The 2014 RAS-ACS
annual essay contest:
“Sometimes it has to come from an old man with white hair,” explained Dr. Wilson. With that, we set out for the patient’s room.
Dr. Wilson filled an already crowded space. He
introduced himself to the worried siblings and terrified mother. The patient lay in bed, stoic; his leg was
before him, splayed open with muscle bellies bursting
from linear wounds. He had a missed vascular injury;
smooth skin concealed a torn vessel. He called out in
pain, but the referring hospital’s unfair assessment mistook pain for a budding addiction.
“Your leg must come off. I am sorry. You may not
live if it doesn’t,” Dr. Wilson informed the patient.
Those were the facts. They spilled into the room
like the tissues freed by fasciotomy. Fear seeped in, as
did the realization that the man with white hair was
right—there was only one way forward. So ended an
afternoon of deliberation; the patient, only 17 years
old and a basketball player, would face life without
Consents were shuffled, and then there was ink-stained skin with a surgeon’s initials—a requirement
in Canada to mark the patient prior to surgery. There
was a Foley, positioning, pink prep, and sterile drapes.
When the saw appeared, I felt nauseous. It was routine until the saw. The discolored and dying muscle
demanded the saw.
Dr. Wilson stared directly at me, perfectly still.
“Everyone has patients they don’t forget. He will
be one of yours.”
I felt sick. This was supposed to be my place: calm,
sterile, and known—where wrongs are righted and
offenders, such as tumors, are excised. I steadied the
patient’s foot as it shook under the assault of the saw.
I turned away when we dropped it into a specimen
bucket. Our patient turned away when we lifted the
sheets to reveal the stump.
I left the operating room for a dimly lit call room.
My TV dinner cooled and solidified on the desk before
me. I couldn’t believe what we had done. Our wound
would be with him for forever. He would try to hide
it with baggy clothes, and he would hesitate on prom
night, self-conscious of how his body had changed,
because of it. It would haunt us—both of us.
A tear rolled down my cheek. Maybe I wasn’t up
for this. When we had wheeled him into our room,
under the bright lights, I had seen barely bridled terror. We were mask-wearing clipboard holders who
had betrayed him. A slower exam might have noticed
the pulse that slipped away. What if it had been me
that judged him wrongly? Was I ready for these high
When our bloodshot eyes met again on morning
rounds I realized I had changed. I saw that I had the
opportunity to be something I had always wanted to
be. Surgery is more than incisions and knots—it is
also wounds. I carry this patient’s wound with me.
It makes me hesitate before I dismiss a symptom or
a patient’s plea. It makes me sit so patients can see
my eyes, and it makes me use my hands to hold other
hands just as readily as I hold scalpels. Being a surgeon
is a tremendous privilege, and I am grateful for it.
wound I carry
by Carla Pajak, MD