Patient is T, who's four and a half. She presented to her primary doctor with two weeks of nonspecific abdominal pain and a six-pound weight loss. Primary doctor, unheard of, got a CT. Showed a gigantic mass lying in wait above her kidneys, coiling around her aorta, and displacing her inferior vena cava and her pancreas. It was huge. She's tiny (14.1 kg). How this gigantic haemorrhagic thing was non-palpable I don't know. And then we made a little incision and went rooting around, unsuccessfully almost, trying to figure out if we were working on tumor or pancreas, while her bowels (did she drink an entire case of fizzy drinks before surgery? They were entirely full of gas) got in the way. A lot. Got our sample and sent it to pathology, waiting for the frozen sections. Stuffed a wet lap towel into the wound, and stood around chatting until Path called back. Neuroblastoma.
That was what we had wanted to hear, in all honesty. As sad as it sounds, as disturbing as it is, hearing that she has a form of cancer gives her a better prognosis than if this horrible mass were benign. Because if it were benign, we'd have to take it out. And it wraps around everything in there. And it's safer - for her - for us to just close up the wound, call in the specialists to get a bone marrow biopsy, and tell her parents that she has a 25-40% survival chance, than to try and remove this huge haemorrhagic thing from the abdomen and pelvis of a four and a half-year-old-girl without her bleeding out or dying in the operation. She'll go for chemotherapy, and the tumour hopefully will shrink, and we'll be able to take it out later.
Neuroblastoma. I watched them do the BM biopsy. They drill into the hip...it looks horrible. She's four and a half. They couldn't get her into the OR until her dad dressed in a protective suit and carried her in.
Apparently the doctors think we should be following patients if we're there for the surgeries. Makes sense. Dr. B wanted to know what was going on, why Shubi was following patients that Andy scrubbed on, etc. And here I am scrubbing because Asher doesn't feel good enough for the OR, and this patient wasn't mine, but the way Dr. B was looking at me, I think I have to take her now.
We'll reorganize the list this afternoon, on rounds. And tonight is choir night, so I'll go home, clean my room, and study a bit before bed as Angel will not be around to distract me. I should also find the chart this afternoon for my third H&P patient, as I have the sneaking suspicion that I need to find the drug dosing for her before they send her home and I get in trouble for not having an adequate plan.
It's hard to believe that I've been doing this for three and a half weeks, or that there are only two weeks left. I can't friggin' wait. :P