“Difficulties increase the nearer we get to the goal.”
-Goethe
Have you ever noticed this, as well?
When the kids were little and we were driving cross-country, they would play and bicker pleasantly all day long in the back seat. Things were not exactly peaceful, but there was an acceptable level of uproar that allowed for happiness in the back of the car and conversation in the front. However, it never failed that when it was time to find a gas station, locate a campground, or figure out how to find an address in some unfamiliar city, the noise level always seemed to reach deafening and distracting proportions.
“How come you always get out of control just before it is time to stop?” I would yell. They would look at me blankly and sulk the rest of the way to our destination.
"Bad Daddy," I would think later.
Interestingly, I was reminded of our car trips one day while working in the operating room. The bilateral neck dissections were proceeding smoothly. Our goal was to remove all of the cancer-containing lymph nodes in the neck, especially adjacent to both jugular veins.
The dissection on the right side went well although the cancer had grown directly through the wall of that jugular vein. In order to clear the cancer, we removed the vein, a maneuver that has no long-term side effects. I reminded the residents that we would have to save the jugular vein on the left because removing both veins almost always leads to complications.
As we lifted the nodes off of the left jugular vein, my heart sank. Once again, the cancer had invaded the vein. My mind flashed back to images of a patient for whom I had cared during my own residency who had lost both jugular veins — his head had swollen up dramatically, his eyes swollen shut and his lips massively enlarged. The swelling took weeks to resolve. I never wanted to see that problem again.
Suddenly, the radio was too loud and the normal operating room chatter became oppressive. The distractions in the room became overwhelming.
“Could you please turn down the music?!” The operating room stilled while I continued to attempt to free up the vein. I dissected the mass from every angle, working to see if I could discover a hidden plane between the cancer and the vein. It proved impossible. Finally, I conceded that the vein needed to be removed.
I had not encountered this exact situation in the past. Just to see what options might exist, I asked a colleague from Vascular Surgery to take a look at the vein. The surgeon scrubbed in and grafted a leg vein into the neck to replace the portion of the jugular that I had removed. The graft went in perfectly and flow through the vein was re-established. I was relieved.
The case suddenly became routine once again. As we closed the wound, I noticed that things were very quiet in the room.
“You can turn the radio up again.” The chatter resumed. Things were back to normal.
Who would have thought that a day in the operating room could have the same long, routine stretches and brief moments of intense concentration as a driving trip with the kids? And that my reaction would be exactly the same?
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The following is feedback received for this blog:
Great post. OF course, I am reading this right before a 8 hour driving trip to Chicago with two year old twins. At least I can think I am not in the OR in any capacity!
- Christian Sinclair
www.pallimed.org
Interesting parallels... :)
- Val Jones
www.revolutionhealth.com/blogs/valjonesmd |