Cutting

Its official. I'm addicted. I love cutting. I can't even explain the exhilaration of it, probably some psychiatric problem I'm sure.

Mr. A is a divorced videographer in his 50s. We got a call from the ICU, it was one of the more, um, exuberant residents. This is how it went when we returned the page:

"F***, what's his name? What's the fat guys name? Anyway, we have a guy with alcoholic pancreatitis and he's going to f***ing die if you don't cut his belly open, we can't even ventilate him anymore."

Years and years of education to come up with such eloquent and concise vocabulary, that's quality.

The 'fat guy' had abdominal compartment syndrome. Pancreatitis is really quite nasty, your pancreas digests itself and then works on digesting the rest of your insides. The pressure in Mr. A's belly was so high it was pushing up against his chest and they were having difficulty getting air into his lungs. Unfortunately, his deaf mother in a nursing home was his next of kin (i.e. decision maker) so she signed things over to his ex-wife . . . who decided he didn't really need the said 'life-saving' surgery. So, we did what most patriarchal medical doctors do when the decision-maker doesn't agree with their treatment . . . two ICU physicians signed a form to make the decision for him, that is, the decision we wanted made.

Our part was the decompressive laparotomy. Quite barbaric really. Although the really barbaric part was when the chief resident handed me the scalpel. The belly before us distended and rock hard from the pressure.

Cut with the belly of the knife. 90 degrees to the skin. One smooth, continuous motion. And there I went. From just below his sternum, around the belly button, and down to his pubic bone. Then we cauterized through the thick layer of fat, through the muscle, fascia and then pink intestines just oozed out, worming their way out of the pressurized cavity. An image of a snake pit from an Indiana Jones movie crossed my mind. Dark brown fluid poured from the opening. Dirty yellow omental fat covered with what looked like white lichen, where its being digested by pancreatic enzymes. Quite the rush.

We didn't close him up, instead we put layer after layer of sticky saran wrap over the gapping belly, cut a whole in the middle and connect it to a vacuum. Back to the ICU he went, most likely to die.

I love cutting. I can't deny that I find surgery stimulating and fascinating, but its just not the same as obstetrics. The full words to describe my thoughts fail me, but the fact is, I'm a better person when I'm doing obstetrics and women's health. My heart felt cold as we wheeled Mr A back to the ICU. In my mind he was the 'fat guy'. I had no connection to him, and yes, compassion, but no empathy.

Three weeks ago there was a woman here on holiday from Spain. She was 17 week pregnant and having a miscarriage. I spend most of my day with her and her husband. I suppose it helped that I spoke Spanish but my soul resonated with their situation. First talking to her and explaining what to expect. Then assuring she had a private room in the emergency department (no small feat). Then fighting again as she was transferred up to the surgery ward to a four-person room as she laboured. Finally staying after I could have gone home to reassure both her and the nursing staff who had never had anything like this happen on their floor before. At days end I caught that tiny being cupped in my hand, wrapped him in a towel and placed him by the window for the priest to come and bless him. Neither of the parents wanted to see. After that, I examined him and slid his miniature body into the plastic pathology container to be sent off. I left them that night feeling not only like a real doctor but a deeply human one.

The reality is that you can't identify with everyone. My hope is that everyone can empathize with someone, being aware of feelings towards patients is probably the first step. Maybe cutting isn't everything, it makes my heart beat fast, but it doesn't make it sing.