Being on the pointy end of the knife

[tussy]

Nothing is worse than needing surgery, especially when you are a surgeon and know everything that can possibly ever go wrong. Last week I found my self in that situation. I had a huge pelvic mass (luckily turned out benign, path came back yesterday woohoo), and had to "go under the knife" with a gynecologist no less! I went it to it terrified of everything; not just the obvious, but worried about developing malignant hyperthermia, significant intraop bleeding, necrotizing soft tissue infections, DVT, PE, hernias, medication errors, etc. Everything i've ever seen or even read about I was sure was going to happen to me.

I chose my surgeons, I chose my anesthiologist, I even chose my scrub tech and circulating nurses. For the previous month I spent extra time at the gym, was at my idea body weight, I watched my diet and made sure I was eating high protein, high fat, etc. I did everything possible that was within my control to get the best outcome. The rest was out of my control. I do not enjoy not being in control.

Surgery came and went last week without any complicatons. I've been home since Friday. Here's what I learned from my experience.

1. I was terrified. I underestimate the terror that most of my patients feel when facing surgery. Most of them are undergoing more significant surgery and they are in worse medical condition than I am and are facing significantly bigger risk. They must be even more terrified.

2. Nurses are awesome. I've always respected nurses, but they truely are angels. When i had severe post op nausea and spent a night with my head in a basin, puking my guts up, the nurse was there, holding back my hair, washing my face and reassuring me that the nausea would get better. They called my surgeon in the middle of the night to get a Zofran order (i will never be annoyed at that call ever again). like she promised, the Zofran worked. When i came back from the OR with horrible puritis she got out a basin and washed off the prep that was irritating my skin. When she injected that incredibly painful SC heparin shots she explained how necessary they were yet apologized for the discomfort in a way that made me roll up my gown and take it. ... Nurses are wonderful people.

3. Don't underestimate the fatigue that goes with surgery. I thought i'd be back to normal in a week. I'm off pain killers, eating well, but I need a nap by 10am. I'm not a wimp. I have no idea why i'm so incredibly fatigued all the time. everyone keeps reassuring me this is normal after surgery. I have give the fatigue is normal speech many times, but i think i only half believed it. I don't know what it is about having someone cut a piece of you out that makes you need like 16 hours a sleep a day, but it does!!!

4. A laparotomy is a painful thing. It's not just the incision that hurts, it feels like someone ran over me with a truck. Because of the nausea I quit all analgesics except NSAIDs and acetominophen on POD2, but it still is way more painful than I ever expected.


So, I now have more sympathy for what my patients are going through. My pathology came back yesterday and is luckily benign. I will be back to work in another 2-3 weeks and will eventually get back completely to normal (except for the scar, and I haven't ruled out an incisional hernia yet). I don't think everyone has to have surgery to be empathetic and a good surgeon, but I'm trying to make this experience positive and help me understand what my patients are going through. Hopefully this will make me a better surgeon.

Just needed to vent; i'm going stircrazy here all day with nothing to do.

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[chirurgeon]

Dear Tussy - thank you for sharing your experience on the forum. It was sobering to hear of all the symptoms you experienced and I appreciate the reminder to be graceful when called by nursing for an anti-emetic or anti-pruritic order. I am thankful that the pathology results were good in your case and I wish you a speedy recovery!

 

[Smurfette]

Glad to hear it turned out to be benign! Thanks for sharing your experience from being on the flip side of things.

 

[SLUser11]

Just needed to vent; i'm going stircrazy here all day with nothing to do.

Tussy,

I'm extremely happy to hear that your path was benign and that you're doing well. Thank you very much for sharing your experience. Get well soon.

 

[Chakrabs]

Great to hear you're doing well and on the road to recovery. That said, this is a damn good post and something I'll certainly try to keep in mind as I start my surgical internship next year!

 

[45408]

Great post, thanks for writing about this! I got a 12:30am call for Benadryl this morning...

1. I was terrified. I underestimate the terror that most of my patients feel when facing surgery. Most of them are undergoing more significant surgery and they are in worse medical condition than I am and are facing significantly bigger risk. They must be even more terrified.

I'm sure it varies by patient population, but I don't think this is the case with my patient population. The people here are very trusting, and very often, their attitude is "Well, you're the doctor, if you say it's best for me, then I'm sure things will work out in the end." Meanwhile, like you, I'd be somewhat terrified to go under the knife for certain things. I would definitely look at the call schedule for a second before I came in with certain problems, lol.

3. Don't underestimate the fatigue that goes with surgery. I thought i'd be back to normal in a week. I'm off pain killers, eating well, but I need a nap by 10am. I'm not a wimp. I have no idea why i'm so incredibly fatigued all the time. everyone keeps reassuring me this is normal after surgery. I have give the fatigue is normal speech many times, but i think i only half believed it. I don't know what it is about having someone cut a piece of you out that makes you need like 16 hours a sleep a day, but it does!!!

Now this one I can believe. I really wish hospitals would implement better ways to let patients sleep.

 

[Svidrillion]

I really wish hospitals would implement better ways to let patients sleep.

Amen. Don't mind your contorted bed, crazy roommate moaning all night about Andrew Jackson who reeks of C. diff, the lights gleaning in from the nurses' station, the Q4 vitals, qHS zolpidem (I know you were already sleeping, but that's what the order says), and getting woken up 3 times before 6 AM--and thank God the medical student is the first and not the last to ask you those 5 questions.

 

[ljpm8224]

OP was this you?

fwiw, I'm also 1 day out post-op (ACL) and have mad love to my nurses for getting me the zofran script!!!

glad you're healing up!

 

[tussy]

Actually my surgeon was one of my students when I was a resident. She was just 2 years behind me. I've done combined cases with her many times and she's an excellent surgeon; i also trust her decision making and that she'd do exactly what we discussed (no frozen section no possible hyst depending on frozen results and all the other gyne nonsense). I also had chosen my general surgeon (in case there were adhesions, bowel injury, hernia, etc) and urologist (in case she cut my ureter). I had all my bases covered. Did i mention that I'm a control freak!

 

[JelloBrain]

Great to hear that you have had a good outcome, and that your pathology is benign. Hope you never have to be a patient again.

A surgeon, and a control freak-well, who would have thought?

I am going to post your tribute to nurses on FB, as a tribute to my awesome roommate who is a nurse, and all her colleagues. Hope you won't mind, it doesn't violate HIPAA.

I would like to disagree on the terror our patients might feel-they (most of them) have no idea of the worst-case scenarios that we have seen, and what the complications we mention in the informed consent part really mean. How can one be terrified of something one doesn't understand?

I had an appendectomy when I was an intern, it was done by my favorite surgeon at my medical school. I know that is pretty minor surgery, but I didn't feel any fear at all, it was more like-"Yay! I get to be a patient in my own hospital where everyone knows me."

 

[tussy]

I had an appendectomy when I was an intern, it was done by my favorite surgeon at my medical school. I know that is pretty minor surgery, but I didn't feel any fear at all, it was more like-"Yay! I get to be a patient in my own hospital where everyone knows me."

and now you'd probably fear the worse: what if they find crohns instead of appendicitis, what if it's a malignant carcinoid, what if the stump breaks down and I get a fecal fistula, what if it's perforated and they have to do an ileocecal resection with ileostomy, what if i get a necrotizing wound infection, ... or am I the only paranoid one around here...

 

[ZagDoc]

On a related note, my mother just had a hip replacement a few weeks back. It took every ounce of my will power to avoid being to "overbearing physician family member." And yes, I called her POD #1 to make sure she ambulated, ambulated, ambulated!

 

[Thanatos]

and now you'd probably fear the worse: what if they find crohns instead of appendicitis, what if it's a malignant carcinoid, what if the stump breaks down and I get a fecal fistula, what if it's perforated and they have to do an ileocecal resection with ileostomy, what if i get a necrotizing wound infection, ... or am I the only paranoid one around here...

This is exactly how I think actually

I would have malignant carcinoid with mets, have a bowel resection followed by an intraabdominal abscess. The IR drain would schwack a vessel and I would need a transfusion, that I would have a reaction to, and the persistent shortness of breath would trigger a PE scan. I would have an anaphylactic reaction to the contrast for the scan, the intern putting in my central line would drop a lung and the chest tube would transect an intercostal. Eventually the surgical service would get tired of my adult failure to thrive and transfer me to a medicine service, where I would beat them to the punch by committing suicide. They would proceed to talk about it on rounds for weeks.

On the other hand, I was rounding with one of the cardiac guys once and made a joke about how if I was about to undergo a huge open heart case I would be nervous. My attending was like not me, I would sleep like a baby. He had this karmic approach to it....like he had done right by enough people that it would work out for him. For me though, the bypass machine would fail and etc.

Glad you are making a great recovery!

 

[45408]

and now you'd probably fear the worse: what if they find crohns instead of appendicitis, what if it's a malignant carcinoid, what if the stump breaks down and I get a fecal fistula, what if it's perforated and they have to do an ileocecal resection with ileostomy, what if i get a necrotizing wound infection, ... or am I the only paranoid one around here...

Well, we're certainly all concerned about these sorts of things, but I'm quite sure that the majority of my patients are thinking "Eh, how bad could it be? I'm sure it'll be fine."

I would like to disagree on the terror our patients might feel-they (most of them) have no idea of the worst-case scenarios that we have seen, and what the complications we mention in the informed consent part really mean. How can one be terrified of something one doesn't understand?

This applies especially to the bariatric surgery population!

I would have malignant carcinoid with mets, have a bowel resection followed by an intraabdominal abscess. The IR drain would schwack a vessel and I would need a transfusion, that I would have a reaction to, and the persistent shortness of breath would trigger a PE scan. I would have an anaphylactic reaction to the contrast for the scan, the intern putting in my central line would drop a lung and the chest tube would transect an intercostal. Eventually the surgical service would get tired of my adult failure to thrive and transfer me to a medicine service, where I would beat them to the punch by committing suicide. They would proceed to talk about it on rounds for weeks.

I laughed pretty good at this one. Just think though - it would be a hell of an M&M!

 

[Buzz Me]

Glad to hear you're doing OK!

 

[JelloBrain]

and now you'd probably fear the worse: what if they find crohns instead of appendicitis, what if it's a malignant carcinoid, what if the stump breaks down and I get a fecal fistula, what if it's perforated and they have to do an ileocecal resection with ileostomy, what if i get a necrotizing wound infection, ... or am I the only paranoid one around here...

Haha, maybe. I had self-diagnosed myself and it seemed like a straight forward text-book case of appendicitis. Two years ago I noticed a very prominently protruding rib and was convinced it was a chest wall chondrosarcoma.

I agree, too much knowledge can be a dangerous thing sometimes for one's peace of mind.