Surgery, like life, can have complex problems. Not too long ago I was operating on a patient who we all believed had a ruptured colon cancer. He was quite sick and I was operating on him emergently*. As I explored the abdomen, it began to have the appearance of something different. I honestly had no idea what we were dealing with.
It was clear that whatever this was, it was involving the colon, the spleen, the stomach and the tail of the pancreas. The entire left upper quadrant of the abdomen was completely cased in hard inflammatory crud. I have no better medical term for it. Every organ was plastered to the adjacent organ.
At this point in the operation, I remembered the words of a sage mentor of mine, Dr. Jeffrey Pelton. “Chris,” he said. “You will, at a few points in your surgical career get into a situation, which at the outset, will seem insurmountable. You will open the abdomen and find a tumor or other problem, which at first, will look like it is completely inoperable. My advise to you is this. Don’t look at the problem like it is one big problem. Take it one step at a time. Use the surgical principle of going from ‘known to unknown’ and start somewhere easy. Go and take down that easy part of the tumor. If you get to a place where you are stuck, go to another part and go until you get stuck. Eventually, this big problem will turn into a series of little problems, which, by the end, you will have solved. It’s like a jigsaw puzzle. Take it a piece at a time and eventually, you will have it solved.”
That is precisely what I did. Start at the colon. Move to the spleen, then the stomach. Finally, tackle the pancreas. Three hours later, it was all cleaned out. All the pieces that needed to be put back together were together. And the tumor, a nasty lymphoma as it turned out, was out. The big problem was taken care of one step at a time. The operation was a success, and the patient has seen me in followup, tumor-free.
As it turns out, Dr. Pelton was right. I have used his advise on many occasions. I have even taught residents the same thing. Take the big problems one step at a time and you will overcome situations that seem impossible.
*as always, details of this patient are changed so as not to indicate any specific patient