Respectful Insolence

One reason I don’t do general surgery anymore

Two words: Necrotizing pancreatitis.

There’s nothing like repeated trips to the operating room to scoop out bits of dead pancreas, trips sometimes so frequent that we leave the abdomen open to facilitate repeat visits, in patients who are about as sick as any patient you’ll ever see. There are few, if any, problems in general surgery more challenging, and saving such patients gives an enormous sense of accomplishment. It’s also one area that distinguishes general surgeons from all other specialties. There’s no other surgeon or internist who can handle these cases. When the pancreatitis really gets too bad for the gastroenterologists to deal with, general surgeons are the docs of last resort.

Unfortunately, I’ve learned that, at least in my case, taking care of such critically ill patients is not compatible with running a successful laboratory and maintaining its funding. If my funding ever lapses and I’m forced to return to my surgical roots, these are the sorts of cases that could be waiting for me.

Comments

  1. #1 PalMD
    September 23, 2007

    Im only an internist, but as I recall from medical school, the cardinal rules of surgery were, “if it looks like a chair, sit in it, if it looks like a doughnut, eat it, and don’t f*ck with the pancreas.”

  2. #2 Aggravated DocSurg
    September 23, 2007

    C’mon, Orac, it’s just like riding a bike! I’m quite sure you could pick this kind of case up and run with it, along with treating necrotizing fasciitis or draining supralevator abscesses, if you really wanted to!

  3. #3 Sid Schwab
    September 23, 2007

    We kept a sterilized large soup-ladle in the OR for scooping out the lesser-sac rot. Many trips; colonic/gastric necrosis; splenic artery hemorrhage; brittle diabetes; sepsis of the most refractory sort; seen it, done it. And you’re right: general surgery is the court of last resort, and not just for pancreatitis. C’mon back: the water’s fine. If a little hot and salty.

  4. #4 Joanne Guimond-Thompson
    September 24, 2007

    The science of caring is slowing going by the wayside…while the science of technology takes over nurse’s time. Little time left of most shifts to actually interact with patients as distributing medicines, dressing changes, runs to pharmacy and labs, many telephone calls to physicians, labs, radiology etc. take up most of our time. Then we must chart….using complicated systems which entails hours of useless “charting by exceptions”. Most nurses do all of this and then resort to detailed nurses notes to cover all of the important issues not adequately contained in the computer system….nurses do not have time to be nurses….we are losing the ability of our hands and touch to make a difference… Patient satisfaction scores are low…only higher than the nurse satisfaction scores….a nurse & patient advocate

  5. #5 jeff
    September 27, 2007

    i earlier commented on Aggravated DocSurg’s post on necr. pan,
    (http://docsurg.blogspot.com/2007/09/dr-phibes-meets-pancreas.html)

    seems like coping with a pt. w nec. pan. isn’t easy at all. patience. time. understanding. meticulous debridement. oh boy.

  6. #6 Bovis
    September 29, 2007

    Great blog, keep it going !

    BO

  7. #7 beajerry
    September 30, 2007

    You could make millions inventing a Panc-Vac!