bypass

They tell us to look for patterns in medicine, in the way diseases work and in the way we treat them. One of our favorite things to do is to bypass. When a vessel supplying blood to the heart becomes blocked, we use other vessels to go around the blockage. Same idea with a block in the vessels supplying the small intestine. And when you don't want food going to the stomach, you bypass it by cutting off a point where two points of the stomach connect and reconnect the stomach to the small intestine instead. It all works pretty well, perhaps not quite as well as the anatomy with which we're born, but after the wear and tear of time and experience we cope the best we can.

Currently on my one month gastrointestinal surgery rotation, and have seen several gastric bypasses for morbidly obese patients. They were good surgeries to see; the abdominal anatomy is compact and clear. When the stomach is cut, you find the pancreas behind it. As you move horizontally to maneuver things, you find the liver and spleen flanking the stomach. And you follow the small intestine down to find the best place to cut, and to reconnect, saying hello to the large intestine amidst the surroundings along the way. Seeing things in real color (the spleen really is purple, and the pancreas off-white), and three dimensions makes for a pretty view.

Sitting in the back during a informational meeting for gastric bpyass patients also afforded an interesting view. Insurance typically covers this procedure once a person's BMI is greater than 40 (ideal being 20) and most of the patients I've seen run beyond 50. They suffer from an interaction between their physiology and their environment that makes it nearly impossible for non-surgical interventions to help. Interestingly, their internal anatomy is not so different from others. At one point, the surgeon giving the talk said all of our stomachs are the same size, "including that of my med student sitting in the back there." To my relief no one turned around to look at me, but I was grateful to be present. A secretary who'd had a bypass herself talked about the experience, the looking forward before she'd had it and the looking backward now that she had, while emphasizing that the process was never over. The surgeon went into detail about what the procedure entailed and what it demanded of its patients. People listened and asked questions.

Medicine so randomly throws you into the stories of people you might otherwise never consider, and being literally dwarfed in a corner of this room made me feel it pretty strongly. Seeing one bypass after another in the operating room fools us into thinking the stitches signify an end and numbs us to the change that's happening or will happen. But hearing an acknowledgment of the anticipation leading to this surgery and hearing the patients be told the long course of care that must happen after the surgery reminds us of context. There's a lot--a lot of work, thought, feelings--encased in a two hour procedure that for those in the operating room starts with an incision and ends with a suture. Up until then surgeries for us as students have been so open-shut, and part of why I feel out of place during the week is because I have nowhere to put what we see on a daily basis. Settling their organs and skin back into place still leaves a sense of intrusion that isn't fully reversed. From the room full of people hoping to become more by becoming less, I'm more able to place what I see back into the people themselves, and this isn't something we can afford to bypass.