anatomy is tricky, increasing the chance of damage, and everything is tiny. If recognized, a hole is sewn up. The danger is not noticing. That can be deadly. And it’s up to me. 
In a fog of fear, the parents listen. I tell them about the possible problem and what’s done to avoid it. I caution that their child might still vomit for a few hours, but in all likelihood, he'll be home in a day or two, doing fine. They agree, of course. 
There's something outlandishly disproportionate about a little baby on a big table in a huge OR. I could cover the entire person with my two hands. All the machinery, the tools, the drapes, the surrounding team seem grotesquely outsized. It's like a joke, except it's real and the stakes are high. Ignore the reality and focus on the job at hand. Tiny incision, toy-like instruments, fine little sutures at the end. It goes perfectly. 
"S#!t," I say, as the phone jars me awake at two a.m. It’s my usual response, whatever the call. Now a nurse informs me the baby has a fever of 103ยบ and his abdomen is rigid, an ominous sign. "I'll be right there," I tell her, forcing words through my suddenly constricted throat. 
It's easy to describe how I felt, because it happens again whenever I think about it. Had my wife awakened, I’m certain she'd have seen me appear ghost-white. My stomach was acid; my hands were ice. I could barely tie my shoes, those cold hands shaking, not following commands. An algid force gripped my neck; I could hardly swallow. 
After splashing water on my face, I ran to my car. As I drove, hands so tightly on the wheel that they were getting numb, I told myself I'd do whatever was in my power to save the child, whatever it takes. Stay by his side till it was over. And then never, never, ever, ever do a pyloromyotomy again. And if he did poorly, I'd never operate again. This was a baby. Someone's precious baby. 
Not waiting for the elevator, I took stairs two at a time to the pediatric floor, saw the nurses standing by, felt as if a million eyes were on me, accusing and angry. (They weren't. But that's how it seemed.) And there he was. Fussy face flushed with fever, but moving around actively, looking otherwise okay. His belly was soft as, well, a baby's belly. An X-ray appeared normal. Whatever that fever was, it was gone by morning. 
Nearly limp, still shaking, I drove home barely able to control the car, wrung out like a wet sock. Exhausted, I crumpled onto the bed, relieved, but absolutely spent. An hour or so later, I dragged myself to work. And next time a pediatrician called me about a kid with pyloric stenosis, I took a deep breath, recalling that night, and said... "I'll be right there."  
And now, for a sad return to current events, read this eulogy for America. Vote for decency and against Trumpic cruelty in November, or it’s lost. There’s nothing more to say. 
 


9 comments:

Oblio said...

Traumatic and inspiring... THANK YOU for being the magician that you are, imbued with the human spirit and marinated with professional grace. Ima getting something in my eye now... prolly a mote of dust or appreciation. Thanks, Doctor.

Sidney Schwab said...

Thanks, Oblio. Very nice.

Dr Strangelove said...

Thank you for bringing this emotional story of yours to the Herald, Sid. It's such a very nice gift to receive as you take leave from your keyboard.

Ditto for the link to Pierce's column. I'll call that out if no one else does.

Sidney Schwab said...

Thanks, Gary. I wish the headline for Pierce's column were a little less hyperbolic. Not that the usual suspects would read it anyway, but seeing that, they'll stop before getting to the obvious and important stuff.

Anonymous said...

Off Topic, but have to say it or burst: Melania in helmet - Pith on her!
EugeneInSanDiego

Sidney Schwab said...

What's the word for such a trenchant comment...

Anonymous said...

Deplorable! just lashing out anything connected to the Orange Monster!

Heartsick at the results of that disastrous election.

EugeneInSanDiego

Sidney Schwab said...

I was going for "pithy."

JS said...

I just read this post. I could feel the intensity of your pain, anxiety, fear, sadness, and anger, all wrapped up in one indescribable but impossibly powerful emotion. I could feel it--but as intense and emotional as it was for me as a reader, my emotions must have paled in comparison to your real experience. Even though I was worn out by the time I finished reading it.

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