the split-second pivot

It happens often in surgery, the need to pivot from a pre-determined course. Many factors force these moments, for example, bleeding, unexpected findings, or here in Honduras even the lack of certain tools can bring me up against a wall and I need to find a way around.

Yesterday, I was harvesting a bone graft from a patient. I was working with dull tools so the task had required some significant effort, but in the end we were rewarded with some nice bone graft to use. The Honduran tech helping me on the case was Sergio, and moments after setting our little cup filled with bone graft down on the table we heard a sharp clang. Sergio had accidentally knocked the cup off the table. Looking down I blinked trying to pretend that all our nice bone graft wasn't in a pile on the floor. I didn't get upset, it was very obviously an accident, but I could tell that Sergio took it personally. He was down-cast the remainder of the case. I did my best to be cheerful in an effort to reassure him, but he still seemed disappointed at the end of the case. This morning my thoughts are still periodically circling back to that case, to that pivot. I worry about the patient, his healing and hoping that what we were able to do was enough. But I also worry about Sergio, praying that he still isn't blaming himself. I don't like to think that any of our OR staff is unhappy.

I'll share another example of the pivot from this past week. It's not my pivot, but still a significant example. There is an OB/GYN, Dr. Michael, visiting and in preparation I did not plan for any elective cases. So when I am not taking care of emergent cases, I join him in order to learn and expand my own skill-set. We have been able to already do a handful of cases for women with fibroids. See below for one example.

very large fibroid

Dr. Michael, had a fibroid case, early this week before I could join him. A young 30 year old, who had never been able to get pregnant and desired children. To hear Dr. Michael tell the story, he had attempted removal of a few fibroids but with closer examination of the wall of her uterus. The disease was so extensive, to remove all of them would essentially result in complete removal of the inside lining of her uterus. She would never be able to carry a pregnancy, and therefore he pivoted and performed a hysterectomy, removing the diseased uterus in its entirety. He kept reiterating that he had never seen the like before in all his years of practice.

Some pivots are easier to accept than others. Some get replayed on repeat, looking for alternative options, maybe better options. But in the end, the split-second decision was made and there's no changing the outcome now.

Pray for the patient's being helped by Dr. Michael this week and the next. Pray for their healing both physically and in the case of the 30 year old lady, mentally and emotionally as well. She too will need to pivot.

Pray for our OR staff as we are in the run of some very busy weeks. After Dr. Michael, there is an ENT team coming for a week. The energy to keep moving and keep smiling, and an extra blessing for all their hard work. And an extra prayer for Sergio, the grace to know that he is a very good tech and takes such good care of patients.

Much love.