Body and Patient Pieces of a Complete Disease Puzzle

On my last day of rounding with Surgical Oncology, and of HIP, the continuity of patients in the hospital made me feel like these were almost people I had come to know. I was aware that a patient I had seen on the first day, now required us to put on full contact precautions before entering her room, as it now seemed that she had developed C Difficile, a common hospital acquired infection. It felt so difficult to see this patient who we all had so gladly and easily visited before, now gowned and gloved just to walk into her room. I can only imagine how ostracized she felt, but yet, hearing her speak I knew just how much she wanted to know for sure that she had C Diff as she was anxiously awaiting the ability to be treated for her debilitating diarrhea. I also humbly entered the room of the young patient I had mentioned before who walked around the floor for exercise on the first day. By finally feeling comfortable enough in my role on the team and in the medical hierarchy, I was able to ask a medical student about her case, and quickly learned that she was not there for cancer, but instead, for multiple bowel surgeries that had prevented her from being able to eat. I had assumed that since she was on the oncology floor, being rounded on by oncology doctors, that it must be cancer, but I soon realized that I was wrong in my assumption and in my labeling. However, her actual diagnosis (ie. without the dreaded label of "cancer")  did not make me feel any less sad as I looked around her room, the “homiest” of rooms I had been in with pictures and paintings on the wall, music playing, and even a Reese’s pillow on the bed, and saw her mom sleeping on the couch. I even began to wonder what my family would feel and do in such a hard illness situation.

Besides finally feeling more of a part of the team and included as part of the patient’s continuity of care, I also learned how the pieces of the body come together to make up the pathology of illness and ultimately, lead to our disease. At first, we spent time watching a cardiac surgery (only about 45 minutes of it, but still I saw a beating heart). In this surgery the resident removed a vein from the leg of the patient to later be put in his heart and I watched as he sutured the vein and checked the vein for leakage. I had never seen just a vein up close and had never thought about the ability to remove and reposition a vein, but, it made me think about the many ways surgery has evolved to use our own parts to help us heal ourselves (even in plastic surgery cases). We then spent some time in both surgical pathology and autopsy labs (doing a lot of touching of internal organs). In surgical pathology, we looked at removed diseased organs and guessed what organs they were (only further acknowledgement of just how little we actually know). The hardest examples for us to ascertain were a placenta and breast tissue, as we threw around organ names completely removed from the reproductive system. In most cases, we could clearly see the tumor within the field, and knew that by surgery perhaps, the surgeon had helped cure, or at least prolong, the patient’s life. Yet, as finding the breast tumor in the mastectomy was difficult, we did question whether the complete removal of the breast was actually needed. Later, we saw two trays of parts from diseased patients and were shown just how the body can give clues to the cause of disease (unfortunately only when the patient has died). We learned how like a puzzle these clues help the pathologist give closure to a family and know the cause of a lung distress or the ultimate beginnings of a metastasized cancer. These cases further suggest just how much of our disease is the pieces that make up the whole, and how, just like the sociocultural aspects of a patients life, these biological pieces cannot be neglected.