I arrived at the hospital as the sun was rising, the sleep slowly wearing off and the coffee ran through my veins. I planned to sit down at a computer in the office to start reviewing my patients charts before going to see them, but the morning had other plans for me. My doc walked in moments after me saying, “There’s a patient in the ED trying to die on us”. My sleepy brain registered the labs he’s relayed to me – pH of 6.9, base deficit of -10, possible dead gut.
If you didn’t know, now you know, a pH of 6.9 is bad. It’s a measure of how acidic your blood is and normal is ~7.4. When the blood becomes acidic it’s a sign that lactic acid is building up, a sign that there are tissues that are not getting any oxygen.
She needed to go to the OR, stat. He showed me the scans and we took the stairs to the emergency department. There our patient was writhing in pain, conscious, but barely able to answer our questions. I’ve never seen anyone as sick as her and she was sick. My doc was saying she might die, but would she? I wondered how I would handle another patient death so early in my third year. Would it be like the patient before?
There was no time to ponder these questions as we wheeled her to the operating room, scrubbed our hands clean and approached the sterile field. This was going to be quick my doc told me. We were going to open her belly, see what was going on and get out as soon as possible.
That’s what we did. The first cuts through the abdominal wall revealed dead gut, revealed a stench, revealed a new life for this woman. Black tissue popped free the moment we broke through the fat into her abdomen. It was her colon and small intestine that were causing the problem. We removed them both, leaving healthy small intestine behind.
Her abdomen left open and she was transferred to the ICU in order to receive fluids and blood products. She was alive.
We took her back to the OR the next day for another operation. She was still alive.
She would go back to the OR again another day. She is still alive.
The opportunity to save this woman’s life does not escape me. We didn’t really do that much, but what we did do will change the course of her story. It allows her story to continue. It allows her grandchildren to know her more fully, for her family to spend more days with her. Life, it’s a beautiful thing.
Surgery was on my list of possible specialties going into my third year. It’s been at the back of my mind since I was an undergraduate performing surgery on rats, and I suppose since I was a child. My grandma recently reminded me of when I was younger and determined to be an orthopedic surgeon.
I learned this week that my left hand is uncoordinated. I learned that dead intestine smells horrible. I learned that six laparoscopic cholecystectomies can all be different, but every patient will be grateful for the removal of their gallbladder. I learned the three keys to success in surgery –
1. Eat when you can
2. Sleep when you can
3. Don’t touch the pancreas.
I learned that being in the OR is exhilarating and I learned that surgery is definitely staying on my list.