Thursday, May 5, 2011

Life is hard

Surgery is hard. Of course there are always technical aspects which are difficult but I am speaking of something completely different. I think most surgeons will tell you that one of the hardest parts of their job is telling the patient and his or her family bad news. Certainly other specialties have this same issue. But somehow, taking a patient to surgery is usually viewed as a major, invasive step toward improving their lives. It is an aggressive intervention which at its heart, is designed to result in immediate gratification.

For instance, most patients with colon cancer go into the operating room with a tumor and leave the operating room an hour or two later without a tumor.  With or without the use of additional chemotherapy, they may be cured. However, if this scenario doesn't happen, it can be anxiety producing at best.

Not long ago I had a patient present with what appeared to be a “routine” colon tumor. At the time of exploration the patient was found to have tumor widely spread throughout the abdomen and was unfortunately completely incurable.* From a technical aspect, this operation was not hard. I removed the tumor in order to prevent intestinal blockage and sampled the tumor throughout her abdomen for microscopic diagnosis. Nothing there was technically difficult.

The difficult part of the operation came next. That was telling her friends and family the news. As it turned out, the patient had only recently gotten out of a 35-year abusive relationship, and the hope prior to this surgery was that she could live the rest of her life in peace. All that had changed now. The rest of her life would be spent with increased abdominal bloating as this tumor progressed, possibly toxic chemotherapy, and getting her affairs in order for her untimely death. The prognosis was months, not years, and months of pain, not happiness.

It's a terrible, sad situation. To somehow see hope or goodness in this is difficult. But, life is difficult and inherently, we all know that. It just sometimes takes situations such as this to make us remember that.

I find that as I get older, and hopefully wiser, I deal with these situations a little easier because I approach them with the underlying understanding that yes, life is hard. There are times in everyone's lives when we will experience pain, sorrow and sadness. Without that we would not be human. Without that, we would not know happiness. And, without that, we would not be real.

Life is hard. Approaching life with this attitude doesn't make sad times any less sad. But it does normalize it. And in some way, it helps me to put everything in perspective.

*some patient details are changed so as not to identify a specific patient

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