Looking Away

 

                    (AI image)

For weeks, I’ve been wanting to write about something other than our dangerously deranged “president,” but his transgressions are endless and dangerous to ignore.

Nevertheless, despite his threat to “bomb the s#^t out of Oman,” a long-time ally; taking credit for falling drug prices resulting from President Biden’s Inflation Reduction Act; succumbing to Earth’s cruelest dictator Kim Jong Un’s weaponized flattery to the detriment of ally South Korea, a longer-time ally, further destroying trust in America; floating the Strait of Hormuz as US territory; threatening the International Criminal Court; blaming vandals (now his all-purpose, go-to excuse for his screwups) for damage to the White House lawn created by his self-celebrating grandstand; launching yet another First Amendment attack; demanding ridiculously expensive and inefficient redesigns of aircraft carriers; further enriching himself by turning his scammy crypto company into a bank; welcoming his unapologetically politicized Attorney General to a political rally – in just the last week – I’ll ignore it all. Instead, from my former life, a surgery story:

Almost erasing the bad luck in her life, Daphne chose to exsanguinate when I and OR staff were immediately available. She’d nearly died before arriving at the hospital. The call came just as I'd finished another midnight emergency case, so I was there to greet her. She wasn't in a position to be sociable. In shock, confused, vomiting blood, she was riding very close to the edge of life.

Her husband looked nearly as pale as I told him she needed immediate surgery, we'd see what we'd find, do what we could. It was a critical situation, I said, stating the obvious. Pushing the gurney myself, running, I pointed the husband to the waiting area and banged through the OR doors.

One thing about operating on the hypercritically ill: when you start from zero, there's no downside. I'm the only hope she has, but I can't make it worse. Death is the default outcome. What you might expect, based on the odds, is a bleeding duodenal ulcer, the surgical approach to which is generally straightforward: get in there quick, make an incision through the pylorus (the sphincter muscle at the distal end of the stomach), throw a couple of well-placed sutures around the duodenal artery, and calm is restored.

Daphne was anything but routine, though: due to taking high-dose steroids, she had two gigantic ulcers, encompassing most of her stomach, front and back, one of which had eroded into her splenic artery. No wonder she was bleeding so massively: that's a really big one, and I'd never seen it be the source of gastric hemorrhage. I put my finger through the hole in her stomach, onto the artery, to stanch the flow and give the anesthesia team a chance to catch up on blood and fluid replacement, during which there was nothing for me to do but stand there, a warm-blooded cork.

A professor of mine once said, "You don't need to worry about bleeding, Doc, unless you can hear it." Good for a laugh. This bleeding, I heard: frightening, shrill, threatening life like a banshee.

Daphne and I were in a fix. Those ulcers took up over half her stomach, plus, by tying off the artery, I'd probably just killed her spleen. At first I tried to save some of her stomach, but it became clear the remnant wouldn't survive. So, against everything desirable in a dire emergency, after prolonged shock, when fast and minimal is best, I removed her entire stomach and spleen, fashioned a sort of stomach-substitute reservoir out of intestine, and connected it to her esophagus. Too much surgery for such a sick lady, but it's what she needed.

In training, there was a generally adversarial relationship between surgeons and medical docs. In practice, happily, it's the opposite. I was partnered with a sensational group of intensive care specialists, and, working as a team, we pulled more than a few people out of the fire over the years. Daphne was one. Despite my having told the family to expect, at best, a long and complicated stay in intensive care, Daphne recovered on a semi-straight path, returning to her tough life.

She lived in half a hovel, to which I made many house-calls over the years. Her kids, named after cartoon characters, struggled in school; her husband rarely worked. But every Christmas I got a card from her, thanking me for another year of life she'd not have had. Once in a while she'd call with some health concern or another and, since it was hard for her to get around, I'd go see her and do what I could.

Several years later, a urologist ambitiously -- maybe injudiciously -- removed her urinary bladder for chronic infection, and once again she teetered on the edge of dying. This time, she had healing problems after she got home, and, by momentum I guess, I became her home-health aide, debriding her wound for months at her sad little home. I guess I didn't want those Christmas cards to stop. They did, eventually, but not for a few more years.