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Surgical Reflections
Rachel Elaine Chamberlain
The first time I saw a mastectomy, I was shadowing a surgeon, a high school friend’s father, and I was 20 years old. I went home and cried that night - I had not expected it, but seeing a woman have her breast removed, a beautiful part of her that defines her sexuality, was very upsetting to me. In the years since then, I have learned a great deal more about breast cancer - the different types, about how catching it early can save the breast, and about where it metastasizes to. I have also learned the mortality rates for different stages, and I have come to realize that for most women, losing a breast is much better than losing her life. However, none of this prepared me for what I would see on my Burn Surgery Rotation.
I came in one Monday to the Burn ICU and learned we had a new patient - a 45 year old woman who had gotten a necrotizing soft tissue infection and had to have tissue removed from the majority of her abdomen below the umbilicus, her perineum including her mons pubis and her labia majora, and part of her buttock just next to her anus. As I was reading about her surgery in Carecast, my resident came in and said with some hesitancy “Um, we have a new patient - a female with a necrotizing infection, they took her to surgery last night and . . .”. I replied saying I knew, I was reading it. We saw the patient that day on the Burn services Wound Rounds, when the surgical team takes a look at the patient as the nurses are changing the dressings.
I can say without tentativeness that this is the most disturbing thing I have ever seen happen to a woman with my own eyes. Unlike a mastectomy in which part of what defines a woman as a woman in our culture is removed - this poor woman has likely had her very ability to enjoy sex cut off. Not to mention that if she survives and the burn team is able to apply skin graft she will have only her labia minora surrounded by scar tissue.
Later that week I was on call and was talking to a resident about the burn service and as I was telling him about this necrotizing fasciitis patient he said, “Oh, you have the vagina island patient.” I hid my uneasiness at this comment and laughed and said something like, “Yes, it is really gross to see.” But the more residents and students I talked to, the more I heard this term, and the more I thought about whether it was appropriate or not. The burn team consists of the Attending, two PA’s, and a resident - all males; and me, the only female on the surgical team, and I am just the student. This put me in a unique position to be my patient’s advocate and I would check on her whenever I had a free moment, even if to just ask how her TV shows were that day or to hold her hand for a few minutes.
Yet I began to understand why people begin to use names like “Vagina Island.” Describing the extent of my patient’s wounds became tolling - not only does it take much longer, but psychologically, describing her defect in full was much harder because I had to think about and picture what had happened to this woman each time. Using a shorter description pulls on your emotions less, and on a service like Burns, when all your patients are going to be severely scarred in some way, sometimes being less emotional helps you get through the day. So while I am not totally comfortable with using slightly derogatory descriptions of patients, I feel that in the first month of surgery, I have come to at least understand them. I am not so naive as the young undergraduate student who cried when she saw a mastectomy that likely saved that patient’s life, but I am also not so jaded as to completely ignore the debilitating impact that patients may suffer from a surgeon’s knife. |