What Cancer Looks Like

I'm going to answer this because I've been asked several times in the last few days by friends and family, "What does cancer look like?"

During this last week, the third of my surgery rotation, I was having a hard day. I was tired. I hadn't slept well. The case we were working on was scheduled to be a 2-hour operation and we were in the 6th hour of it. There were complications managing the patient's vitals. And I had the most horrible cramps in my shoulders from helping suction, retract, and generally just staying the hell out of the surgeons way. A fellow PA came into the room to assist. We had both already put in a 12 hour day of nonstop rounding, operating, and trying to stay afloat. So, when I asked how she was doing I was somewhat expecting the standard, "Okay", or "Damn, I'm tired, too."

What I got instead was, "Awesome. I am having an amazing day!"

When I replied, "Really?", she clarified with, "Absolutely, we are actually saving lives. Today we cut cancer out of three people's bodies. This is an absolutely amazing day." And she was right. I stood up straighter for the last two hours of that surgery and forgot how tired I was.

Cancer looks different from anything else I have ever seen, because it is something that is not supposed to be where it is--in our bodies. What it mostly reminds me of is a smooth piece of fabric or a rope with a knot in it. That knot is made of cells that are very good at doing one thing: growing. And there are different types of knots. Some are super tough and hard to get out, some are more loose and easy to undo. Some knots begin to collect more knots around them, using up more of the surrounding material. But, most of all, with a knot in the fabric or rope (or tissue or skin or organ) it makes that area (organ, etc) look different. And in the body, things that look different usually act differently than they are supposed to, and cancer is one of these things.

But aside from looking different and acting different than other tissues in the body, cancer is so many other things.

I get to the hospital before everyone else, before my preceptor, the 5 other PAs I work with, before all the surgeons, the residents, and the attending. I do this for two reasons. First, I want to have a handle on how our patients are doing so I can not only present this information during rounds, but also so I can gain a better understanding of each patients post operative management. It is much easier to learn, I have found, if I understand the medicine being discussed. So I get there early and I leave late and in between and every chance I get, I study.

Second, I get to the hospital early because I have my favorites.

Sal (name changed) is one of my favorites. I was in on her surgery several days ago to remove a cancerous polyp from her sigmoid colon. We bonded a bit after surgery because she was in pain and her son wasn't available to come see her right away. Unfortunately, Sal had a few post op complications and we had to bring her back into the OR. Of course, this frightened her, and we still had not heard from her son. So I sat by her bed and talked with her about her kids and her grandkids (I know from my own folks that grandparents ALWAYS want to talk about their grandkids!). I even prayed with her a bit because that is what she wanted to do. I asked to scrub in on her case because I wanted to be in the room and follow through with her from start to finish. When they wheeled her back into the OR for her second surgery about 20 minutes later she was praying quietly, and clutching a red rosary in her hand. As the anesthesiologists did their thing and the RN and scrub tech situated the operating field and prepared the room, Sal was given a general anesthetic. As Sal began to fade to sleep, the RN grabbed the rosary to put it back with Sal's things, in another room, down the hall. I stopped her, clutched the rosary back, and tucked it into Sal's hand. I taped it into her gentle fist. I told the nurse, "I think she wants it with her."

When I checked in on Sal at 630am the next morning, she mentioned to me that someone had taped her rosary into her hand and that is why she thought her surgery, ultimately, went so well. And I smiled. Because I knew what Sal didn't know, and actually what I didn't know until today, and that is that we removed all the cancer from her sigmoid colon. The cancer we found wasn't metastatic, it was removed cleanly with excellent margins, and she was going to recover fabulously.

Unfortunately, the biopsy results for each patient are not always so promising. Today one of my other favorites found out that we removed a metastatic tumor from his lung. Metastatic means it has most likely already spread to other parts of his body, and we might not know exactly where those areas are until they grow tumors of their own.

The hospital, and this rotation, is a constant rollercoaster of emotion. One minute I am assisting on a major repair in an OR, the next I might be sitting bedside laughing about a patient finally passing gas (this is a BIG DEAL after surgery! It means things are getting back to normal!) The next moment I might be in the middle of a 6 hour surgery thinking about how tired I am or maybe thinking of absolutely nothing at all. Or I might be thinking of how I want to hold every patients hand, whether we are giving them great news or some of the most difficult news they will ever hear.

In talking to friends and family, I compare this rotation often to the tv series, Grey's Anatomy. In many ways, the show is a fairly accurate portrayal of working on a surgical service in a hospital. I don't walk behind my attending, I run. I utilize every neuron trying to come up with logical complicated explanations for a patients new symptoms. I often fail. I often look frazzled, unkept, and so put my hair under a surgical cap and a smile on my face when I go see the patients. And I glance at the cases (surgeries) for the day first thing each morning to see if I can somehow weasel my way into some of the cooler ones that I haven't seen. And when I get home I am tired to the bone, more tired perhaps than I have ever been. But I am also so exquisitely in love with the experience.

I probably identify most with Izzie, from the earlier seasons of Grey's Anatomy, because I think the greatest challenge for me working in surgery is going to be managing boundaries with patients. Because I won't always have the time...to catch up, to say hello, to follow each person all the way to discharge. I may have to find a way to hedge my desire to care too much about who they are being discharged too, if anyone. Do they live alone? And, perhaps most importantly, are they emotionally ready for the real healing, which begins once they walk out that door?