Inspired in the OR

Midday on an ordinary Thursday in the OR. I was on my Lower GI placement that week and I spent all day in the op theatre, attending back to back operations and occasionally getting to hold a retractor or two. The operations were as usual, fascinating and riveting: The day was a smorgasbord of different types of colorectal surgery: your hernia repairs, hemicolectomies and what nots. The budding doctor in me was all wide eyed and awestruck watching these badass seasoned surgeons dissect, mend and craft these patient’s insides to get them as close as possible to “as good as new”. I still don’t get how these surgeons do it. The poise,the skill, the precision, the power, the confidence. And the trust, faith and hope that the ailing patients put in the adroit hands these competent doctors who had mastered their craft. Knowing the accident-prone, clumsy me, I’d probably end up dropping half of the surgical instruments on the floor, accidentally poking and cutting the other surgeons with the remaining ones, slit the wrong arteries and then realise I’d forgotten the scalpel in there after sewing up. Oh and not to forget the possibilty of nearly fainting at the end. I have almost passed out more than once while assisting in the OR and have had to be all lame, sit down and sip soda water. The smells, the heat, the stress, the standing still, the anxiety inducing sterility-preserving snappy, snarky op nurses…is enough to make a poor soul like me feel all wonky. Yeah, no, there’s no budding surgeon in the future of this doctor. Anyway, I digress.

The next operation we had was a herna repair, a pretty simple and standard operation usually done with the patient under general anesthesia.  Due to reasons I’ve now forgotten, the doctors chose to operate this patient under spinal anaesthesia. Let’s call this patient John. John was totally wide awake during the whole procedure. I chose not to assist this one and stood instead on the anaesthetist’s side, by the patient’s head. On a footstool of course because I’m too short to save my own life. There I was sticking my head over the drape and looking into the operating field as the dexterous surgeons tinkered away. I then thought of how weird and scary it must be for this patient to lie there, helpless and wide awake as the doctors cut into him. I shifted my focus to him and seeing his anxious expression, I struck a conversation with him. “I can imagine how strange and anxious you might be feeling right now. Don’t worry you’re in good hands, we are here for you.” He smiled, and admitted that it undeniably felt weird and scary to go through this. The mindfulness bug inside of me begged me to continue talking to help him unwind. I tried to restrain myself from blurting out unsollicited, preachy advice. I went back to focusing on the op: the hernial sac, the inguinal ligament, the spermatic cord. I know that surgeons have mastered the art of dissociating the actual human person from the body parts during surgery. The moment a surgeon ponders on the humanity of the person on the op table, he or she loses focus and feels pressure to perform and potentially setting him/herself up for failure. But the urge in me to help this alive awake and breathing person who was possibly scared and worried, was much stronger. I had to say something. “You can maybe focus on your breath and relax.” The words seemed to help him. That gave me the momentum to go on. “You can let go. It’s hard to relinquish control over the situation and put your life in others’ hands, but the more you resist and focus on the discomfort, the more stressed you’ll be.” That’s when the energy shifted. He said. “Yes. I know, I’ve learnt to focus on my breathing during uncomfortable situations and focus on the present moment. It’s hard, but I am working on it. Acceptance is the key.” Those words were like music to my ears. I lit up with excitement. In my head I was like: “He gets it! He totally gets it!!”

I excitedly went on. “Yes, exactly! Acceptance, non resistance and being in the now is freeing! Have you heard about Mindfulness?”. “Yes,” he replied, “I have recently taken up mindfulness and meditation and discovered different layers of my psyche. I have learnt to rise above the different situations and stay at peace. No matter what happens on the outside, it’s how you deal with it that counts.” By this time, inside my head, hundred of bells were chiming in unison, overjoyed by this exhilarating conversation. “Oh my god, this is exactly the message I try to share with others. I want others to realise that happiness lies not on the external circumstances but on our internal joy. But you are already a pro at this!” He then went on to tell me how he was diagnosed with prostate cancer a few years ago, how that was a dark, scary, low point in his life. He dreaded the solitude and alienation that came along the diagnosis. That’s how he discovered meditation as a path to find himself and his inner core of serenity admidst the tragedy of cancer. Silence in the chaos. A lull in the storm.

I believe that the reason cancer has such a bad rap is knowing you’ve been sentenced to death. With the quintessential Sword of Damocles hanging over your head, unaware when your time will come…when the angel of death, the Grim Reaper, will knock on your door. Living in a constant fear and anguish of imminent death lurking round the corner must be torture. We’ve heard of people being diagnosed with a cancer of a poor prognosis and low 5-year survival rate. But they then end up living many years, some even a decade. And all the time enduring each day with the dark shroud of cancer over their head, expecting to die any minute. I’m of course talking about cases where there is no more that can be done, for example recurrence of an aggresive cancer after rounds of chemo, radiation or surgery  or abstaining from treatment due to poor prognosis, such as a frail elderly patient in the late stages of the disease or even a younger patient with an agressive cancer and advanced metastatic disease. I’m not referring to the curable or treatable cancers with good 5-year survival rates.

Different cultures deal with cancer and end stage illnesses differently. I have seen many relatives of elderly patients of foreign backgrounds (South Asian or Middle Eastern) trying to shield their beloved one (the patient) from the truth of the diagnosis so they don’t get affected. But in Western cultures, such as here in Sweden, the patient-doctor relationship requires a doctor to tell the patient of their illness no matter how bleak the outcome. There is no wrong or right, of course. Sometimes I wonder, however – and I’m sure many others share my point of view – if it would have been better to live without knowing you are going to die. Embrace the bliss of ignorance.  But then again, those not sentenced to looming death would not know of the importance of cherishing what is left of their life, savouring the the happy moments and enjoying the beauty of their remaining days. They would just go on with their everyday mundane 9-5 lives, with the same routines and petty worries, sweating the small stuff, that in the big scheme of life, do not matter one bit.

How, then, do you live and enjoy the remaining beautiful moments when you know you are going to die soon? How to enjoy the joys of life admidst a grim, torturous verdict? The key is ACCEPTANCE, one of the pillars of mindfulness based stress reduction (MBSR). Once you overcome the agony of unescapable death and reach the point of acceptance, you end up realising the true meaning of life. One realises the triviality of mundane material things and begins to see the daylight: The true value of love for our near and dear, the significance of appreciating the beauty around us… the beauty of a sunny day, the smell of fresh flowers, the wam embrace of a cup of coffee. Basically finding joy and wonder in the little things around us.

As I stood in that OR, on my little footstool by the drapes separating the operating field from the patient’s head and neck, as I was trying to distribute my attention between the physical body of the patient and the soul of the person I couldn’t stop thinking “Yes, he gets it. John totally gets it.” He was enlightened, at peace with himself and had unlocked the key to living a blissful life. Yeah, I had to face it, I had my heart set on the actual person and his soulfulness, and at that moment I lost interest in the patient’s actual surgery.

There he was, having been diagnosed with prostate cancer, undergone surgery and coming out on the other side of it, five years later, alive and kicking, unscathed and totally at peace…despite even after all this having to deal with his current fate of having an annoying bulging hernia in his stomach wall. I’ve seen many patients go through a panoply of illnesses, big and small, occuring simultaneously or in sequence, and be defeated and sick (literally and figuratively) of it all. They end up drowning in the sorrow of self pity and victimisation. Sometimes having survived a big life threatening illness, and then being slapped with the tiniest affliction is enough to push one over the edge. It may be the last straw, “la goutte qui fait déborder le vase”, as they say in French (the drop of water that makes the vase overflow). “After going through all of that, now this?! Why? Why me?!” they may ask in desperation. But no, John was totally cool with it all, he had accepted his fate. He realised that suffering is only brought about by resisting pain. He knew that there was nothing to lose, because at the end of the day, you never know what is awaiting you in the future. No one knows when exactly your time will come, so might as well deal with the curveball, and still be unyielding, not budging, like a rock by the shore, unhinged despite the unabated crashing of the waves. Of course he was a bit nervous as he lay there on the operating table, paralysed and powerless, but who wouldn’t? But he accepted his vulnerability and dealt with it. And of course the inspiring conversation about the wisdom of life and mindfulness with the little doctor did help. As the operation drew to a close, I told him, “This has been one of the most inspiring conversations I’ve had. Thank you for sharing.” I then realised that we’d been talking non stop for about half an hour, in the middle of the OR, with all the op nurses, the anaesthetia team and surgeons in the room. They probably thought I was cuckoo, talking about weird woo-woo stuff. I don’t know (nor was I concerned) if a doctor was even allowed to have this type of conversation with a patient, but in that moment nothing mattered. I’d lost track of time, space and my surroundings as I dwelved into this stirring, uplifting exchange.

Moral of the story? Acceptance, Non-resistance, Presence. Never stop being in wonder of the charm and grace of everyday life, no matter what you’re going through. After all, you never know what’s going to happen tomorrow.

Love, light and all things bright,

Dr Happiness

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