It's not me. She has chief-resident-itis. It all seems so clear now, and I feel a great weight lifted from my heart. As Dr. G, elder, dismissed her and I to go scrub on a surgery, she waited until he was out of sight before conspiratorially whispering to me, "I think it started at 8, and I think it was supposed to be benign, so they might be done and we won't have to go change and go, and we can just hang out all morning." She walked slowly, chatted with MP, told the story of surgery yesterday...
The surgery was sad, O Best Beloved. It was scheduled from 0800 to 1600, an eight-hour monster of an anterior exeneration (a drastic surgery in which the uterus, cervix, fallopian tubes, ovaries, vagina, bladder, rectum and part of the colon are removed) for endometrial cancer. We opened her up, and looked inside. This isn't endometrial... And when we pulled lymph nodes, it wasn't. It appears to be cervical cancer, stage IVA clinically (it's growing right into her bladder) and stage IVB surgically (we have metastases at the root of her mesentery). So we took lymph nodes out of her pelvis to get rid of some of the tumor bulk, removed both ovaries due to their cancer, took a few biopsies, and closed. Radiation and chemotherapy, a later debulking, and palliative care. Survival is something like 15% at 5 years. And she had a normal pap.
She presented because of leg pain and swelling. CT scan found thrombophlebitis, but also extrinsic compression of her veins. One scan led to another, which discovered this horrible disease. It grew through the bladder wall in less than 4 weeks, because Urology had scoped her for something else. It's anaplastic and incredibly aggressive; you can almost hear it growing. And there is nothing we can do but try and keep her comfortable.
We did a cystoscopy (looked in the bladder) during the surgery, to see the horrible growth in there. They strung up the tubing so that I was trapped in place. I brushed against it as I was trying to work. "You're contaminated!" Anaesthesia, I think, had it in for me this time. I re-gowned and re-gloved. Then Dr.M told me to close off the cystoscope water. I looked at her. She looked back at me, repeated the order. So I did. "You're contaminated!" I re-gloved again, just so I could hold sterile forceps while IL put staples in. For Pete's friggin' sake.
We laughed about the contamination. We didn't laugh about the cancer. She's 54. How terrifying.
Angel says to me that I'm not allowed to go into oncology. Angel, as usual, is right.