Doing (Surgery) Unto Others

A contribution from MS3 Peyton Hanson:
“Pull it fast or she’s really going to hate us,” I hear from over my shoulder as I reach for the Jackson-Pratt (JP) drain hanging out of the patient’s left breast. The voice belongs to Dr. Barb Pettitt, Director of Surgical Education at Emory and mentor to every surgical student that walks Emory’s halls. Her hand rests on my left elbow ready to intervene in the event that I stray from her directions. I turn my head to nod affirmation - I have pulled drains before but as a medical trainee I have grown used to receiving repeat instruction. As I turn I catch a glimpse of the patient’s daughter, pensive and clutching her purse on the other side of our 8x8 feet clinic room. Her eyes are fixed on her mother, who lies disrobed from the waist up on our exam table. The patient is a 84-year-old woman who underwent de-bulking of an extensive breast mass by our team 10 days prior. 

She is here for her first follow-up appointment to have her sutures cut and the JP drain pulled, which is often placed at the end of an operation to drain excess fluid from healing tissue. Pulling a drain after 10 days is no comfortable affair, as the body has begun to heal and form adhesions to the drain. These adhesions do not break painlessly.  As I turn back to face the patient, she clutches my scrub top with her arthritic right hand and winces in anticipation of what is to come. ​ Des, our faithful translator, speaks calming words to her in Creole as I tighten my grip on the drain.

“Okay, now pull it and don’t stop,” Dr. Pettitt commands. In one fell swoop I pull the drain and place gauze over the wound it left behind. The patient yelps and gives a retaliatory yank to my scrub top. She pants her breaths and whispers “Merci, merci,” relief showing as the pain passes by.

It is moments like this encounter with a patient and her daughter that have struck me most during my first time here in Haiti. The daughter was her mother’s primary caretaker and was present for every step of her care with us. She had brought her mother to us to help alleviate her suffering. The patient and her daughter placed faith in us - people who do not look like them, do not act like them, and do not speak the same language as them. They trusted us to cut her open. They trusted we would do our best. And they have trusted us to take care of her after surgery. We are foreigners to this country and this city and have been granted an incredible trust by the people of Pignon that we will do unto them as we would unto ourselves, our mothers, our fathers, our siblings, and our families.

This thought caused me to ask a series of questions to myself over the next few days - how would I feel if a group of foreigners came to my hometown of Toccoa, Georgia, and were performing surgery on my own mother? How would I want them to treat her? How would I want them to act towards us? Would I wonder what their intentions were?

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As I pondered these questions I came to a few conclusions. I expect that they will not be groundbreaking to most readers, but I have compiled a few here as best as my limited writing talent and public school education will allow me. The first thing is that I would want them to follow-up on their work and not skip town as soon as the surgery was done. I rest easy knowing that this is something that the month-long nature of our trip allows plenty of. Most days in clinic are filled with encounters like the one I described above - seeing patients to follow-up their surgery, cut sutures, pull drains, etc. Our team is very proud of this follow-up care.

​I would want them to stay within their scope of practice and to perform surgeries that are of practical help.

Dr. Paul Parker, an old warhorse pediatric surgeon who has frequented this trip, explained it best when he told me, “We don’t get excited for hernia repair back in the States, but here these people’s livelihood depends on their ability to perform manual labor, rendering the hernia repair of utmost importance.”
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Most importantly, I would want them to work humbly, treating my family and my hometown with respect and dignity.  For this thought I must give due credit to Dr. Carla Haack, an Emory acute care surgeon with whom I got to operate this week.

At the beginning of each case, she would end the call to order by saying, “and we are here to care for this person with as much love, dignity, and respect as we would our own family.” If someone were to perform surgery on myself or my family, I would undoubtedly hope that the surgeon would refocus the OR on this objective before the case begins.
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Admittedly, I had hoped to come to Pignon to find answers, such as how to care for patients in low-resource settings and how to be a better student of surgery. But I found that I have left with more questions than I have found answers. How can I serve these people best? What improvements can be made to the care we provide, as myself and my student colleagues begin to plan next year’s trip? And most importantly, how can we best do unto others as we would have done to ourselves?