That Thing Was Growing Inside Me? (Part 1)

24.05.2017

I am amused by the frequency of requests from patients to see the malignant tumor or tumors I surgically remove from their body. Not a month goes by without being asked to take a photograph, or in more extreme cases, to trot the specimen out to the family members, and subsequently to the patient to show them the offending malignancy.

Sensory abilities and acuity vary drastically from person to person. Some people have partial or complete loss of one or more of their five primary senses. They must adapt to the world around them using their remaining neurosensory capabilities. The difficulties faced by those with who are blind, deaf, or saddled with other sensory deprivations are challenging, but also a testament to human spirit, tenacity, and strength.

Did you say something?

My youngest daughter can hear a whispered conversation from two rooms away. It is unnerving when she yells out a comment or comeback to something we assumed she couldn’t hear. She has hearing that makes me wonder if she has some evolutionary similarities to elephants, bats, dogs, or cats! My wife and I sometimes think we need the “cone of silence” from the old television show “Get Smart”. Unfortunately for my daughter, she enjoys listening to loud rock music much like I did in my younger years. As middle age approaches for her, she may suffer from the same mid-range frequency deficits I developed.

Winner! Winner! Chocolate dinner!

Other people have a highly refined palate. There are professional tasters of wines, other alcoholic spirits, foods, spices, and even olive oil. Professional and amateur tasters amaze me with their discernment of subtle variations in foods and beverages I will never detect. I probably burned out many of my taste sensing receptors as a boy eating very spicy chili from Chimayo (red) and Hatch (green), New Mexico.

The olfactory sense is keen in many animals, and some humans amaze me with their prowess detecting scents far beyond my scope. Once again, a wine connoisseur can describe relationships to a variety of fruits, woods, and other flavors based on the bouquet arising from a glass of wine. I can smell a difference between a red or white wine, but I will not speak prolifically about the subtle fragrance of grapefruit, oak, pears, and so on. I do have one highly refined odor I can discern even at a great distance. Chocolate. I was once taken to a locally renowned chocolate factory in an old city in Europe. I was allowed to taste several of the delicious chocolates. One afternoon two days later, I was wandering the city alone when I recognized a faint odor of chocolate. With no map and no knowledge of the winding, hilly city streets, I followed my snozz for the next twenty minutes or so until I located the chocolate factory. I entered the shop and the amused factory owner, amazed by my ability to locate his factory in a busy urban area, gifted me with a kilogram of his finest chocolate delicacies.

I spy with my little eye…

Vision is very important to all of us.  If our visual acuity is not perfect, we undergo surgical procedures, wear glasses, or insert contact lenses to provide sharp, focused views of the world around us. Surgeons rely on their vision to perform operations every day, and we frequently wear special magnifying loops to provide greater detail of fine structures like small blood vessels or tiny duct structures. One of the putative advantages of laparoscopic or robotic surgery is the magnified view through the surgical telescope placed into the patient’s body cavity.

I am accustomed to the frequent requests from patients to see the malignant tumor or tumors I surgically remove from their body. Not a month goes by without being asked to take a photograph, or in more extreme cases, to trot the specimen out to the family members, and subsequently to the patient to show them the offending malignancy. When the latter request is presented, I politely decline to cause a commotion in the surgical waiting area by walking out with a liver lobe, a chunk of pancreas, or a portion of the gastrointestinal tract to show to patient’s family. I do occasionally ask my pathology colleagues to take de-identified (no patient names or information) photographs of the resected tumor, particularly for rare or unusual cases, both for the medical record and for my own use in surgical lectures. Depending on the specific patient and their family’s ability to tolerate graphic cancer pictures, I have at times shared these pictures with the patient and interested parties. This is always a little risky because such photographs can induce an unexpected syncopal (fainting) episode in a family member, and I don’t want anyone going to ground with a loud thump, ending up in our emergency room with a large bump on their head. 

Taking the OR to school

Some people like seeing pictures or video images of surgical procedures. When my son was in the second grade, I was invited to come and speak at career day. I called his teacher and asked permission to show a carefully edited 60 second video clip of a portion of a liver resection. She hesitantly agreed as long as I promised there would not be “spurting” (her word) blood and disturbing images leading the students to complain to their parents about their frightening career day experience.  I appeared on the allotted day wearing my surgical scrubs, a surgeon’s cap, shoe covers, and a surgical mask. The children were delighted when I provided shoe covers, a paper surgical cap, and a mask for each of them. I explained in second grade terms what I did as a surgeon, and then asked if they wanted to see a short movie of a liver operation. They all cheered and screamed excitedly. I looked at the back of the room at three teachers anxiously eyeing me, wondering if they had made a mistake. I loaded the videocassette into the machine and pushed play. I had asked the cameraman filming this hepatic operation for close up views only, and I had carefully edited the film to show use of an instrument to gently dissect through the liver. As soon as the images of the liver being transected appeared on the screen, high-pitched screams emitted from many of the students. I quickly turned the video off but was met with shouts of, “No, turn it back on!” I complied, and the video resumed to the “Oohs” and “Ahs” of the wide-eyed second graders. 

About 45 seconds into the video, I quickly turned the television off. This was met with a chorus of complaints and boos from the children. I explained to them I was compelled to turn it off because I noticed one of the teachers in the back of the room had become pale, diaphoretic (sweating profusely), and looked like she was about to pass out. The other two teachers fanned her furiously with papers and I went and sat her down in a chair to be sure she didn’t fall over. She recovered and smiled wanly after a few minutes.  She thanked me for participating in career day. She almost sounded sincere.

The next week my son presented me with a packet of brightly colored construction paper in a manila folder. He informed me the teachers asked the students to write thank you notes to all of the career day speakers. As I went through the notes, most simply said “Thank you Dr. Curley” with a crayon picture of a surgeon, or their stick figure version of a surgeon, standing wielding a dangerously large knife, bordering on something the size of a sword, over a hapless patient lying on the table. One note I framed and hung in my office. It had a detailed crayon picture of a gowned surgeon standing beside a patient lying on an operating room table with a piece of liver protruding from an abdominal incision.  The written note, with perfect spelling and punctuation said, “Dear Dr. Curley, Thank you for the surgery movie. It was disgusting! Your friend, Sean.” 

Mission accomplished. You are welcome, Sean!

 

Keep reading:

That Thing Was Growing Inside Me? (Part 2)

That Thing Was Growing Inside Me? (Part 3)

Image copyright: Archangel12/flickr/CC BY

Article last time updated on 13.06.2017.

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