Gyn Onc

I'm exhausted to the point of incoherence, so this will of necessity be brief.  Gyn onc is, in some ways, a sad but fitting bookend to the experiences of labor and delivery.  In L&D, the patients are new mothers and their children as they make the transition from "unborn" to "born."  Every day is an encounter with the miraculous; every day is filled with lives just starting out.  In gyn onc, however, the spectre of death is very real.  One quick story for purposes of illustration.  Prior to heading into the OR for her surgery, I quickly met and introduced myself to the next patient on the schedule.  MRI had shown an endometrial cancer in her uterus, and the uterus needed to be removed to ensure clear margins.  She had been scheduled for a laparoscopic hysterectomy, and since she was nulliparous (no children) and hadn't had any prior abdominal surgeries, it figured to be a quick and easy case.

Of course, Linakis's First Law (coined by my father) states that "the plot ALWAYS thickens" and this case failed to become the first known exception to said law.  I had scrubbed in and was watching the procedure.  The attending was saying that it probably wasn't going to turn out having been worth scrubbing for; he correctly pointed out that during a laparoscopic procedure you can generally see as much from halfway across the room as you can with your hands on the operating table.  Less than five minutes after he made that comment, he finally located the uterus among all the abdominal adipose tissue.  It should have been normal-looking.  It was not.  A large gray-white tumor was clearly protruding from the top of the uterus.  Immediately things became more serious.  This was no longer a quick and easy procedure that could be done laparoscopically.  She needed a laparotomy; that is, her belly had to be fully cut open so that we could go searching to see whether the cancer had spread.  Still, though, we were hopeful; if this protruding tumor was an isolated lesion, the patient's odds would still be pretty good.  That optimism lasted an even shorter time than the laparoscopic attempt.  When we opened her abdomen, we found small, nodular tumors everywhere.  Her omentum (a large fat pat in the belly) was liberally spotted with metastatic disease.  The colon appeared to be involved.  And all of a sudden, the once quick and easy case had turned into a nightmare.  Don't know who had to discuss our findings with the patient, but I'm glad it wasn't me.  Please keep her in your prayers tonight; the prognosis is (obviously) pretty poor.

Anyway, that's it for me.  It's time for bed; up at 4 tomorrow to start work at 5.  Yay.  Oh well, at least I have a good team!  Back with more updates in the evening.  Till then, peace and God bless!