Best Doctors for Women 2011
(page 2 of 13)
Dr. Laura Schrag, Emergency Medicine
How to Break Bad News
We had a boy who dived into Lake Minnetonka, hit the bottom, and broke his neck. A 19-year-old, totally healthy kid. And broken necks are so awful because these people come in wide awake. They can look at you. They can talk to you.
This kid is totally conscious, but he can’t move anything. He’s terrified, but he isn’t screaming in pain. Just calm. It’s a little freaky, honestly. He probably has a clue as to what’s going on, but nobody wants to say aloud that he’s paralyzed.
I know it right away. It’s textbook: dive in, hit your head, can’t move anything. And the hardest part is, I know we can’t really do much. You get this unbearable feeling of helplessness. You feel the dread.
So I have to tell him he’s probably going to be paralyzed. I feel like it’s always best to bring the family in and let them see what we’re doing. That way, they see that we’re doing everything that we can, and they can be part of the process. The key thing is that they often don’t hear what you say the first time. You still go straight to the point. So I deliver the worst news first, let them soak it up, answer any question, and then come back to the point.
I also try to avoid saying anything is “certain.” You don’t want to eliminate hope. Because there’s always a little bit of hope. Even some neck injuries can be, we say, “reduced,” which means the person can move again. But you absolutely have to be truthful.
I also make sure there’s someone that can stay with the patient and his family—a nurse or a chaplain. Those people are phenomenal. They do a fabulous job of taking over, answering questions, listening. It’s a total team approach. In fact, afterwards, I always ask them for feedback, to see if I handled the situation appropriately or if there’s something I can do better next time.
Then, you have to set it aside. You tell your partners you need a few minutes to walk the halls. You turn your beeper off. You know, we’re part of a team. The nurses, techs—they recognize what just happened, and they’re there to support you. I’ll tell you, it can put your life in perspective in a heartbeat. And it happens every single day.
Dr. Jennifer Harrington, Plastic and Reconstructive Surgery
What It Feels Like to Reattach a Pair of Severed Arms
It is 2:30 in the afternoon. My beeper goes off, and it’s the ER.
They say they’ve got a little two-and-a-half-year-old boy who’s been hurt in a farming accident. Something about his arms getting caught in a grain auger. Now, I’m not a farm girl; I don’t know what that means. But I’m a brand new surgeon, three months into my private practice, and I’m feeling pumped for any new challenge. I’m so ready for this surgery.
I zip over to the ER. The boy’s being stabilized, so I check in quickly with the family, shout out a few orders, and grab the cooler with the severed arms. You have to prep the limbs before reattachment, clean them up. So I head to the operating room and open up the cooler—and I just gasp. It’s a mutilated, contaminated mess. Do you know what an auger is? It’s a giant corkscrew blade, like a drill. And his arms went up into it. They had been amputated sequentially. There is grain embedded all throughout the tissue. I call my mentor, Dr. Van Beek, whom I had trained with at the Mayo Clinic, to come down and help.
Dr. Van Beek arrives. He takes one arm, I take the other, and we’re sewing. For the tendons and muscles you use bigger sutures. But for nerves and vessels, you use sutures tinier than an individual hair. You wear these magnifying goggles to see them.
Thirteen hours later, the surgery’s done. We’ve got a little boy with both arms on, with 10 pink fingers, and I’m feeling really good. I look at Dr. Van Beek, and he says, “You’ll be lucky if you save one elbow.” And I’m thinking, “Wow, way to be a pessimist.”
But I was naïve. The arms got infected. Over the course of about two weeks, I had to go in and start cutting pieces off. There were 19 additional surgeries. The right arm, the one I had just reattached? We took it off completely. The left arm we amputated at the elbow. Just like Dr. Van Beek said: we got one elbow.
I felt like a failure. I had never let a patient down before. I cried. I had sleepless nights. Even later, when colleagues congratulated me on saving that one elbow, when the family thanked me for all the work I had done, I still felt conflicted.
Luckily, the patient is doing great. He ended up getting into public speaking. He’s addressing groups of surgeons and other amputees. We’re still friends, actually. And knowing him—it sounds cheesy, maybe—has really shaped me. Not just as a surgeon, but as a person.
Dr. Margit Bretzke, General Surgery
What It Feels Like to Operate on a Human Brain
It’s my first night on call for neurosurgery, and I end up racing down to the hospital. The ER physician says he has a 17-year-old kid who was out partying, fell off the back of a car, and hit his head.
I get there, and the patient is showing signs of an epidural hematoma—blood pushing hard on the brain. Of course, the inside of the skull is a finite space, so adding pressure is like squeezing a balloon: it forces the brain to bulge. But the only place it can expand is into this small hole that attaches it to the spine. That’s called herniation. If you herniate, you die. And this kid was definitely herniating.
The chief resident, Dr. Nagib, arrives. He’s going to do the operating. I’m just there to assist and to learn. After a quick CAT scan, we rush the kid back to the OR and put him to sleep. At this point, I’m pretty worried: this kid could die. Every minute that slips away is impacting his recovery—or if he even can recover.
We start the craniotomy, which is when you lift a flap of bone from the skull to see inside. I had never witnessed this before. They shave his head, and Dr. Nagib drills several holes into the patient’s skull. Because this is 1980 and drills aren’t motorized yet, Dr. Nagib is cranking the drill by hand, boring into the skull. After drilling a few holes, he cuts from one hole to the next with a motorized saw. The result is this little window.
He lifts the flap of bone out, probably the size of a teacup’s saucer, and the blood pours out. But then he clips an artery, and the bleeding stops. It’s a surprisingly bloodless operation—which means you really get a good look at the brain. And it looks just like you think it would. It’s gray and folded, and it’s compressed because all this blood has been pushing on it. I realize I’m looking at a live brain for the first time in my life, and I’m just awestruck.
And then it starts ballooning out. It starts pushing up through this little bone window, and it’s scary. It’s very scary. And that was just too much. I got so light-headed I couldn’t stand up. I was sweating; I was dizzy; I was seeing colors; the room was spinning. Finally, Dr. Nagib just said, “Margit, go sit down.”
It was just the high stakes of it all. We truly saved this kid’s life. The whole thing worked. Dr. Nagib and I stopped the swelling. He wired the brain flap back on, and the kid did fine—he totally returned to normal. After that, I was fine, too. The brain never freaked me out again.