Thursday, March 27, 2014


“When you arise in the morning think of what a privilege it is to be alive, to think, to enjoy, to love …” ― Marcus Aurelius, Meditations


Life gets to you at times, doesn't it? I don't often write about work. I think it's because I have desensitized myself to a lot of the human emotion I deal with on a daily basis, purely on a survival mode. I have probably interacted with 50 different patients today, performing surgical procedures, helping them with their pain, sometimes the worst pain of their life, other times talking them and guiding them through their recovery, sometimes successful, other times not so successful. I think if I actually processed all that human emotion, actually thought about each individual person and what they carried home based on their current issue, be it their gallbladder, their gangrenous toes, their occluded aorta, their metastatic cancer, or maybe just their painful clotted varicose vein, or even their incidental cosmetically bothersome spider vein, (oh yes, it happens,) I would become an anxious crazy mess. 

And then I write, or start to process these thoughts and I do think about all this STUFF, for lack of a better word. It's not often. I guess I seek solace in knowing that most of the time, heck I hope all of the time, I at least make a good attempt and TRY to make things better for people.

Until that doesn't happen.

Today started off a bit hairier than most, but not entirely out of the ordinary for Katie the PA-C. We've had a run on gangrene lately. I think I started my morning with three different patients, among 15, fathers, grandfathers, husbands, friends.....who had gangrenous toes, feet, etc. One recovering from a vascular surgery, the other suffering from diabetes and renal failure. Both not having much sensation thus being able to withstand in office debridement.

So there I find myself, sniping, excising, swabing, placing pressure, and repeating, dead flesh, dead toes, dead tendon, dead, dead, dead. Until blood flow is reached, healthy pink tissue, having a fighting chance. We stop. We've chatted though the whole thing, one patient teary eyed, visibally disturbed at the awful site of his own foot, another rather cofused and somnolent, another very calm and collected while his distressed 6 year old grandson looks on, myself trying to focus on the task at hand, trying desperately to ignore the nauseating smell that I've become accustomed to, trying to find life in their limb, trying to distract the child, trying to calm my mind in wondering WHY this child has to witness this, why is their parent letting them witness this sight.

This is all rather common place. Pus, blood, dead tissue, alive tissue. I work with it, configure the appropriate treatment using surgery, fancy dressings, wound vacs, antibiotics, and move on, expecting success, planning for failure. Death is apparent, but in small pieces. Dead tissue, a dead occluded artery, a ischemic dead portion of the brain, infected dead bone, etc. A small piece dead, but the person as a whole is still very much alive.

Until cancer.

Today I had to tell a dear 60 year old Mom, Aunt, Niece, Sister, Partner, Friend, Patient that her pancreatic cancer had spread, quickly, and was now causing common bile duct obstruction. 

This really isn't news. Except she had just had surgery, a huge surgery, weeks ago, for palliative measures, to help prevent this very thing, or at least give her more time. To prevent her extreme yellow glow, her vomiting bile, her unrelenting pain.

She had been CONVINCED of surgery. This Friend, Mom, Aunt, Niece was not immediately a fan of surgery. She would rather not know of the cancer and die that way, she told me in her own words. I'm not sure if it was her family or her that made the final push to have the surgery, but it happened. As well as a filter to catch the venous clot, it happened too, placed in her vena cava, to catch that inevitable clot that would become a pulmonary embolus and kill her. Kill her QUICKLY. Where now she is dying, leaving this world, rather slowly, quite yellow, quite uncomfortable. 

My brain can get the best of me in situations like these. I explain the CT results. Tell her of her growing cancer pushing on the very bile duct bypass that was created to bypass the original cancer. Listen as she tells me this is it. No more procedures. Listen as she tells me she wishes her filter wasn't in, as she wouldn't have to suffer, as the CT shows a big clot the filter has caught...saving her life...for what? She asks. 

I get on the phone to hospice, which she has not wanted until now. Too tough, too thrifty, "too much money", "I'm not bad enough" was what she said before.

Now she says, please, soon, NOW! I'm ready now.

I can't get them to her soon enough, is what I feel. I should have gotten them there last week, last month, last year....

"At first do no harm"



Alison Willis said...

Heavy heavy stuff Katie. Sounds like an especially tough day at work...hang in there. Your patients are so lucky to have you and what a good reminder to appreciate being alive!!!

Sheelagh said...

WOW! That is heavy sista! I can not even imagine what this kind of job would do to me. I have much respect for you. I could not handle it for sure. You are even more amazing that I though 2 minutes ago. I do NOT have you on a pedestal, but do recognize your loving heart and also your oh soooo knowledgeable brain and especially skilled hands.

And what you write here, it all makes me think.....I should be clear with my loved ones about what kind of end of life I would like, giving specifics and details so they know what to do for me and why I will ultimately make the choices I make (one day). It is something no one wants to talk about, but is ooohhhh so important.