Sunday, April 19, 2009

The ability to cut

As a medical student I heard the surgical residents brag "the ability to cut is the ability to cure." While I enjoyed the way surgical patients tend to improve much faster than those receiving medical therapy I have also achieved a healthy respect for the risk of complications from surgery. I understand why patients wish to avoid surgery when possible. Yet there is a subset of patient that seem to enjoy having surgery.

Take this case of a woman who has been my patient for the last ten years. I have operated on her four times and delivered two children for she and her husband. I am not proud of the four operations. I feel that two of them were probably avoidable. It is difficult for me to explain especially to non-physicians how I came to do these two probably unnecessary surgeries but a clue comes from the last encounter I had with this woman.

The patient walked into my office looking the picture of health and stating that she never felt better four weeks following her latest surgery. Looking at her operative incision which is now well healed I said something like, "You look great and you seem to be doing great, too."

"Yes," P exclaimed, "I do feel great. I think this will last at least a couple of years.

"A couple of years? You shouldn't ever have to have surgery again!" I exclaimed.

"No, I am sure that I will get some adhesions [scar tissue in the abdominal cavity, a known complication of abdominal surgery in about 15% of patients], " was her quick reply.

"Well, " I said thoughtfully, "I think you have about an 85% chance of NOT getting them."

She frowned. She enjoyed her time in the hospital away from her children ages five years and 18 months. Enjoying time in the hospital as a patient is something that I fail to understand. It seems like a difficult way to get a vacation. Also from my experience on patient side of it surgery hurts. I don't mind confessing that I don't like needles and I really don't like tubes in places that I am not use to having them.

All this said, the patient is now "well" and no complications were encountered. At least not yet. This surgery was successful. I can and do feel good about that.

The ability to cutSocialTwist Tell-a-Friend

No comments: