Operating on a friend

One morning during my surgery rotation, I looked at my list of patients and was shocked to see a friend's name scheduled for surgery later that morning. I went down to pre-op immediately after rounds, deciding that providing emotional support was more important than respecting her privacy. I'm glad I did because she really appreciated me being there for her. She expressly invited me to watch her surgery, even though I hadn't even planned to ask, so I accepted her invitation.

The moment my friend slipped into unconsciousness, I struggled against my habit, acquired out of necessity, of relating to the person on the operating table as just another body that needs to be fixed. The legs were spread open to insert a tube into the bladder; taking care to pad pressure points, the body was contorted into a position convenient for the surgeon; the surgical field was sterilized with a solution that turned the skin a robotic bronze hue; finally, everything was draped so all that remained of my friend was a rectangle of this bronze-colored skin neatly wrapped in thin plastic.

I cringed behind my surgical mask when the first incision was made. I cringed despite such measures that effectively obliterated any hint that the body on the operating table was a human being, let alone my friend. That initial discomfort passed quickly, though, as the laparoscopic camera entered the patient's body and I saw the familiar array of organs on the monitor. Looking up at that monitor further distanced me from my friend. Young or old, fat or skinny, we're all made of the same building building blocks and put together approximately the same way. Without consciousness, we're all just another body.

The surgery went well, no complications. It was over before I knew it. Perhaps the time flew by quicker than usual because I was so transfixed by this internal struggle of remembering who owned those organs displayed on the monitor. The surgeon, who I had worked with many times before, knew that the patient was a friend of mine. "Do you want to help close?" he asked me when the surgery was nearing the end. That was his way of acknowledging that I had broken my routine of always asking if I can help sew up. "No thanks," I replied, "I want her to have a perfect job." "We wouldn't let you close if we thought you'd be anything less than perfect," my resident said. Still, I passed.

With the procedure finished, the surgeon invited me to go with him to the waiting area. In a bland windowless room, I silently observed the conversation between the surgeon and my friend's loved-one, reassurances that the surgery went well. I was struck by the solemnity of the conversation. I was also impressed by the respect and appropriate emotion afforded by the surgeon throughout the conversation. This was the only time I had the privilege of being included in a post-operative conversation with loved-ones.

I spent more time than usual with my friend in post-op, holding her hand and telling her that everything went great. Later that day, after she had been moved to a room upstairs, I spent more time than usual checking up on her. The standard post-op questions about nausea and vomiting and urination and ambulation seemed less important; I stayed for more than an hour, visiting, quality time. Rounds the following morning were somewhat awkward as I had to balance my dual roles of friend and medical student, not being able to give as much time to my friend as I would have liked.

I wish that I was able to give all of my patients this VIP treatment. Even if I can't always carve out time to connect with my patients on a more personal level, I think it's worth remembering to go back to the bedside when I do have a few minutes to spare. Observing my friend's operation and caring for her afterward also highlighted how easy it can be to accept the sufferings of my patients as routine and how I must guard myself against that attitude.