confliction

today was going swimmingly, i was suturing and assisting all over the place...and then happened to be in the right place at the right time for a case i was interested in watching...and ended up getting roped in...which was great but....much more difficult than i bargained for.

mostly, i find that surgery is not so bad as one might think. i don't really give a second thought to slicing and dicing because all i ever see is what is right in front of me. a square of betadine scrubbed skin surrounded by layers and layers of drapes. you don't see the pt's face or body other than that. there is no crying, no wincing, and if you don't look too close, no hint of sickness.

and then there was today. a 3 year old little boy with cancer. tiny. no hair. very sick. spent a lot of time with him pre-op and just couldn't really shake the big picture. even after he was all draped, i couldn't quite get over it. he was just so little. and so sick. so when the surgeon let me put in the chest tube for this kid's thoracostomy and scope i sort of had my first brief moment of hesitation in the OR. how do pediatric surgeons do it? is their secret just pure just love and sheer hope? comfort in the fact that they are helping these kids get well? what about when you pretty much know for sure the kid you're about to cut into will never be well and you are just going to make him more miserable in the short term? all i could do was blink a few times, kid myself that "THERE'S NO CRYING IN BASEBALL!" or surgery....and get on with it. deal with the problem at hand, worry about the rest later.

but seeing just as much sickness was inside this kid and correlating it to how much sickness was outwardly present was almost too much. nodules all over his lungs. huge chunks taken out to biopsy. solemnly hand delivered to pathology and ID with as much care as possible. pleural fluid drained. lungs stapled up, ribs sewed back together, skin sutured as nicely as i possibly could. my parting gift to this child, in a way.

undraped and back to his whole reality. de-intubated and groggy, but thankfully not yet crying was how i left him in PICU. mom was a mess. i don't think i would have kept it together if he had started crying. sigh. 3 hours of eye stinging from all this confliction. bigger sigh.

one other valuable lesson learned today (besides being able to cross peds off my list of future endeavors) is that the peds OR is always kept toasty warm. add that to inherent nervousness and the freak out factor of having to deal with cutting into sick kids and all you do is sweat profusely. it's a regular sauna in there. which gets old REALLY quick.

perhaps tomorrow will be better. i was offered a spot in the am urology clinic. here's my chance to perform non-stop prostate exams for hours on end- that should take my mind off of today. woot!