“Are you like Doc McStuffins?”
I look down into a pair of bright, inquisitive blue eyes framed by thick black lashes. My first pediatric patient is sitting on her stretcher in a Care Bear-covered gown, her arms crossed. She is clearly auditing my credentials to see if I measure up to her animated hero.
“Kind of?” I offer. Her lips immediately purse into a skeptical pout. I sit on the edge of the bed and pick up her stuffed beaver. “What’s this fella’s name?”
“That’s Justin. My aunt gave him to me for my birthday.” She snatches him back, clutching him to her chest.
“Ah. Justin Beaver.” I make a mental note that her aunt has an excellent sense of humor. “Well, would you like Justin to come to the operating room with you? He needs his tonsils removed, too.”
“Can he? Then we can match!” She beams. “But, are you as good as Doc McStuffins?”
She waits, arms crossed.
“‘Don’t be afraid — the doc really knows her stuff!'” I tell her in my best sing-song voice.
The lyric from the theme song slips out of my mouth, unearthed from some deep, cluttered corner of my brain. All those hours role-playing with my children — where I was always the patient and never the doctor — finally paid off. “It won’t hurt at all,” they would tell me as they poked me with surprisingly sharp toy syringes. Liars. It did hurt.
She relaxes a bit and picks up the coloring sheet: “Do you want to see the unicorns I drew?”
“Absolutely!”
On the operating table, the child’s eyes are covered with a blue towel, mostly for protection. The dehumanization aspect of only exposing the operative field is a bonus. Somewhere along medical and surgical training, we’ve all learned to compartmentalize and engage in just the right amount of dehumanization. Besides faces, hands are the hardest for me. People’s stories are etched on their hands — a faint tan line from a wedding ring, a set of perfectly manicured, bejeweled nails, and a faint yellowish nicotine stain around the index finger and thumb. I have to look away and focus on my craft, the task at hand.
I crank the mouth gag open, a device that resembles a medieval torture instrument that suspends the child’s jaw. A tonsillectomy can be as routine as a walk in the park 99% of the time, but 1% of the time it is as horrendously bloody and sphincter-tightening as “The Texas Chainsaw Massacre.” Given her history of recurrent infections and recent abscess, I knew this was going to be a challenging one. The pediatric population is even trickier, as their carotid artery is just a centimeter deep to the tonsil bed, and there is nothing more humbling than staring at a pair of synchronously pulsating tonsils.
Since having children of my own, dehumanizing my pediatric patients as they lie on the OR table has become harder. It’s not just seeing the same Spider-Man socks that my son also wears, or the same Jellycat stuffed toy my daughter can’t sleep without. It’s the soul-deep love I reserve for my kids — the same love bestowed on the kids on the table — that reminds me how much is at stake.
I dip my finger in a blob of translucent lube and apply it around the corners of her mouth, not a routine part of tonsillectomy. But with the mouth gag in place, the corners of these little lips often crack, and I can’t stand it.
Halfway through the case, a large intratonsillar abscess bursts, obscuring the field. My shoulders tense, and my posture stiffens. Following a few more swipes of the Bovie, blood pools faster than I can evacuate it. Each time a char forms from the cautery, the bleeding starts anew around it. Stubborn. Scrappy.
I ask for an Afrin-soaked cotton ball, a tamponade of sorts. I watch the long arm of the clock drag itself 360 degrees across the face, forcing myself to be patient. Without the clock, my typical surgeon’s distorted time continuum would have said, “Yup! That’s been about a minute,” after applying pressure for 10 seconds.
It slows the gush down to an ooze, one I can manage and work around. I shake out my hand for a brief second before re-grasping the clamp, unaware of the tightness of my grip. I huff a sigh and continue.
While I not-so-patiently wait holding pressure, I release the gag momentarily, which has turned the tongue a deep shade of purple. As soon as the mouth gag loses pressure, the rush of pink perfusion returns to her little, chubby tongue. My mind drifts while holding pressure, wondering if she is one of those kids who lick and never bites a popsicle. There is that failure of dehumanization again.
I swipe away the intrusive thought before it can remind me that it’s not the tonsils that are bleeding, it’s Justin Beaver’s overly protective owner, who is holding out on her verdict about whether I measure up to one cartoon doctor in pigtails.
“Your days of plaguing this beautiful girl are over!” I say, as I finally plop the tonsil onto the Mayo tray, with a bit too much vitriol. Yes, I’m talking to a specimen, as I may have starved a few brain cells while holding my breath.
I put a mask and purple IV gauze on Justin so he can convalesce with his owner and trudge to the waiting room to meet her parents.
I used to think successful surgeons needed a certain amount of emotional distance. Then I had children. Now I notice the Bluey T-shirts, the fidget spinners, and their tiny teeth when I release the mouth gag. My thoughts linger on the stuffy in their tight grip and the anxious parents in the waiting room.
The dehumanization no longer comes as easily. And that's a good thing. I am always reminded of what’s at stake. I have become a better surgeon because I am a mother.
How has humanizing your patients helped you to practice better medicine? Share below.
Previously published on Substack.
