Wednesday, September 21, 2011

We Do Not Say Thank You For This

Remember Avatar?  I think about one of the scenes from that movie a lot.  Toward the beginning of the movie, the main woman character kills a few wolves who are attacking the main male character.  He thanks her for saving him; and she harshly reprimands him with "We do not say thank you for this!! This is sad!"  She's saying that any death is wrong, and it's never something that should be rejoiced in anyway.

It's hard in surgery sometimes, because the biggest and "coolest" surgeries are almost always the result of someone having a terrible terrible cancer.  Today I was in a surgery for a colon cancer, that ended up being fixed to the pancreas and duodenum.  So we did a combination right hemicolectomy and Whipple procedure.  That probably means incredibly little to most of my readers; but the bottom line is that it was a ridiculously "cool" procedure, and the sort of thing that happens once every 10 years at a big academic hospital like ours.

I try to remember every day that we do not say thank you for death.  We do not get excited about advanced cancer.  When the patient is asleep, their cancer may be "neat"; but the moment that they wake up and learn what we learned during surgery- their cancer is devastating.

I bounce back and forth constantly.  I told one medical student about what we were going to have to do for this patient, and I was annoyed that they didn't recognize how cool the surgery was.  Another student was excited about the rarity of the surgery; and I was annoyed by his insensitivity.


  1. This is one of the inevitable dilemmas in medicine - the things that are the most interesting to the practitioners are always the most devastating to the patients.

  2. I looked up whipple and hemicolectomy. My vocabulary grew by two words tonight. What a sad outcome but, the patient was blessed to have surgeons with the skill to do the Whipple. The article that I found said "great skill" is required.

  3. You know? I think it's okay to be excited about learning and practicing a difficult procedure. It is important to you at this stage in your life. No need to feel guilty about it, as long as at some point you remember that "the patient is the one with the disease" and they are likely to be devastated.

    I'm a psych NP, so my excitement comes from different places. But as a surgical patient, I don't think I'd care to have a surgeon who didn't enjoy her work, who was blase about it already at the beginning of her career.

  4. I think it's just that residents and attendings are annoyed by med students no matter what they do. How quickly they forget...