Enhanced recovery after emergency laparotomy
18 May 2023
30 November 2022
I came home after a particularly testing on-call week and announced to my flatmate: “so I’ve realised I have to apply for surgery”.
It was early 2021 and I was the colorectal FY1 on call. It was a horribly busy day, marred with the umpteenth TTO, lightning speed ward round and too many bleeps to count. Despite this, there was a spring in my step every day that week. Perhaps it was the camaraderie of the surgical handover, or the fact that surgical ward entries can be completed with a beautifully simple “history noted- Plan: MFFD (medically fit for discharge)”. Most likely it was the fact that patients were admitted to the surgical unit often quite unwell, and after intervention with a scalpel (and extensive training) they were sat up in bed the next day and keen to go home.
This was particularly pronounced with one patient that week: a young woman with excruciating right iliac fossa pain, looking like someone had taken a syringe and sucked all colour from her face. Classical appendicitis. She was admitted and consented for a diagnostic laparoscopy +/- appendicectomy. I saw her the next day with the consultant and the difference was astounding: she was sat up with ruby red cheeks. It dawned on me that the ability to acquire such skills as cutting into a person and making them better with your own hands was something of incredible prowess. It is an honour and privilege to have another human being put their life in your hands quite literally, and the calm with which surgeons operated was something that absolutely fascinated me.
Of course I was not naïve enough to think every operation would be a success. That is not the nature of medicine or indeed human illness itself. I had to see how I would feel when the happy ending was not there; whether or not I would see the joy of surgery even when the odds were dark. I got my opportunity (for lack of a better word) that same week on a CEPOD list. A middle aged lady was undergoing a laparotomy after being admitted with collapse and found on CT to have total occlusion of her superior mesenteric artery and subsequent bowel ischaemia. Being present in theatre as serious discussions were held amongst the three consultants as to whether or not to attempt bowel resection when the chances of survival were so low was something that stuck with me. I was in awe of how these surgeons had the weight of expectation on their shoulders and yet somehow, managed to scrub into each case with a keenness to tackle the next challenge.
As I sat in the mess eating my lunch at the end of that on-call week, I reflected on my excitement and fascination with surgery and reached the only logical conclusion that I would re-iterate to my flatmate that very evening: “so I’ve realised I have to apply for surgery”.
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