Dispatch from the operating room

As I open my eyes in the morning, I remind myself what time it is, where I am and what my schedules are, the people I need to connect with for the day, and my deadlines.

Six months ago, I flew to Tagum City for a yearlong internship. In my new room, I face my laptop screen often. If not, it is my iPad. These days, I habitually read e-books about surgery, as I am “helping” in the surgery department — my third to the last rotation before I finally end postgraduate internship and take the medical board exam this year.

I had my initial surgery experience last year while in clerkship, the fourth year in medicine. I have not yet decided whether to go into general surgery residency, but I have found a combination of struggle and joy after meeting patients who were once in need of acute care, and now are able to do daily activities after a successful operation.

Flashback nine months ago. The cardiac monitor alarmed us again. It read 80 percent oxygen saturation — hypoxia. The patient might be having hypothermia, a situation where the body loses heat beyond normal.

I’d been standing  for 10 hours. No water. No bladder break. The intermittent turning off of the air-conditioning  made me palpably feel the tiny drop of my sweat rolling down the lateral side of my eyebrow. I wiped it cautiously using my shoulder, as it might unsterilize the field.

I was extremely thirsty and tired. My throat was drier than dry. I wanted a break, a little opportunity to quench my thirst and relieve my almost full bladder. The female consultant surgeon gave no sign of pausing; she was brave.

“I am younger, my body can compensate — I can’t complain otherwise,” I told myself.

With the remaining strength I had, much of which had already been consumed by 11 hours of emergency-room duty that morning, I continued to retract the tiny, fragile newborn baby’s abdomen.

Not too tense, not too slack. Just enough to let the two surgeons visualize the almost missing distal third of the esophagus (a part of our gastrointestinal system that looks like a tube, which connects the stomach to the pharynx and oral cavity).

The operation on a 7-day-old baby boy who had esophageal atresia (closed esophagus) was very intricate. It required both discipline and some discomfort on our part.

While the thorax and abdomen were both incised, instruments were laid out and organized to be used exclusively for one anatomical region.

“What’s for thorax, for thorax. Abdomen, for abdomen!” the surgeon tersely told the nurse.

We couldn’t afford to introduce normal microbiota of the thorax to avoid cross-contaminating the abdomen and vice versa.

I braced myself to endure the rising temperature in my own body, wrapped in a surgeon’s gown, gloves and mask, as the air-conditioning was switched off to keep the patient warm and prevent further unnecessary heat loss. We don’t want table deaths, do we?

Gratefully, the first layer of the abdomen of stitching was made. The nurse started to count and confirm the number of sutures, instruments and needles used. Eventually, the entire incision on the thorax and abdomen was closed. The anesthesiologist computed his fluids and planned his pain management orders.

We ushered the patient from the operating room to the neonatal intensive care unit. Intubated, attached to a mechanical ventilator and monitors, the newborn is kept safe and  monitored in case of complications and bleeding.

I was desperately hungry, sleepy and dead-tired. It was almost 6 a.m. I left the operating room and went up to the third floor of the hospital, at the clerk’s quarters so I could rest, hoping there would be no more late admissions. I freshened myself up and set my alarm to 7:45 a.m. so I could join the daily endorsement at 8 a.m.

Despite all this, it feels fulfilling when you remember details from that successful operation and the progress of the newborn who is now 9 months old. You feel rewarded that, somehow, sometime in your life, you helped extend the life of someone who might become “somebody” in the future.

It feels satisfying when you see your patient’s progress as you stalk their loved ones’ Facebook. You feel reenergized when you receive a simple “thank you” from patients or patients’ guardians after you’ve taken only an hour’s nap.

Despite the cynicism some people feel toward our profession, I believe there are still many people who trust doctors. Now I am facing my laptop screen, trying to put my experiences from medical student to clerk to intern into words.

As my phone rings, I know I have to stop typing, as I will assist another surgery in the operating room: another case to solve, another promising patient to help, another life we hope to save, or at least extend.

* * *

Grace Gladys May G. Dayuha, 27, has been dressing wounds every day since 2019 started.