Thursday, January 06, 2005

Surgery. Crap.

I've been posted on a surgical floor for this rotation (we didn't really find out until 7 o'clock this morning - my group and I all thought we were lucky and placed on a medical oncology floor). Ninety percent of the patients have GI cancers and have had some sort of awful surgery involving pancreases (my favorite), bile ducts, gallbladders, intestines and livers. Therefore, the next seven weeks will be filled with drains of all kinds, stents, colostomies/ileostomies (plastic poop bags), nasogastric tubes, incisions and wounds. Crap. Literally. So more or less this placement is an everything-I-really-really-really-really-don't-like one. However, there will be one important challenge here: most of these patients have liver or pancreatic cancer which generally have low survival rates. A great many of the surgeries are palliative only and meant to improve the quality of life for these patients before they die in a year or so. I'm looking forward to see how patients, families, nurses, doctors and I cope with this.

If people are interested, there is an interesting debate concerning the state of modern psychiatry on the "comments" section of my posting on Tuesday. I have only had one class in the subject and can't properly contribute but, essentially, I believe I will neither burn my DSM-IV nor worship it.


Blogger Nurse C said...

I'll tell you how the consequences of poor-prognosis surgeries are handled in acute care hospitals. The patient is discharged as soon as he can hold food down. This is almost always before the pathology results comes back. The surgeon signs off the case, instructing the patient to follow up with Oncology to discuss further treatment. Through this avoidance strategy the surgeon hardly ever has to give bad news,instead punting that sensitive task to the oncologist.

In the unlikely event that the surgical wound opens up or bowel function is delayed, the patient languishes for weeks on parenteral nutrition while the surgical team avoids them.

Surgeons have many amazing skills and qualities. The ability to handle delicate interpersonal situations is not usually one of them.

1:34 AM  

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