After observing for a day with the General Surgery service, I’m struck by what a trusted privilege the surgeon is given to enter within the body of a patient. Cutting through the protective layer of skin that separates the ‘us’ from the ‘outside’, the surgeon enters the most intimate recesses of a person – the cavities and tissues of their body. Such intrusion; such vulnerability. Yet every day, patients entrust surgeons with this privilege, literally bearing their inner biological lives on the table.
What an intimate privilege to enter within a body, and I’m so immensely grateful to have briefly had the opportunity today. Shadowing a general surgeon, I was allowed to witness a superficial parotidectomy (removal of the superficial lobe of the parotid gland), a lumpectomy (breast-lump removal), and a lumpectomy with axillary dissection (removal of lymph nodes from the armpit). Those last two cases were for women with confirmed breast cancer. My role was, of course, exclusively to watch the procedures, but they did ask me to retract here and there, or cut stitches. I think they wanted me to feel included!
Surgical dissection can be exquisitely precise, and particularly for the parotidectomy it was important for the surgeons to identify numerous nerves and arteries as they slowly worked around the resection. Damage to any of these nerves could have resulted in paralysis of the patient’s facial muscles – a horribly debilitating and life-changing complication. Once a nerve was located, the surgeon would electrically stimulate it to observe for an effect. For example, if he stimulated a nerve to the orbicularis occuli muscle, the patient’s eye would squint.
Practising medicine is surely a privilege – to have the invested trust of patients for their lives and well-being. But the intimate privilege granted to physically enter within the body is greater yet.
Wow so cool! But you have to include everyday vocabulary for us dummies in your posts so we know the types of the body you are talking about. I have no idea what part of the body you were watching when you saw the ’superficial parotidectomy’…I guess I could always google it…
Comment by Miriam Booy — April 24, 2009 @ 11:39 am
Oh, **slaps self**, sorry!!! The parotid gland is a salivary gland in your face. It runs from just below the ear along the line of the jaw and forward towards the corners of the mouth. The patient I saw had a benign ( = not cancer) tumour of the parotid gland, presenting as a large, hard bump on her face. You can appreciate then how important it was to complete the surgery precisely, and with concern for the cosmetic consequences.
Comment by Jason Booy — April 24, 2009 @ 11:54 am
Great blog! I remember the first time you ‘looked’ into a body. You were @5yrs old and needed a heart echo. As the technician was running the instrument across your chest, you anxiously looked into the TV screen showing your heart and said, ‘where’s Jesus’? The good doctor can peer into the physical body but a great doctor will know that there is an even deeper inner self that no surgeon’s knife can penetrate but equally needs understanding and healing.
Comment by Dad — April 24, 2009 @ 1:56 pm