Sunday, May 02, 2010

Go Big or Go Home.

Dude had a benign tumor in his midsection that was more than a foot wide at the smallest part.

The day after his surgery, when most people are hitting the hell out of their PCA pump button, he was sitting tranquilly in a chair. When I asked him how he felt, overall, he said, "Better than I've felt in six months." He'd been split both ways from Sunday, had had his entire gut taken out and put back in, and was feeling fine.

*** *** *** *** ***

Another patient had had a teeny-tiny tumor, less than a centimeter wide, at the base of her brain. It was not malignant, but it had caused (for some reason) a hell of a lot of swelling--enough that when she was transferred, the chief surgeon on the case came to me specifically to talk about what he was worried about. (That never happens. This guy walks around with angels announcing his presence, y'know?)

About halfway through the night, she started getting sleepier and more irritable. I hollered at the attending (again, this never happens: guys who walk with choirs of angels don't generally want to be bothered at 2 a.m.) and let him know. He came in and put in a ventriculostomy (see "this never happens", above) because he wanted the resident to get his sleep, and also wanted to monitor the patient himself.

(Woah. I just threw a run of about four PVCs. I think I need more sleep and less caffeine.)

Anyway, about an hour after he'd placed the ventric, while he was still at the bedside (see "this never happens") I went in to check the level of fluid. As I was bending over to see the meniscus, the patient suddenly sat up, said, "Oh, ouch" and about a pint of blood poured into the ventric.

I estimate it was a pint, because the minute it started pouring, I did what had been drilled into me for eight years, though I'd never seen it: yanked the collection tube and bag off the ventric line and let it drain freely.

The surgeon and I stood there, amazed, as the patient laid back down (all the while bleeding freely through the tube in her brain) and said, calmly, "Well, that feels better."

He has north of forty years' experience as a brain surgeon. He told me that he'd never seen a patient have an intraventricular hemorrhage and be feeling fine during and after it.

*** *** *** *** ***

If you have cancer of the penis, it's probably best to have it at the tip of your penis, because, as awful as that is--and it's pretty awful--it's easier to reconstruct. Don't be like my patient who had a large sarcoma on the *base* of his penis.

(Hi, Mom!)

Because the surgeons will take off the part of the penis that is unaffected and attach it to a connected flap on your belly. They will then excise the tumor, and wait for the belly-connected penis to form a really good blood supply to its flap before they reattach it where it belongs.

(Every male reader of this blog, and about half the female readers, just crossed their legs reflexively and shuddered.)

The thing about flaps is this: they're purposefully made much bigger than they need to be, so that the whole area has great blood supply. As they meld to the area where they're transplanted, the excess tissue is cut away by the plastic surgeon and you end up, eventually, with something that looks normal.

What you get in the meantime, though, is a Penis For The Ages. It was fully as thick and as long as my forearm (and I have muscular forearms) and, just back of the mitre, was as thick as my wrist.

He looked down at his belly as the residents took down the dressing. "I'm not sure how my wife will feel about this" was all he said.

*** *** *** *** ***

So I'm down at MRI the other night, with Fred The MRI Dude and Scotty, The Other MRI Dude. The scan we're doing on my patient is scheduled to take something like three hours, and about an hour into it, I start feeling really, really sleepy.

"Dudes," I say, "I need something to do. I'm about to crash out here in this chair."

"What would you do at 3 in the morning if you were at home?" Scotty asks.

"Either drink or lift weights." I reply.

Fred nods once and reaches into a cabinet. He pulls out a set of barbells ranging from twenty to a hundred pounds and lifts an eyebrow at me. "Have at it" he says.

Turns out Fred, when he's not working the MRI in the middle of the night, is a semi-pro powerlifter. A sixty-pound bicep curl is nothing to him. I did a forty-minute heavy workout with him correcting my form and spotting me. Yesterday, during my workout with Attila, I was so sore I could barely do a fifty-pound lat row.

Far from dreading having to go to MRI now, I kinda look forward to it.


The Future Missy Prissy RN said...

Busy week huh? lol

'Drea said...

This instance is the second time in two days that I've seen that title. Maybe it's going to be a recurring theme/challenge in the coming week.

I wonder if patient #1 had a history of tranquility or if it was recently tapped into...

Unknown said...

Out of curiosity, why pull the collection bag off the ventric line? Too much volume for the bag? Pressure differential?


Jo said...

Brian: Too much volume for the bag. If somebody starts to bleed like that, you have no way of knowing when or if it'll stop, so everything comes off.

It's just me :) said...

Wow! It is amazing how differently people react to the same things. Just goes to show that you never know what could happen.

Sounds like you had a pretty interesting week.

messymimi said...

This is why they call medicine "practice." It is never the same, you have never seen everything, and there is always more to learn, more for the record books.

Penny Mitchell said...

Okay, I'll be the infant who asks if at least a fraction of that extra penile tissue was preserved, and if Mr. I-Have-Cancer-WHERE????? at least got a nice parting gift for his troubles?

The verification on this post is "popsmsho". I predict that word will become a permanent part of my vocabulary. Deal with it.