Wednesday, July 23, 2008

tickin' on down life's poop shoot

current time: 9:40 pm on wednesday july 23rd. current mood: giddy. the source of my child-like giddiness comes from the most unusual of places. the ice cream man, you might guess? nope. a fresh batch of puppies? huh-uh. hannah montana? not even close. the elation and excitement pouring forth from my being stems from a colon. yes, you read it right. a large intestine. a crap canal. the long squiggly thing that connects the small intestine to the poo hole. at precisely 7:15 tomorrow morning i'll be meeting my uncle at his office at memorial hospital where i will then be wisked away to the ladies' locker room, outfitted in scrubs (YES!) and taken into surgery. and while the details of the exact procedure are still a mystery, the fact that i'll be in the OR watching someone get sliced open is enough to send me over the moon.

friday, july 11th, was my last official day working at 20th century fox. the feelings were certainly bittersweet, but i have no doubt that all the "good" parts of that job will carry over into my life, like the people, for example. they will all be in my life in one way or another. but i couldn't stay for other people. it was my time for me to move on. i knew it. and the Lord knew it. and He made no bones about telling me loud and clear to just...go. the daily duties of my job weren't exactly thrilling or fulfilling. i had hoped to go out on a film but after over a year, that desire had not come to fruition. it was no one's fault really, well unless you count Owen Wilson and the entire collection of Hollywood writers.

so, i left. partly because of my sedentary existence that was driving me crazy, partly because of the men's restroom that lingered a mere 5 feet from my sensitive nostrils, and mostly because i just knew that i needed to DO MORE. that feeling not only included dreams and aspirations in the world of entertainment, but also my medical school yearnings. i swear, the best way to describe my love-hate relationship with this medical school thing is to compare it to a puppy that wants to play SO bad and just keeps nipping at your heels. medical school is that puppy. i imagine it to be a little lab or retriever. sometimes i want to play with it and other times i want nothing to do with it (those are the times where a cute baby has stolen my attention away from the fluffy puppy). note: the baby here = entertainment.  after going non-stop in LA for 3 years, the abrupt halt into unemployment was a bit jarring. i decided to take a trip home to lake charles to visit them fam, relax, and hopefully catch a surgery or two...just to give the puppy a little treat (a beggin strip, perhaps).

i arrived home in lake charles on july 18th after a swift 24 hours in houston (that included hooters, the aquarium shark voyage, and my dad driving semi-intoxicated). my la pal, em rose, decided to come to lc-towne with me and experience the South in a new way. she, too, needed some R&R and, let's be honest, there's no place better to tick-on-down than right here in SWLA.

em rose and i had a great time. 3 days of non-stop action that was surprisingly relaxing. we took the moss megastation out on the lake, went tubing on the boat, fishing on the warf, and we ate ALL the time. total vacay. when em left, i was here...alone. when i woke up on wednesday morning without her here, i felt as though one of my arms was missing. lc town can get lonesome real fast. luckily, i had one major event to look foward to - a colon surgery. not my own. but one that might very well SAVE my life...
the time now is 3:10 pm on thursday, july 24th. (sidebar - x-files 2 comes out tomorrow, how excited are you!?) this morning, as i was eating my pepperidge farm cinnamon swirl toast, i never imagined that i would be sitting here able to say i held a human right ascending colon with a tumor. but them is true words! i met uncle ken in the lobby of lake charles memorial hospital and swiftly headed upstairs with him to the women's locker room where i got changed into scrubs. as soon as in donned the blue cotton duds and cinched the drawstring around my waist, i felt connected to something. i felt not only connected to family but also to a purpose. i imaged making that dressing or "suiting up" ritual a part of my daily routine. these mere pieces of cloth being the armor that i would put on to walk into battle with a foreign invader on behalf of someone else's body. ATTACK.
i walked down the hall around to the nurses station and looked for Cori, the nurse who was helping to prep the patient. i spotted her cap from down the hall (it had some festive little bears on it...or something) and she motioned for me to "come this way." and so i did; i follow directions well. she told me to snag a mask and hop on into the OR. as i tied the last knot in the mask around my face i kept thinking about how lucky i am. upon merely asking, i'm about to walk into a supremely private moment in one man's life - a moment that is literally life or death. i can't help but wonder WHY the Lord has placed this interest inside of me, this desire to HELP people, this love for science and the body? and WHY, with all of that...stuff...did the Lord nearly equally place inside of me this passion to tell stories and to create and write and appreciate art? when i'm on a set, i feel like there's no other place i'd rather be. but standing here, standing on the cold tile floor in the OR, machines pumping and beeping, nurses sterilizing and prepping scalpels and clamps, why here, now, do i never want to do anything but this?

the patient was awake when i walked in. he was alert. and scared. the anesthesiologist was getting ready to put him under as the nurses were prepping the body. as i walked over to the patient he began to fade away and within a matter of minutes he was gone. the "milk of anesthesia" had done it's job, along with a short term muscle relaxer. the nurse then began to shave the abdomen and the anesthesiologist asked me if i wanted to help to put a tube in. "yea!," i replied. "let me go get some gloves." when i walked over to the glove box, my uncle was standing there. i had been in the OR the whole time so i didn't really realize that my uncle had gone away to "get pretty" (as he calls it) and had come back in sterile. i put on my gloves just about the same time that he cracked a joke and, in what was an involuntary comedic response, i reached out and slapped him on the shoulder. oops. my bad. he looked at me and i immediately knew what i had done - touched his sterile gown. he made it not a big deal at all and just changed his gown and gloves quickly on the opposite side of the room. note to self: sterile means sterile. don't hate or contaminate!

i moved back over to the patient and placed my hands on a KY-lubed tube that was to go in through the nose and down the esophagus into the stomach. the anesthesiologist got it started and once it was in i took the reigns. i slowly slid the tube down, fighting a little resistance but nonetheless making it down the GI tract. every once and a while he'd have me stop and he'd affix a suction to a port to see if any green bile came back through the tube. that was a good sign (it meant we had arrived at our destination). once the tube was in, the cutting began. i'll be honest, i wish i could have made a few cuts but i think that might have been a little unethical. the primary midline incision down the right side of the abdomen didn't look incredibly hard. but once through the fact, tissue, and muscle we hit the mother-load as the abdominal cavity opened up. my uncle grabbed a retractor to open up the space for easier working conditions and the swiftly plunged his hands inside our patient. his hands were there one minute and gone the next, deep inside the body poking and prodding. one thing he was doing was feeling the liver to make sure it was clear of any palpable tumors. after that, it was time to find that damned tumor and remove its carcinogenic ass!

as the surgery progressed, my head bounced back and forth between the surgery in front of me and the anesthesiology going on to my right. (i was standing on a small foot stool at the patient's head). i was learning so much so fast. my mind had a million more questions but i didn't want to slow down the surgery at all (as i knew that the longer a patient is under anesthesia the more risky it is). i asked questions when appropriate and figured i'd look the rest up in my books (or on google). my uncle was voraciously attacking the right ascending colon, making sure to get all of the mesentery and "blood supply" components along with it. there were some really neat "tools" that he used during the surgery that cut so many "steps" out of what i can only imagine would have been a tedious process otherwise. one such tool performed in one swift motion a GIA (or gastrointestinal anastomosis). the tool literally bisected the bowel at the point where the right ascending colon meets the transverse colon and anastomosis (which means the connection of two structures - referring to connections between blood vessels or other tubular structures like the loops of the intestines) was done using a stapler with a 75mm cartridge. in seconds one piece of bowel became two, with both new "cut" ends already sutured shut. the sutured end of the transverse colon would remain in the patient's body, while the sutured half on the right ascending colon was about to come completely out. after a few more nips and cuts, the entire right bowel was removed and placed into a sterile bowl (this is the first "piece" of your large intestine that connects to the small intestine and also carries the appendix). when the bowel came out, uncle ken told me to go put some new gloves on and feel it. i was hoping he would say that! i trotted over and gloved up then picked up the bloody organ. it was quite large and slimy. as i palpated the bowel with my fingers it was very evident where the tumor was sitting. a hard, fibrous-feeling mass about 4 cm large. i was actually surprised that they had removed such a large section of the colon, but it makes sense, i guess. not wanting to leave behind any surrounding tissue that could be invaded and cause another tumor to form in the new area.

the nurse immediately called pathology and they were to do what was called a "frozen section" on the specimen. this means that the pathologist will immediately come up to retrieve the specimen and give an analysis right then and there before the patient is closed up. normally pathologists don't examine the tissues/organs until the following day but, in this case, there was a more urgent need for analysis. how is a frozen section made? A cryostat, a special microtome (fancy mechanical knife) refrigerated to -20 C, is sued to cut a froz en section, which is put on a glass slide, stained, and coverslipped for examination under the microscope. it was cool because as uncle ken continued to work, the pathologist spoke to him about the prelim results via intercom.

time to reattach the small intestine to the new bowel (now minus the right side). i won't go into extreme detail here but instead make it easy to understand. the GI tract (down to the poop hole) is basically like a system of connected pipes. if we think of it that way, it will make it easier to understand the new "system." i've also included a, shall we say, "rendering" of how it worked. so, the right side with the tumor is now gone. all that remains of the large intestine is what you see in GREEN below. also, notice where the small intestine USED TO connect to the part of the colon that is now gone (marked by the yellow/blue circle at the bottom. that opening to the small intestine will NOW MATCH UP with the yellow/blue circle on the wall of the TRANSVERSE COLON. uncle ken cut a small hole in the wall of the transverse colon that will match up with the mouth of the small intestine. now, this man has a new set of pipes!
as he was sewing up the new pipes, i simply stated, "man, now the way he poops will be a little different, huh. there's not as far for it to travel now." he said that i was right and started explaining how the changes would affect him. to understand that, i'll have to explain a few general body functions. first of all, the job of the large intestine (aka colon) is to absorb the remaining water from the bowel and turn it from a liquid to a solid (stool) form. the right ascending colon (which we removed) plays a major part in that water extraction. also of importance is the valve that resides at the intersection of the small intestine and colon (basically where that yellow/blue circle is above at the mouth of the small intestine). this valve (called the ileocecal value) regulates the flow of undigested food (aka chyme) from the small intestine into the bowel as it opens and closes. since we've now REMOVED this important regulatory valve, undigested food will flow more freely and fluidly into the bowel. apparently people who have a problem with constipation love this surgery. i couldn't help but think about the people on the other people...the IBS people. yikes.

he sutured the edges of the mouth of the small intestine to the circular hole created in the wall of the colon. an inner and an outer suture. gotta make sure that baby is SEALED. wouldn't want anything leaking. not good. the suturing process was cool, too. i learned that there are two main categories: absorptive and non-absorptive sutures. some sutures are meant to, over time, be absorbed by the body as the tissues naturally heal in the process. then, there are others that are permanent. for example, those on the INNER seal of the small intestine/large intestine were absorptive (chromic sutures) and the outer ones were permanent (made of silk). so much to learn!

after it was all stitched up, it was time to "close." but before that could happen, a few warm bowls of saline solution were poured into the abdominal cavity. uncle ken explained that there is a limerick to recite to remember how to make sure to reduce the risk of infection. and it goes a little somethin' like this: THE SOLUTION TO POLLUTION IS DILUTION. basically, that means this - when the saline is poured into the abdomen, it finds small pockets of bacteria that are lurking around and "washes" them up and then the solution is sucked out.

as ken started sewing up the main midline incision, i realized suddenly that i was just a part of a life being saved. if not saved, certainly prolonged. i had an overwhelming sense of purpose - a feeling that people search for most of their lives. i pictured myself standing there, being the one in control, being the one to have the answers, to possess the skills. i could see it as clear as day. and i liked what i saw :)

the final staple was punctured into the stomach and the skin was closed. a job well done by all. uncle ken left the room to go and do his post-op routine (dictating the surgery, filling out meds orders, etc) but i, of course, stayed and tried to squeeze every ounce out of the experience. as the masks came off and the patient began to wake, it was over. i followed the bed form the OR to the Recovery Room, shook a few hands, and tossed my scrubs into a bin. as i put my street clothes back on, it took everything in me to NOT steal a set of new scrubs! not STEAL, but take to commemorate my experience. i didn't do it. but as i sit here, about to get ready to go to bed, i'm thinking how sweet it would be to put those babies on and crawl into bed. i think i'll have to talk to my uncle about snagging a pair of those beauts!

what am i doing right now, other than reflecting? oh, just watching HOPKINS on ABC...a medical show set at John Hopkins in Boston. (sigh) DEAR LORD - WHERE DO YOU WANT ME!????? PLEASE! observing surgery didn't PUSH me over the edge, but it certainly didn't make things any easier. i've decided that when i return to LA, i'm going to heavily start researching schools and programs and applying to post-bac programs. i can't start classes til next year anyway, so i'll have time to settle into a decision and keep pressing on doors in Hollywood. as long as i keep seeking God's will, i think either path will be blessed.

dr. moss
signing off


Jessica said...

I just read this whole thing (actually I'm not going to lie-- my eyes sort of glazed over for two or three paragraphs where you explained the medical doo-dah, but that's it!!) and you are amazing. I love you.

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