Thursday, March 20, 2014

Gallstones

"My doctor sent me in for an ultrasound - he thinks I have gallstones because I've had this pain..." points to right upper quadrant "...for about a week".

Well I had seen the ultrasound report and yes there was a gallstone but more worrisome than that there were many other findings that suggested stage IV cancer.

There are moments that change your life forever. The event that defines 'before' and 'after'. At times, working in healthcare means being a person who straddles that precise moment in someone's life. For better or for worse.

The nice thing about obstetrics is often this is a joyous time to share with patients. The before we knew we had a son who had ten fingers and ten toes and his father's nose to after. But more often I have had to share moments that I would rather excuse myself from, altogether.

I have developed a very irritating contact dermatitis on the backs of my hands, a constantly itchy, burning rash that never completely goes away thanks to all the handwashing and O.R scrubbing I have to do. Despite my efforts with creepy mitts, vasoline, and steroid cream at night, it remains a dull roar. I have never had a nervous tic or habit until this came along. I catch myself scratching my hands now as my anxiety level climbs at work and I have to wonder sometimes if it isn't just the weather and the washing that has brought this on. I am mulling, processing, worrying about patients I saw in a way that is different now.

Now I find myself at this woman's bedside and I feel myself scratching and will myself to stop. I am nervous because this is a tight rope walk of being alarmist for possibly no reason versus alerting her to the fact that she might have an advanced, and likely fatal, disease. She has always been healthy, on no medications, no surgeries, doesn't smoke or drink, having spent her days being a farmer's wife.

My attending comes in and explains the ultrasound findings. I see the husband's face start to change under the thick brim of his baseball cap. I see the information sinking in and that moment of before and after forming. He suddenly looks very agitated and I can tell the discussion is over, he wants to go. We excuse ourselves and I hang on to the hope that this lovely lady does not have a death sentence, that the ultrasound was wrong, everything benign.

While scrubbing in for a case a few days later the general surgeon tells me that the ultrasound was not wrong and that she has very advanced disease. I look down while he tells me this. I feel the rough end of the brush against the back of my hand while the chlorhexadine soap suds roll down my arms. I picture the conversation they must have had and inaudibly shudder. She came in thinking she had gallstones and walks out knowing she metastatic cancer. The water rinses the lather off and trails into the drain at the other end of the sink. I push the swinging O.R door open with my foot and take a green sterile towel to dry my dripping, raw hands. 

4 comments:

rural_obgyn said...

It is so great to read about your life again. Thanks. And having myself chosen to practice in a, shall we say, unspoiled area--I'd vote for civilization or at least closer to it than your current locale.

Albinoblackbear said...

Hey rural ob_gyn - thank you! Could you drop me an email sometime at blackkermode [at] gmail [dot] com? I have questions you might be able to answer...Thanks! :)

peace said...

That is heart breaking. I love how you use your social intelligence and mix it with your life wisdom to deliver post like this. To make us live the moments with you. Can one prepare him/herself for such heart breaking news? I fear not. But putting ourself in others shoes make us more considerate.
Thankyou ABB

Just Me said...

What a powerful post. I have also had the job I loved in a place I hated. Guess what - chose life! Chose the area that makes you happy and then you'll make the job. Life is too short and no patient will even tell you they wish they worked more. Life more :)
By the way, it's totally the hospital soaps. Combined with the gloves, its a nightmare on hands.