Dr. Peter Saul at TED: Let’s talk about dying

he walks alone

Many of the stories I have to tell aren’t really my stories. They’re the stories of others. Sometimes it’s the patient’s story, sometimes it’s the family’s story, and in this case, it’s the surgeon’s story.

She had been told she had to have bowel surgery to resect a tumor. She was quite frightened of this because she’d seen it happen to other members of her family, and they had gotten quite sick and nearly died. She was terrified of what would happen, especially after the surgery, when an arduous recovery would not necessarily mean that she was cancer-free.

She procrastinated. Her procedure, while not exactly elective, depended on her consenting to the surgery, and so she put it off. As is wont to happen with cancers, and especially gastrointestinal ones, she became more wasted as the weeks wore on, her body unable to properly absorb the nutrition that she was able to keep down.

Finally, the day came where she reached the point of no return. She presented in emergency gravely ill, with suspicions that her bowel had perhaps obstructed and perforated. She was operated on by one of the best — I didn’t enter into that equation until after her surgery.

She’d arrived decompensated and in poor condition and required a lot of blood during surgery. As happens somewhat rarely, she had a transfusion reaction. This precipitated respiratory failure and my involvement. Sadly, due to multiple factors, including how truly sick she was going into the surgery, her body failed to rally. Her surgical sites refused to heal and broke down, requiring further laparotomies. Finally, after returning to the operating room for the tenth time, the surgeon threw up his hands. There was simply no more bowel left to resect. Either she would recover, or she would not.

I remember a conversation that I had with him in the hallway after he had discovered she’d have to go to the theater for the last time. He had taken very personal care of this patient, not handing her over to a colleague even over the Christmas break. He poked his head in on her every single day that he was physically able to.

“You know, you think you do a good job…” he said to me, shaking his head. Knowing only the little that I knew, I tried to offer some meager reassurance that he had done what he could with what he had, which was arguably not very much to begin with. He simply shook his head and walked, alone, down the hallway to get the patient on the slate for surgery.

He carried the entire weight of this person’s recovery on his shoulders. I can only imagine how he’d felt when she began the downward spiral towards her eventual death. Especially being as he’s South African, reading Bongi’s post about the graveyard made me think of him. There most certainly is a tombstone somewhere in this man’s mind, with that woman’s name on it.