30 August 2007

Putting the practice on ice

This picture was taken during an operation I did a while back in the nursery intensive care unit. The operation was fixing a birth defect in a baby boy. I got to know his parents before he was born, because they had learned about his birth defect during an ultrasound. They were worried but hopeful. In addition to the little preparations all parents make, they also prepared for the worries and stresses of medical treatment. They were calm, far calmer than I could have been. I heard about the research they done and learned their depth of knowledge about their child's condition, and learned their calm was not born of ignorance of the risks.

When their baby was born, he was cared for by the newborn specialists. His birth defect affected his lungs, and he required assistance from a machine to breathe. After the initial days of adjustment had passed, he was ready for his operation. That brings us to the picture above. The baby is covered with blue sterile sheets. Under that, a machine breathes for him through a tube. The newborn specialist nurses and doctors give him medications to keep him sleeping during surgery.

I wear sterile gloves and sterile waterproof gown. On my head is a surgical cap that one of the nurses made. It has stars on the cuff and tiny hearts on a red background. She is a trauma nurse, and she sold the caps to raise money for cab fare to give to trauma victims who need to get home. I also wear surgical telescopes that magnify an area five inches across, two and a half times larger. Over these I wear a fiberoptic spotlight. The hole I made for the operation is about three and a half inches across. It is completely hidden behind my hand and skinny fingers. The assistant surgeon holds the edge of the wound open as I tie a knot in a stitch through fragile tissues in the baby's chest.

I look at this picture and I can distinctly see the view through the telescopes. I rember the feel of the tissue and the way I had to adjust the repair to make it fit his individual body. When I see this picture I know I'll never quit because I couldn't find anything else that feels quite like it. I worried about this boy. He stayed in the hospital several months, and even needed another operation. He came to visit me a few months ago and was chubby and beautiful with wonderful blond hair. He held onto his mother and peered around my office with bright curious blue eyes. She and her husband must have seen this outcome long before I did and were right to be calm. I don't know which brought me more happiness, performing the intricate operation or seeing him so strong and well after passing the initial speed bumps.

Two days ago I did my last sheduled operation before my departure. It was a quick simple operation on a vigorous school age boy. I knew his parents well because I had taken care of one of their other children previously. I was please to see him eating well and enjoying cartoons the day after surgery. It has been hard to close up my practice. For weeks I have been referring requests for surgery to a civilian pediatric surgeon because I ran out of available operating room time weeks ago. I am taking care of a baby in the nursery intensive care unit and I will have to turn his care over to a visiting doctor. He is well on his way to recovery, but I want to see him the day he is well enough to leave and his proud parents carry him to the elevator. I think it is tougher because I am a solo pratitioner. If I had a partner, I think it would be easier to keep the office open and reassure parents: "Don't worry, my partner will see you in two weeks to make sure the incision is healing well." Even though the doctor who will cover me is one I know well and trust completely with my patients, it hasn't felt responsible to do a major operation when I won't be there to try and pick up the pieces if there is a complication.

I will be changing gears soon. The surgery at the combat hospital is completely different. The patients are much bigger. The wounds are larger. The urgency is greater and the pace is quicker. Even the children we treat come to us needing rapid control of life-threatening injuries and clensing of multiple wounds with removal of destroyed flesh. It is important work and the chance to make an immediate difference in another's life in the here and now. But I know I won't feel guilty when I long to return to the delicate measured pace of operations in the newborn intensive care unit.

It is late. I have taken far too much time tonight installing the garbage disposal under the kitchen sink. To paraphrase They Might be Giants; now I'm even older, now I'm even older, and now I'm older still. (listen here) Sweet dreams.



ChefSara said...

I love TMBG!! And that particular song has been in my head a lot as I approach a milestone birthday...one that ends in a zero!

Chris said...

Thanks, ChefSara! Imagine how much fun it is introducing TMBG to a new generation: "The Sun" is a big hit with our oldest boy as a good companion to science class. I don't know where "Triangle Man" fits in: mathematics or psychology?