It's Been A Week

It’s been a week. Wednesday to Tuesday kicked the snot out of me. So much happened it felt like a month. Let’s work our way backward. 

TUESDAY

Anesthesia clinic. Saw a couple dozen patients to assess them for upcoming surgery, but just one stood out. She was a lovely 67-year-old woman who was scheduled for excision of lesions on her scalp. A biopsy of one of the spots came back showing metastatic breast cancer. She’d had a mastectomy six years prior, with radiation and hormone therapy. She thought the cancer was gone, but now it was growing on her scalp. “And I’ve got this cough. My husband thinks it might be the cancer. Oh, I really hope it’s not.” I’d reviewed her chart previously and saw the results of her last CT scan. “It is,” I said sadly. “The cancer is in your lungs. And also in your right hip.” She started to cry, her cheery disposition melting before my eyes. “My husband has Parkinson’s — I was supposed to care for him. And my mother is 86 years old in a nursing home. She told me, ‘I want to die, but you’re the one with cancer!’” Life isn’t supposed to go this way. By the end of the visit, we sorted out a plan for her surgery. I asked if I could give her a hug and she readily agreed. 

MONDAY

Running on four hours sleep, I went straight into an endoscopy slate. I managed to stay awake through twelve cases in seven hours. At home, I got into a tiff with my wife. Then I lost my temper with my 10-year-old boy for complaining too much. That evening, I coached a soccer game against our arch-rivals, shouting from the sidelines (mostly encouragingly) at fifteen teenage boys to run harder and get back on defense. Got up 3-1, then 4-2. Then my 15-year-old son got a straight red card on a terrible call. He wasn’t only kicked out of the game but couldn’t even sit on the bench with his team. He went to the truck and cried. Broke my heart. And now he’s suspended for the first game of our playoffs this weekend. We lost the game 5-4. 

SUNDAY

Got woken up twenty minutes into a much-needed afternoon nap for an epidural on the maternity ward. Some poor gal was exhausted from laboring so long. Later that evening I was called in for another one. Slept in hospital again. 

SATURDAY

I could see the blue sky and warm summer day out the window as I spent the day inside the Operating Room with three complicated cases. 

A 70-year-old man had spent so much time in a hospital bed after a stroke that his backside had rotted off, leaving a massive horseshoe-shaped ulcer across his buttocks. We had to cut away the dead tissue — stinky. The final bandage stretched from hip to hip, and lower back to upper thigh. Not sure if it’ll ever heal.

A 58-year-old university professor had recently retired when he came to hospital because of abdominal pain. Tests showed a partial bowel obstruction from an apple-core-shaped mass in his colon. Cancer. It had already spread to his liver and lymph nodes. It was a death sentence. Emotionally, he wasn't in a good place. “I lost my whole family a few years ago, and now I’ve been told I have Stage 4 cancer.” His room was empty — no visitors, no cards, no flowers. All alone. In the OR, we took out half his colon. Surgery went well, but it was all just to relieve his obstructive symptoms, not to cure his cancer. 

I ordered pizza for the OR team. We all needed it. 

A 62-year-old woman had a perforated peptic ulcer. The hole in her stomach had leaked acid all over her abdomen. Dehydration from four days of illness had reduced her kidney function to zero. Four hours of surgery finally cleaned up the mess and pieced her organs back together, but it took days for her kidneys to start filtering toxins from her blood. Not sure how she’s still alive. Tough lady.

FRIDAY NIGHT

Midnight. Called in to put an epidural into another laboring woman. Dragged myself out of bed and started driving. Halfway to the hospital I got another call that an 11-year-old girl was bleeding from tonsil surgery. She'd had a tonsillectomy 36 hours prior, and now blood was pouring out of her mouth. Running into the trauma bay, I found her sitting up in bed, white as a ghost. She had a bucket in her hands and was spitting globs of blood into it. The fluid level was an inch deep — maybe two cups of blood. Two other buckets with similar amounts were on the table beside her. Add to that whatever she bled at home (much of which covered her clothing) and it was a wonder she had any blood left inside her. 

This was bad. It's the type of horror story case you hear whispered in the back halls of medical schools. The girl couldn’t speak because she was spitting every few seconds, her heart rate racing at 140 bpm. I called for ketamine and succinylcholine. As it was being collected, I told her parents the danger their daughter was in and our plan to stabilize her. “She has lost a lot of blood, and we need to put a breathing tube in her so we can pack throat to slow the bleeding. She'll be in a medical-induced coma for all of this, plus transport to the children's hospital in the city.” They were wide-eyed and scared, understandably so. As the parents were ushered out, I switched from everyday language to medical talk to address the team. “Crash intubation. Rob will push the Ketamine and Succ, then flush it in. I'll take a look with direct. Lisa, can you make sure suction is running? The 6.0 tube needs a stylet. Hook up the bagger. Then pass me TXA-soaked gauze so I can pack her throat. Yes, go ahead and start the first unit. If this doesn’t work, we have a bougie, glidescope, and OPAs. Questions?” Emergency equipment was put in place and everyone on board. Go time. 

Medications were pushed through her IV. Three seconds later she slumped backward in the bed, asleep and paralyzed. Laryngoscope blade inserted in her mouth, I saw dark blood and clots in the back of her throat. Suctioning it clear, I was able to see her vocal cords as her oropharynx refilled with blood. The tube went in without trouble and we were able to ventilate her lungs. In that time — maybe half a minute — her oxygen level dropped like a stone, down to 72%, but we were able to bag her up quickly. I packed gauze into the back of her mouth as tight as I could. Fluids were going in through her IVs. Blood was running in. More sedation, more paralytic. Finally, she stabilized. I think she lost half her blood volume. Who knows how much longer (an hour? half hour?) before she would have bled out completely. 

I got the epidural into the laboring woman upstairs, an hour late, then checked back in on the bleeding girl. The transport team was packing her up. Blood was slowly oozing out of her mouth and nose. The gauze was saturated, but at least it had slowed the bleeding way down. 

The next day, I read her operative report. She had been rushed to surgery as soon as she got to the children’s hospital. The packing was removed from her mouth and the surgeon found a bleeder on the inferior pole of where the left tonsil had been.  Cautery finally stopped it. An orogastric tube was inserted through her nose into her stomach, which was full of blood and clots. Her stomach was sucked out and washed clear. Then a bronchoscope went down her endotracheal tube and clots were found in her right lung. They were sucked out too. Last I heard, she was in the Pediatric ICU. 

Alive.

FRIDAY

After a full slate of scheduled cases, a special-needs 38-year-old male had an abscess in his groin. The infection was so bad he was septic. In the OR, we cleaned out the pus and ordered antibiotics. Two hours later, he still hadn’t gotten his antibiotics on the ward and was getting sicker. “But I feel totally fine!” He said this while fevered with a heart rate of 135. God bless his pleasant demeanor. 

Later that evening, I was called in to sedate an elderly man with an abscess behind his ear. Except that it wasn’t an abscess, it was a big basal cell carcinoma. “Sir, how long have you had a lump there?” “Oh, a few years.” It wasn’t an issue that needed to be dealt with that night, but he’d probably lose most of his ear to have the skin cancer removed.

THURSDAY 

Up half the night before with obstetric cases, but the General Surgery slate went ahead as planned in the morning. A gallbladder, three hernias, scalp debridement, and two hemorrhoids. A colleague covered call this evening, so I got to recoup at home. 

WEDNESDAY

A full ortho slate — three total knee replacements and three knee scopes — was followed by a cholecystectomy. Later that evening, the hospitalist called me to ask for help regarding the second knee patient who was in a pain crisis. I was already in hospital for an epidural. One of her regular home meds was blocking the pain meds. I ordered a ketamine infusion, which worked great. She slept like a baby all night. I, however, did not, since the second epidural of the night ran into trouble and needed a C-section at 5:00 in the morning. Finished just in time for the Gen Surg slate. 

AND OTHER STUFF 

Spent three out of the last five nights in hospital, sleeping on a plasticky mattress in the doctor’s call room. But even on the nights I was at home, I couldn’t fall asleep when I wanted to. 

The farm chores were piling up. The cattle needed grain and the pigs’ water barrel was leaking. Weeds were growing everywhere, especially in the garden. Our lawn mower needed a full tune-up, with all three blades sharpened.

Got in a tiff with my wife about who-knows-what. Yelled at my younger son for complaining too much. The farmer who works the land next to us keeps spraying the edge of our lawn and I lost my temper after the most recent spray killed even more of our grass. 

My little girl had her tonsils out a couple years ago. At the time, she wasn’t even half the size of the 11-year-old girl I saw this weekend. My daughter wouldn’t have survived such a bleed. 

We play our arch-rivals in soccer matches three more times this week, the first of which will be without my son, one of our best defenders. Gonna be tough to keep the rest of the team positive if we can’t keep the ball out of our net.

SUMMARY

People were getting diagnosed with cancer all over the place this weekend. Others were pulled back from the brink of death, dangerously close to slipping down the drain. As far as I can tell I don’t have PTSD, just dazed from the extreme workload and emotionally heavy cases. Isn’t survivor syndrome what soldiers get when they see their buddies die? Why should I go on living when so many others are dying of cancer? I'm getting paranoid that some terrible tragedy will strike my family. I’m so worn out I can’t even think straight. Being on call for anesthesia in a small town is no joke. 

So yeah, it’s been a week. Happens to us all. Some days it can feel impossible to put one foot in front of the other. Having a front row seat to death can rattle a guy. But this is what I signed up for, isn't it? Give me a few days to recover and I'll be fine. Probably. Just need to apologize to my wife.

Again.

© D. B. Ryen Incorporated, July 2025.