A Lesson in Pallative Care

~Warning- some pictures in the following post may be considered graphic~

When you really enjoy what you do for a living it doesn’t always feel like a job. Sure, the early mornings can be killer and there are some days that you just wish you could go home and never come back. But if you have a real passion for your work the majority of your days are filled with a sense of accomplishment and pride.

Being a surgical tech is one of the most rewarding things I’ve ever done. It’s not glamorous and it’s not full of recognition. But every day I know I helped make a difference in someone’s life. Maybe I helped relieve their pain. Maybe I assisted in giving them back their range of motion so now they can play with their grandchildren. Or perhaps I helped perform an emergency surgery that saved their life. The patient often has no idea who we are and the only part of our face they see is from the eyes up. But that’s okay because when they wake up from their surgery they can hopefully look at the faces of the people they love and know that they’re going to be just fine.

Sadly though, that’s not always the case. Sometimes we can't cure what ails them. And the only thing left for us to do is to try to improve their quality of life and give them the most pain-free time we can give them.  This is called palliative care.

 I first heard of this back a few years ago when my grandfather suddenly got sick. My family and I waited for days in the hospital waiting room praying that the doctors would be able to give us good news. But it never came. We had two options. Keep him on life support or realize that he lived a full life and let him pass away peacefully with no pain. I can tell you that it was the hardest decision our family has ever had to make. You never want think that there is no more hope. You never want to give up because what if……..but we knew it was the right thing to do.

What television and movies don’t tell you is that when you take a person off a ventilator they don’t die instantly. By any means. So the doctors told us that they were going to move my grandfather to the palliative care floor. There he would be given a practically endless supply of pain medication and they would simply continue to care for him but no live saving measures would be a part of his care. It was the right choice.

In surgery palliative care means that we perform a surgery or surgeries that will alleviate a patient’s pain or will give them a better quality of life until they die. We can’t cure whatever is wrong with them, usually cancer. When you find out that you’re performing a palliative procedure on a patient, your heart sinks because you’re used to fixing people. The prognosis is usually good. But in these cases you know better.

Recently, I had a patient coming in for an exploratory laparotomy. This means that we make a long midline incision in the patient’s abdomen to expose the bowel.

Then we basically look around (not always knowing what we’re looking for) and try to find the source of the problem. For this patient it was gastrointestinal cancer.  In this case the cancer had metastasized to other organs and there was nothing else that could be done to cure it. The patient had already had a partial gastrectomy (removal of part of the stomach) but the original tumor was in her bowel and had grown large enough to cause an obstruction (blockage) and was causing her considerable pain.

Once we located the tumor (which turned out not to be too hard…it was the size of a softball) it was just a matter of deciding how best to proceed. 

The surgeon decided that the best outcome would come from a Roux-en-Y procedure. This is named after the surgeon who developed it, Cesar Roux, and the way the final product looks (the letter Y).

After clamping the bowel on both sides of the tumor we used a stapler to both close the bowel and cut it.

Bowel surgery is very delicate because the contents of the bowel are highly contaminated with bacteria and it’s very important that we don’t let it spill out into the abdominal cavity. Once both sides had been stapled shut and were cut we were able to remove the diseased portion with the tumor. Then it was just a matter of reconnecting the remaining portions of the bowel to what remained to her stomach and to each other.

All in all the surgery took about four hours to complete. It wasn’t easy and to be honest, I wasn’t entirely sure I was ready to scrub on it by myself but I tend to underestimate myself and did just fine. As a team we did exactly what we set out to do. We took out the source of our patient’s pain and gave her a little more time to spend with her family. That’s all we could do. But at least we did something.