I remember a time during my surgical rotation when I was convinced I was cursed. I wasn’t sure by whom and why, yet I was so convinced of it I would lie awake at night thinking of all the people who had died in the days before, trying to make sense of what had happened.
It was one specific case, one specific life, one specific death, that catalysed this entire notion. Her name was Mrs J. She was bubbly, cheerful and very upbeat.
Even after sustaining a femur fracture which landed her in the orthopaedic ward. She told me the story about how her husband, Mr J, decided to buy her a brand new motorbike for her 45th birthday. Mr J had felt their lives had become somewhat mundane and to avoid any inkling of a hormonal breakdown or a midlife crisis, he presented the motorbike to her and she was, of course, thrilled.
The excitement overpowered her and they set out for the test run on a Sunday morning. Everything was going well until a car failed to brake in time and knicked the back of the motorbike, propelling her into a robot pole, taking a piece of her femur with it, and sending Mr J in the opposite direction.
They were wheeled into casualty where I met an unusually cheerful couple given the circumstances. I was minding my own business, busy attending to a ruptured appendix when I heard her voice, “Oh doctor its nothing too serious right? How serious is a broken femur? There’s no one to feed my dog at home since both my husband and I are here”
I watched as the orthopaedic medical officer explained to her that she did need the bone to be nailed back together and should recruit a neighbour to feed the dog as their stay would not be a short one. The necessary formalities were done and pretty soon they were upstairs in the orthopaedic ward being prepared for surgery.
My call continued as expected, busy and draining. In we went to theatre, and out came the appendix. My medical officer got a phone call which made her lips purse into a disdainful expression. Now what? I thought.
“Moosa go to the ortho ward, the orthopods are worried about an abdomen, shes in bed 1”
I was confused. Orthopods worrying about an abdomen? This must be serious. I was visibly stressed. I made my way to the ortho ward and found Mrs J, her usual bubbly self, but with an abdomen the size of a balloon. A very big one. She ate her pear quite unconcerned as I approached her.
“Any pain, discomfort, change in bowel habits, vomiting?” I enquired. She denied any. The only symptom was a very distended abdomen and in any surgeon’s book, it’s a bad sign.
I placed my hand on the bulging balloon and I was surprised to find no reaction at all. No characteristic jumping indicating a peritonitic abdomen. I pressed harder, I tapped, I listened. Nothing. I was pleased but still worried. I called my medical officer to have a look.
She was just as confused as I was. “Do a blood gas, pull all her bloods, put in a nasogastric tube, phone the radiologist. We need a CT abdomen”. I did as I was told. During the weekends, the radiologist was called out to do the CT scan with contrast and the medical officer and consultant would view it but the formal report would only be available the day after. We decided to try our luck.
The CT scan looked normal to be but what did I know? I called the medical officer to sent the video to the consultant on call. We were stumped.
I sat with Mrs J as I tried to get more information to make sense of the situation. She wasn’t too happy this time around as the nasogastric tube which went all the way from her nose to her stomach wasn’t the most comfortable thing in the world.
She told me about her life and her love for dogs and food. How she was a teacher and spent her free time giving free art and English classes in the nearby communities. Her daughter who was my age was living in London and pursuing her studies on that side. Her face radiated with pride.
I continued checking on her throughout the night and did the blood gases religiously to avoid missing any electrolyte changes which could point us in the right direction. A decision was made to operate her on that Monday morning and perform an exploratory laparotomy on the abdomen and allow the orthopods to fix the femur while she was on the table. Everything was set, a few more hours until we find out what the hell was going on inside her non-compliant abdomen.
I proceeded to tell Mr J who lay in the cubicle next door about the plan of action. He was quiet, humble. A contrast to his wife. He questioned me diligently about what we anticipate to find and I gave him the possibilities. All in all, we aim to fix the abdomen and femur at the same time to avoid 2 surgeries. He seemed pleased at that prospect. As I turned to leave, he looked up and raised his voice. “Look after my wife please, she is all I have”. I smiled and gave him a big thumbs up.
It was 9am on a Monday morning, my medical officer and I had been awake for 26 hours straight running around during the night doing amputations and squeezing in appendixes. We looked forward to some answers about Mrs J’s abdomen. The consultant arrived and the surgery commenced.
The abdomen seemed to have grown from the last time I had seen it 2 hours ago. And something foul appeared in the nasogastric tube. Please don’t be a bowel injury, I thought. I knew those often ended badly. The consualtant ripped through the skin with precision and we watched the distended peritoneum appear from beneath.
The moment of truth, I peered over waiting to see what had caused all the fuss. I saw the bowel emerge in all of its glory and my heart fell. It was swollen, ugly, white and lacklustre. I knew that wasn’t a normal bowel. The consultant looked at the orthopods who were waiting to begin on their femur and signalled them to have a seat, this was going to take a while.
As usual, things began to go south very quickly. The bowel had been injured through a blunt trauma to the abdomen due to the force on impact to the robot pole. ‘pneumoperitoneum’ the consualtant said grimly. He began removing the ischaemic bowel when her blood pressures began to tank. She began bleeding from the site. Damage control was done. She had lost 2L of blood which meant she needed a massive blood transufion and therefore was hemodynamically unstable and so she could not be extibated. That means… ICU. I dreaded this thought. ICU and bowel injury usually meant one thing.
In that very moment I was overcome with sadness. I regretted the thumbs up I gave Mr J and the reassuring I had done. I regretted feeling optimistic and hopeful only to be met with a blow of these unfortunate events. Suddenly, a wave of tiredness and hunger surfaced.
The feelings I had forgotten I was capable of. Basic human needs which had been supressed by the adrenaline rush of the events throughout the night.
It was my time to go home at 12pm and I passed by ICU to see Mrs J before I went home to sleep. I chatted with the ICU staff and got an update about her condition. “Quad strength adrenaline infusion” the words I hated with every fibre of my being. I felt defeated. I didn’t want to leave her side because I knew there was a very real possibility that if I do, she might not be here when I return the next morning. A reality I wasn’t ready to face.
At 2pm the ICU staff chased me away as I dozed off on the counter and I reluctantly left. I found myself in bed, staring at the ceiling, waiting for a phone call to tell me Mrs J had died. My heavy eyes felt the weight and I eventually dozed off. When I woke up I grabbed my phone and dialled the ICU number. I waited until they told me Mrs J had demised a few minutes ago. I was distraught.
I thought sadly about how Mr J would be feeling. His words rung in my ears. he had lost a wife, her daughter had lost a mother, and the community had lost a person who was interested in making a difference.
I find it amusing how I can tell you the course of the vagus nerve from the brain to the abdomen in anatomical detail, or how the segments of the liver are split and why, or the layers of the abdomen and how to incise to prevent scarring. I can recite in parrot fashion to you the blood supply of the thyroid and the method of ligation. I can insert any tube in any orifice and pull bloods from the femoral artery in the groin with one eye closed. I can close and open a uterus and give fundal pressure to pop a baby out. Ive been taught so well in medical school yet ive learned very little in life.
I cant tell you much about grief, only that I have felt it a lot. I cant explain to you why people die. I cant console you to the best of my ability because I, myself need consolation. I cant tell you why life is so paper thin. You and your loved ones are here, now, but tomorrow? I don’t know.
In medical school people teach you about the body and how it works, death is mentioned and described in detail. The decomposition of a body, the pathology of it all. But no one tells you how to cope with the burden of it. No one tells you that doctors are not miracle workers, or magicians.
We stall death. no matter how hard you try to fight it,
You will never win