Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

A patient gives the gift of poop

Allie Gips, MD
Conditions
February 15, 2019
Share
Tweet
Share

In broken English, against the backdrop of the emergency department’s chaos and clatter, Mr. Simon relayed his story: unintentional weight loss, gradually yellowing skin, weeks of constipation. He punctuated his list of devastating symptoms with laughter — exaggerated but genuine guffaws.

Over the next few days, as the medical student responsible for his care, I was also responsible for handing him piece after piece of bad news — an obstructing gallstone in his bile duct. Actually, an obstructing mass. Likely a malignancy. Chemo. Radiation.

With each update, he would grin. And then he would laugh.

Did he not understand me? Despite his heavily accented protests — “I’ve lived here for years! I understand English perfectly!” — when the time came to fill out the consent form for surgery, I insisted on using a Nepali translator.

“Pancreatic cancer,” she explained. To remove the growth, Mr. Simon would need a Whipple procedure. Step by step, the interpreter outlined what that procedure entails.

Mr. Simon chuckled. He waved her away. He smiled beatifically.

I studied for hours in preparation. Before dawn broke, I woke to a huge breakfast. For a medical student, the Whipple is the pinnacle of the surgical experience. It is a massive enterprise, involving the removal of half of the stomach, half of the pancreas, the entire gallbladder, the bile duct and part of the small intestine, all followed by careful reconstruction of both the digestive and biliary tracts. The surgery usually lasts around eight hours — ample time for the attending physician to grill me on minutiae. I peed twice before we started.

But Mr. Simon’s surgery took only half an hour. Before the cutting begins, the Whipple procedure starts with a diagnostic laparoscopy — a quick peek within the abdomen. In Mr. Simon’s case, that’s also where it ended.

His intestines, his liver, his abdominal tissues: All were caked with flaky white lesions. We biopsied several, dropped them into a sterile container and accompanied them out of the operating room as they journeyed to the pathologist.

The truth was just as obvious under the microscope as it had been to the naked eye. There was already too much cancer. It wasn’t worth continuing.

On our way back to the operating room, my attending gazed intently at me and my flooding eyes. She was in her mid-30s, young for a surgical oncologist, and one of the few women in the field.

“What’s the mortality after a successful Whipple?” she asked me.

I had studied. I was ready.

ADVERTISEMENT

“Um. The five-year survival rate is around twenty-five percent, I think.” I couldn’t look her in the eyes.

She nodded. “Correct! So, honestly, he was doomed anyway.”

For a few days, Mr. Simon was quieter than usual. He still laughed, but now, for the first time, it sounded fake. His smiles, once so broad as to be cartoonish, were forced.

He was the first patient I rounded on each morning. At 5:30 a.m., when even Manhattan lay dark and quiet, I would gently rub his right shoulder. Unlike everyone else, he never grumbled about being woken. Despite being more subdued, he was always pleasant, ready to answer my questions, eager to pull up his johnny so that I could examine his taped-up laparoscopy scar.

Except for this one morning, several days after our failed Whipple.

When I walked in, Mr. Simon was already sitting bolt upright in bed, overhead lights on, grin firmly in place. Giggling so hard that he could barely speak, he handed me a folded newspaper.

I opened the paper. It held a piece of poop. His poop. Medium-sized, firm, the color of clay. It was his very first bowel movement in weeks. He’d gift-wrapped it just for me.

He laughed and laughed and laughed. And, for the first time, I joined him.

We were both wary of our futures: I feared that my days were going to be spent in the company of people who believed that answering questions correctly was more important than experiencing human emotions, and he feared that his days were growing ever more numbered. It had not been a pleasant time for either of us. I felt tired, humiliated and belittled, and he felt exhausted, nauseous and alone. I was only one month into my clinical rotations, and I was already wondering if going into medicine had been a mistake.

But that morning, as the sun rose over the city, we didn’t think about any of those things. That morning, we focused only on the good sh*t.

Allie Gips is an emergency physician. This piece was originally published in Pulse — voices from the heart of medicine. 

Image credit: Shutterstock.com

Prev

The clinical and financial life of a pediatrician

February 14, 2019 Kevin 0
…
Next

Will medicine become a young person's sport?

February 15, 2019 Kevin 0
…

Tagged as: Emergency Medicine, Gastroenterology

Post navigation

< Previous Post
The clinical and financial life of a pediatrician
Next Post >
Will medicine become a young person's sport?

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Allie Gips, MD

  • Female physicians: You’re lucky to be here

    Allie Gips, MD

Related Posts

  • A letter to a cancer patient in palliative care

    Alison Vasa
  • Happy National Grateful Patient Day!

    R. Lynn Barnett
  • My first patient to be diagnosed with cancer

    Ton La, Jr., MD, JD
  • A universal patient medical record

    Michael R. McGuire
  • A patient waits. And waits.

    Michele Luckenbaugh
  • Treating the patient’s body is not synonymous with treating the patient

    Steven Zhang, MD

More in Conditions

  • 5 cancer myths that could delay your diagnosis or treatment

    Joseph Alvarnas, MD
  • When bleeding disorders meet IVF: Navigating von Willebrand disease in fertility treatment

    Oluyemisi Famuyiwa, MD
  • What one diagnosis can change: the movement to make dining safer

    Lianne Mandelbaum, PT
  • How kindness in disguise is holding women back in academic medicine

    Sylk Sotto, EdD, MPS, MBA
  • Measles is back: Why vaccination is more vital than ever

    American College of Physicians
  • Hope is the lifeline: a deeper look into transplant care

    Judith Eguzoikpe, MD, MPH
  • Most Popular

  • Past Week

    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
    • The hidden cost of becoming a doctor: a South Asian perspective

      Momeina Aslam | Education
    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • If I had to choose: Choosing the patient over the protocol

      Patrick Hudson, MD | Physician
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • If I had to choose: Choosing the patient over the protocol

      Patrick Hudson, MD | Physician
    • How a TV drama exposed the hidden grief of doctors

      Lauren Weintraub, MD | Physician
    • Why adults need to rediscover the power of play

      Anthony Fleg, MD | Physician
    • How collaboration across medical disciplines and patient advocacy cured a rare disease [PODCAST]

      The Podcast by KevinMD | Podcast
    • 5 cancer myths that could delay your diagnosis or treatment

      Joseph Alvarnas, MD | Conditions
    • When bleeding disorders meet IVF: Navigating von Willebrand disease in fertility treatment

      Oluyemisi Famuyiwa, MD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
    • The hidden cost of becoming a doctor: a South Asian perspective

      Momeina Aslam | Education
    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • If I had to choose: Choosing the patient over the protocol

      Patrick Hudson, MD | Physician
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • If I had to choose: Choosing the patient over the protocol

      Patrick Hudson, MD | Physician
    • How a TV drama exposed the hidden grief of doctors

      Lauren Weintraub, MD | Physician
    • Why adults need to rediscover the power of play

      Anthony Fleg, MD | Physician
    • How collaboration across medical disciplines and patient advocacy cured a rare disease [PODCAST]

      The Podcast by KevinMD | Podcast
    • 5 cancer myths that could delay your diagnosis or treatment

      Joseph Alvarnas, MD | Conditions
    • When bleeding disorders meet IVF: Navigating von Willebrand disease in fertility treatment

      Oluyemisi Famuyiwa, MD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...