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I can understand how outsiders might see what surgeons do as borderline barbaric—slicing into people’s bellies, opening up their skulls, taking out their organs—but to me it has never seemed that way. Even with a patient’s small intestines splayed out across their abdomen during an exploratory laparotomy, within the environment of the operating room somehow that process seems controlled and purposeful. On the table, under the halo of the OR lights, something as brutal as sowing someone’s flesh back together becomes an art of approximating skin flaps precisely so they line up – not too far apart, not too close together. This is the way I felt until I met Mr. Crow.* The first time I saw Mr. Crow was in the Emergency Department where his MS-ravaged body lay rigid on a gurney; his face was pale and sweaty with strained breathing despite a CPAP strapped to his face. His hemothorax on CT was obvious even to me, and combined his esophageal perforation, so was his need for emergency surgery. Despite the patient’s wincing, the most agonizing part wasn’t the physical discomfort of multiple IV sticks, or the struggle to breath. I saw the painful side of medicine as I stood in the corner and watched as the attending realigned Mr. Crow’s expectations with reality. Tracheostomy. Discharge to a SNF. A 50/50 chance, given his co-morbidities. “Not yet. Not yet.” He strained over the hum of the CPAP machine, referring to the tracheostomy, as his eyes frantically swept the room. Even in the OR, with ET tube in his throat, a chest tube between his ribs, and later a scalpel in his chest, I never felt his pain as acutely as that moment in the ED, as his eyes bulged and his wife sobbed in the background. The emotional pain that we inadvertently bring upon our patients is often overlooked in favor of treating the physical pain we have inflicted. Physicians bring people nose to nose with their own mortality and after a conversation of that magnitude people on both sides of the table need emotional support.
I believe the emotional distress associated with surgery, particularly in emergent cases, can be devastating. Trauma of that nature can be harder to reconcile with the spirit of medicine and more difficult for patient and provider alike. As a medical student, I couldn’t talk to him about his chances of surviving the operation. Nor did I have any experience to lend about inserting a chest tube. I could not alleviate his physical pain, but I did the one thing I could do – as they sedated him in preparation for intubation, I held his hand. *Not the patient’s real name.

- Anonymous, M4