Day one of surgery. A spring afternoon, an unfamiliar inner-city hospital-home for seven weeks. First opportunity to observe in theatre, grabbed eagerly after some diplomatic wrestling from the enthusiastic future surgeons in my clinical group. Whipple procedure. How exciting! A rush to the textbooks, internet, to glean what we could. A quick request to see the patient beforehand. While only two of us would be watching in theatre, we brought the whole group. Walking through the door, the technicalities of the surgery filtered out. There lay before us a fit, apparently healthy middle-aged man. Smiling. He told us his story-a one year history of vague abdominal discomfort, followed by rapid onset painless jaundice and eventually some pain. Overnight admission via his GP, blood samples and ERCP. Diagnosis: pancreatic adenocarcinoma. Two weeks later, he was ready for surgery. Admitting he was slightly altered by pre-operative sedatives, he claimed he was going to beat it; he knew the statistics were against him but he had absolute faith in his surgical team. Our expressions were serious, bewildered. Never before had we faced such stoic optimism. Never before had we seen someone so well gather their thoughts before a major operation, with what, despite our inexperience, we knew was a poor prognosis. In our first term at university, a surgeon told a lecture theatre of 300 of us that pancreatic cancer was the worst type.
His family turned up: a tearful anxious wife, teenage children-trendy, silent. We filed out of the room to let them accompany him to theatre. Later, we watched as the surgeon made the incision, performed a biliary by-pass and closed up, unable to complete the procedure as the tumour was too advanced. He nodded gravely toward us-life expectancy 3-6months.
The patient suffered from almost every post-operative complication we had been taught. He was unable to speak to us and after a few steps with the physiotherapist became breathless, listless and grey. Still, we checked his chart for progress every day. We asked for information on his discharge-the answer was invariably negative. We chased his pathology and blood results. We wrote about pancreatic conditions, their biomarkers, their complications, their symptoms, diagnosis and limited treatment options. Several times, we meekly approached his bed hoping to see a glimmer of a smile or some of that uniquely strong character witnessed minutes before his anaesthesia. Always however, his eyes were closed tight with pain.
We went only to the minimum number of surgeries required. While older students expected us to fight over other Whipple cases and hepatic resections as our predecessors had done, we chose different patients to examine, different conditions to research. When the seven weeks were up, we moved on. He was still there. In autumn of that year, my classmate noticed his obituary. 5 months after we first met him. An ordinary man. A vicious disease. Our introduction to surgery. And the greatest impact life as a medical student has had on me so far.
I am an external intercalating medical student at University of Edinburgh, originally from Ireland.
