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This May Hurt a Bit

This May Hurt a Bit


The intuitions, insights, and growing pains of a medical student
This May Hurt a Bit Home

Post-operative check

The views expressed are those of the author and are not necessarily those of Scientific American.


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It’s okay that you don’t remember me. My name is Shara, and I’m part of the surgical team. I’m checking to see how you’re doing after your surgery.

Do you know where you are right now?

Actually, you’re in the hospital. You had surgery a few hours ago, for a broken hip. You used to be able to walk before you broke it, so it was important to fix it as soon as it was safe to.

We’re not sure how you broke it either. You said you couldn’t remember falling or even having much pain. Your daughter noticed swelling in your leg a few days ago and brought you here.

She went home for a bit, but she’s been here with you the past few days.

We waited a few days before the surgery to make sure you were medically ready. You had some fluid in your lungs when you first arrived, so we gave you medications to help get rid of it.

It probably wasn’t related to what you ate or drank. You were eating a lot, though. You’re the only person I’ve ever seen with a broken hip with that good of an appetite. Do you remember the last thing you ate before your surgery?

It was a big chocolate chip cookie.

 

I was there during the surgery. I’m still a student, so I didn’t do much. But you can learn a lot from watching. Thank you for letting me watch.

I was there when they wheeled you into the room. Your surgical cap was too big for you, and it kept falling off. We asked you your name, and you said it. All three names. We didn’t even ask you for the middle one, because we didn’t know you had one.

We then put you to sleep. You took deep breaths through an oxygen mask, before we turned off your consciousness and paralyzed your body. I held your hand as you closed your eyes. The nurse whispered to you that everything would be okay.

We fixed the bone. It took a few hours, because your bone is fragile. There was bleeding, but that’s normal. Bone bleeds a lot. We gave you blood and fluids to replace what you lost.

Did you know that many surgeons play music during operations? It was going so smoothly that we were humming along to “Who Says You Can’t Go Home?” It was during the bridge of the song that your blood pressure suddenly dropped. The anesthesiologist called it out. I looked at the monitor and saw numbers flashing in red.

There was a lot of red, actually. Blood in the wound, blood in the suction container, blood in transfusion bags, bloody footprints on the floor. No more than with any other patient. But I think somewhere along the way I learned to take the sight of liters of blood for granted.

I was scared. I stopped watching them stitch and stared at the monitor, which suddenly seemed like my closest connection to you. They called out the medications they were giving you to raise your blood pressure.

After a few minutes, it worked. Your blood pressure slowly climbed to green numbers. I was still shaking as I silently willed the numbers to stop bouncing around.

But the numbers stubbornly drifted down. Even though they were keeping up with the fluids. Even though you were on medications that force your blood vessels to clamp down and your heart to beat harder.

The red returned and was unrelenting. Your blood pressure was too low, your heart rate too high, the tracing of your heart rhythm irregular and non-shockable.

“We can be done in ten minutes,” the surgeons said.

I’ve never seen surgeons work so fast. They’re usually so particular about their stitches, getting the perfect angle and length for each one.

I’ve also never seen so many anesthesiologists at the head of an operating table.

I’ve never seen an ICU bed booked so quickly.

I’ve never seen someone lose their carotid pulse.

 

Apparently it’s rare to die on the operating table. They almost always get you to the ICU first.

Twice in eight years, said the anesthesiologist. Once in fifteen years, said the surgeon.

Once in eighty years for you.

I couldn’t bring myself to touch your hand again. I watched, though.

I watched as the room slowly cleared and people tried to figure out what to write and who to call.

I watched as they kept your eyes shut and handled your body just as gently as they had a few hours ago.

I listened to the final zip of the body bag. I don’t know who had the time to switch off the radio, but I’m glad they did.

I listened as the nurse asked God to rest your soul.

I watched you leave in a different kind of bed, to a different place. I’m not sure where.

You can learn a lot from watching. Thank you for letting me watch.

We fixed your hip, sir.

Shara Yurkiewicz About the Author: Shara Yurkiewicz is a fourth-year student at Harvard Medical School. She was an AAAS Mass Media Fellow, and her work has been published in the Los Angeles Times, Discover, and The Best Science Writing Online 2012 and 2013. She is interested in medical ethics and has served as guest editor for the American Medical Association's ethics journal Virtual Mentor. She conducted ethics research at Harvard, Yale, and the Hastings Center and received a B.S. in biology from Yale. Shara's previous blog can be found at This May Hurt a Bit. Follow on Twitter @sharayurkiewicz.

The views expressed are those of the author and are not necessarily those of Scientific American.



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This May Hurt a Bit




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  1. 1. tuned 11:23 am 04/7/2014

    Should have mentioned do many die AFTER breaking a bone. Especially the hip.
    Needs work, often in a few pieces.
    It’d just there’s so many blood clots some end up in the lungs and heart. Then its strokes and attacks.
    Getting old is just the price (so far).

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  2. 2. tuned 11:24 am 04/7/2014

    I should have said ‘even weeks after’.

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  3. 3. ftwom 4:14 pm 04/17/2014

    So many clots? Getting old is just the ‘price’? Aren’t anticoagulants routinely administered prior to, during or after operations where clots are a major factor? There are risks to surgery, yes, but dying from hip surgery? There is always a cause and effect relationship to any event, and unfortunately Shara, although her writing is eloquent, compassionate and moving, doesn’t touch on possible causes, only to say that “. . .people tried to figure out what to write. . .” What did they write?

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  4. 4. wallacegal 10:14 pm 04/17/2014

    Sometimes, there just aren’t any answers, at least not ones we’re willing to accept. Don’t lose your compassion, Shara. Ever. Yes, cover it with snark or detachment if you must, keep it hidden from your coworkers if it helps, but make sure your patients see it. I’ve sat with a lot of dying patients. Sometimes, you’re all they have in their last moments.

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  5. 5. anotherViewPoint 12:39 pm 04/18/2014

    I must be having a bad day, but this article struck a nerve with me. If you read it from the perspective of “what does this contribute?” I found it offensive. Does it help the family to read this (‘we fixed you hip, sir.’ – please!)? No. Does it help the medical profession? No – and don’t give me that it helps other students going through the same process. This helps Shara and pretty much no one else. Oh how eloquently you write! I went though five years (yes that is correct) of chemotherapy for 2 cancers that my son had (he is fine now). It was funny to hear the insecure all-about-me doctors come in and introduce themselves as “Dr. so and so”. Invariably, they were the eyes and ears of the actual doctors. Those doctors would walk in and say, “hello, I’m Cindy….”. Shara strikes me as a “I’m Dr. Yurkiewicz” type… Thanks, but no thanks, I’ll find another doctor that doesn’t try to exploit an 80 year-old’s death for her personal benefit.

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  6. 6. Shara Yurkiewicz in reply to Shara Yurkiewicz 12:48 pm 04/18/2014

    Approving the above comment because this articulates my greatest fear. anotherViewPoint, I appreciate that you brought this up. What is the point of this type writing? Who does it help? Who does it hurt? I have been struggling with this for four years, and I’m sure I’ll continue to do so. I am very sorry you were hurt by my post. I give a lot of thought to what I write, and it’s important to know what strikes both rightly and wrongly.

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  7. 7. agray3 3:16 pm 04/18/2014

    As a woman who lost her mother during surgery- or rather, my mother did make it to the ICU and struggled to survive for two and half weeks before I decided to turned off her life support as her doctor suggested- I was incredibly moved by your piece. It has been some time since I have thought about the team of people present during my mother’s surgery, other than the surgeon himself. I have mostly come to terms with the fact that I will never know exactly what went wrong with my mother’s surgery. Many “experts” involved had different opinions about wether it was a failing of the medical staff or of my mother’s body or both. Due to administerial walls I was never able to have a real conversation with those involved without a team of hospital PR people and lawyers. That is my own wound to heal. It was very touching to read your perspective as simply a witness to this patient, this person’s death. I appreciated you openness and honesty. But I have to say that the ending took me by surprise. I have sense of the tone you were intending in reflection, but it seemed inappropriate to me to be so seemingly flippant about the loss of life. I think the piece is valuable, but needs reworking to really touch a wider audience. Especially, those outside of the medical realm. Especially those who have lost loved ones during “routine surgeries”. Edit the part about “We fixed your hip, sir.” It was like a knife in my heart. My suggestion is to end with more love and respect even if just for this man in question. Thank you for your time.

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  8. 8. Excelless 5:34 pm 04/18/2014

    Thank you for writing such a poignant piece. The humorous bits sprinkled inside, in my opinion, turns it into something markedly different than the multitude of other pieces that deal with death.

    Even what may seem like a facetious remark at the end can also be seen as an expression of the helplessness that those in the medical field may feel after a death. For some, a deep mourning is a way to deal with a loss. For others, a way to make matters less burdensome is their way of dealing with it.

    @Shara, Whether your writing helps other people or not, I think, is a non-issue. Even if it only helps you (although I’m betting many other people can relate to your works), your writing about your medical endeavor is as valuable as treating patients. The medical field burns out many talented people, so if sharing your work helps you out, all the more power to you. Good luck and I look forward to seeing more of your writing!

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  9. 9. onceinterested 5:59 pm 04/18/2014

    I don’t think Shara meant to be hurtful with her final statement. If I may, being a writer…

    The final statement brought it all full circle with a double edged heaviness. On the one hand, they did what was intended to be done. On the other hand, he would never know that it was done.

    I once was interested in being a doctor and attended a GT summer day camp where I was thrown into the ‘fun’ world of medicine. I was in third grade – the youngest in my group, actually. Most of my other peers were in 6th, 7th, and 8th grade. So, I was considered mature mentally. We had to perform surgery on frogs – I had a heart patient. These frogs were legitimately ill. There were three teachers in the room, should anyone’s frog start flatlining. My frog was fine. It survived through surgery. I didn’t kill him. I didn’t need help.

    However, it clicked in my mind very quickly that I could have killed it. That frog could have died under my care. Maybe I was too young to stomach that gracefully or I simply knew by intuition that it wasn’t a responsibility I could handle. Either way, doctors have to come to terms with this fact and not cry over it. They have to harden and somehow not be Izzy Stevens from Grey’s Anatomy. Sure, Izzy was a great doctor – but she made more mistakes from acting on feeling as opposed to logic.

    Shara’s last statement reflects that battle between emotion and logic. “We fixed your hip, sir.” The statement hurts only if you want it to. The statement is factual if you let it be. It’s whatever you make it out to be, whatever you read in to it.

    Regardless – thank you Shara. Your blog is quite insightful.

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  10. 10. mhulce 10:27 pm 04/18/2014

    Your writing IS stunning and like one of the other commenters, I, too, had a hard day and am tired. Some people like all the gory details, I am one of them. Some people never turn their head when the needle goes in, I am one of them. Your perspective is utterly fascinating to me and it is valuable because it is yours and you’ve made people curious to hear more. I am hoping you are the next Atul Gawande! Keep it up. I look forward to more, maybe in book form?

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  11. 11. delayedDelivery 4:51 pm 04/19/2014

    Dear Shara, I think that it would be ok if you ever become a doctor. If not, think about some of the fine writers, like Rabelais, Chekhov, Bulgakov…
    And do what you think is right. Thanks for your writing -

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  12. 12. alanna 1:04 am 04/20/2014

    My fiance had his left hip replaced April 4th, 2014. It was two weeks ago yesterday. He will have his right hip replaced as soon as we can. He is 38 and has been in a wheelchair on heavy narcotics for 2 years. I have spent the better part of 3 years being his daily caregiver and learning about his disease which began after a single seizure two months to the day after we started dating. I have also spent the better part of the last three years learning how to find health insurance for him. He was a cook in a cafe. I learned all about Medicaid and then learned all about it again after the Affordable Care Act kicked in. I also had to learn how to help him apply for Social Security Disability. Then I got to learn about Medicare. All of this research and learning came together on that day that the medical staff made me let go of his hand as they wheeled him away and I had to let go of more than his hand. I had been involved in all of his care up to that point. I knew he was comfortable and these people had trained for years and done this surgery hundreds of times. But for me this was the big event that we had been preparing ourselves and our relationship for. It was one of the hardest things I have ever done. Not the learning or all of our preparations, but letting everyone else take over where I could not. Thank you for letting me have a glimpse behind the door into the world that I was not allowed.

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  13. 13. Excelless 6:10 am 04/20/2014

    @Onceinterested – Ah, I think you hit it right on the head with your remark about that last sentence. I was always trying to formulate the words to try to explain it that way, but I just gave up. Thank you, and I wish you good luck with your writing career!

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  14. 14. robbyn 4:19 pm 04/20/2014

    @anotherviewpoint, I think you’re being quite unfair to both Shara and the act of writing. Of course, you clearly had a hard experience with what your son went through, but it’s dangerous to attack this author based on your observations purely on a short essay you read online. You do not know her. Please do not judge her.

    I think it’s also important that you stop speaking for others. Do you know this doesn’t help the family? Perhaps they wanted to know what happened in that surgical room from a human perspective. To say this doesn’t help future doctors is just a lie. This piece is about an emotionally shattering experience, and it is meant to instruct from a position not accessible from a textbook. The learning the author experiences here is something I’m sure she will carry to her grave.

    It’s also vital to note that you do not have the right to delineate what deserves to be written about. Writing, as said by someone who teaches it and makes a living doing it, has multiple functions. Sometimes it’s purely utilitarian such as when you write out a receipt. Sometimes it’s just for yourself as in a diary entry. There is no right or wrong type of writing. And while the author could veer into exploitative waters given this subject, it’s not my opinion that she does. Yes, I find the last line odd, but it has more to do with a tone change inconsistent with the rest of the piece (Oh how if she were in my workshop I would have loved to suggest “It doesn’t matter anymore, but I want to let you know we fixed your hip, sir.”). This piece’s contribution to the world can suffice as a record, to say something happened and someone felt something– which, is 90% of what all of literature does.

    I’m sorry you feel this piece did not offer you what you were looking for, and it’s fine not to enjoy this work for whatever reasons you have. But I would like to suggest you withhold your value judgements on a woman you have never met and not cast such a net on the act of writing itself as to declare what can and cannot be written about.

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