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. Just one patient stood out, 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 as metastatic breast cancer. She’d had a mastectomy six years prior, with radiation and hormone therapy to follow. 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, but I think it might be Valley Fever, because we spend the winters in Arizona. Oh, I really hope it’s not cancer.” I’d reviewed her chart previously and saw the results of her last CT scan. “It is,” I said sadly. “The cancer’s 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. My mother is 86 years old in a nursing home. She said, ‘I want to die, but you’re the one with cancer!’” What could I say? 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. Somehow got 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. We always lose to them. Shouted from the sidelines (mostly encouragingly) for fifteen teenage boys to run hard 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 night I was called in for another one. Slept in hospital again. 

SATURDAY

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

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

A 58-year-old university professor had recently retired when he came into hospital for intermittent pain in his abdomen. 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. I first saw him the evening prior, having just learned of his dismal diagnosis that day. 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 and minimal intake 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 in 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 was bleeding like crazy from somewhere in the back of her throat. Running into the trauma bay, I found the girl sitting upright on the bed, white as a ghost. She had a bucket in her hands and was spitting globs of blood and drool into it. The fluid level was an inch deep, so probably about 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. 

The parents were wide-eyed and scared. The girl was pale, with an elevated heart rate. She couldn’t speak because she was spitting every few seconds. This was bad. A horror story case you hear whispered about in the back hall of medical schools. I called for ketamine and succinylcholine. Quick as possible, I told her parents the danger their daughter was in. They were ushered out as I explained the plan for a crash intubation to the team. Emergency equipment was put in place and everyone on board. Go time. 

Ketamine into her IV. Succ followed. Then a flush. 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 breathing tube went in without trouble and we hooked her up to the bagger. In that time — maybe half a minute — her oxygen level had dropped like a stone, down to 72%, but we were able to bag her up fairly quickly. I packed TXA-soaked gauze into the back of her mouth as tight as I could. Fluids were going in through her IVs. We called for two units of blood. More sedation, more paralytic. Finally, she stabilized. I think she lost half her blood volume. Another hour — even another half hour — and 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 with blood and clots, 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 the left tonsil area.  Cautery finally stopped the bleeding. An orogastric tube was inserted through her nose into her stomach, which was found to be 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 developed sepsis. 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 130. 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 emergency to be dealt with that night, but he’d probably lose most of his ear to have the skin cancer excised.

THURSDAY 

Up half the night before with obstetric cases, the General Surgery slate went ahead as planned. A gallbladder, three hernias, a 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 seem to 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 our acreage keeps spraying the edge of our lawn and I lost it on him after the third spray in two years 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 three more times in the next week, the first of which will be without my son, one of the best players on the team. Gonna be tough to keep the rest of the team positive if we can’t keep the ball out of our net.

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. I don’t have PTSD — no flashbacks or nightmares — just dazed from the extreme workload and emotionally-heavy cases. Isn’t survivor syndrome what soldiers get when their buddies die but they survive? Why should I go on living when so many are dying of cancer? I'm getting paranoid 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. Gonna take a bit to recover. But I guess this is what I signed up for. And, even after such a difficult week, I’m still thankful for the privilege of serving my community in this way. Just need to apologize to my wife.

Again.

© D. B. Ryen Incorporated, July 2025.