Shit Storm – Sometimes karma is instantaneous

My preceptor said it was a waste for me to there. It was the surgeon’s first crack at robotic colon resection and anyone’s guess how well (or horribly) it would go, but I was determined to stay and learn. We took our best guess on the setup (since there was no precedent and consequently-no preference card to follow). With the robot and patient draped and ready, we waited for Dr. Abbott to arrive with her assistant (Dr. Costello, a fellow surgeon).

We were doomed from the start. Everything from the placement of ports, to docking the robot, to which instruments to use was an argument. If Dr. Abbott wanted to use a PK forceps, Dr. Costello argued to use a fenestrated grasper. If Dr. Costello wanted to take down omentum, Dr. Abbott argued they should search for the area to resect instead. Technically, it was Dr. Abbott’s case, but you’d never know it listening to them quarrel. Dr. Costello, a particularly obstinate individual, began to pick apart everything Dr. Abbott did.

Dr. Abbott wasn’t dissecting the right plane.

Dr. Abbott wasn’t dissecting fast enough.

Dr. Abbott wasn’t approaching the resection from the right direction…

Over several hours, the situation devolved into Dr. Abbott pleading to abort the robotic approach and switch to a more typical laparoscopic one and Dr. Costello simultaneously refusing to give up on the robot and berating Dr. Abbott and everyone in the room for every minor infraction from not handing instruments fast enough to the volume of the radio.

I was finally relieved for lunch. When I returned, the relief tech met me in the sub-sterile. He looked exhausted-like he’d aged fifteen years in the 30 minutes I’d been gone. I asked how things were going and he just shook his head saying, “Good luck” as he drifted, shell-shocked, down the hallway. While I’d been gone, Dr. Abbott had finally won and they’d abandoned use of the robot. Dr. Costello had conceded using the robot, but continued his verbal assault as they finally removed the offending section of bowel.

It had been nearly six hours at this point, and I was elated that this nightmare of a surgery was close to an end. They finished the anastomosis then the doctors rock-paper-scissored to see who would go “downstairs” (to the anus) to pump in air to test the bowel for leaks. Dr. Costello lost and despite being near people’s buttholes being a normal part of their day, I secretly reveled in his loss. He pumped in the air while we filled the abdominal cavity with saline. We watched for air bubbles, indicating a leak in the anastomosis, but found none. The saline was suctioned out and Dr. Abbott began pressing down to release the air from the bowel.

That moment is when karma reared its ugly head. As Dr. Abbott pressed down, a stream of curse words erupted from Dr. Costello. I looked down just in time to see the stream of curse words accompanied by an eruption of excrement from the patient’s bowels-aimed directly at Dr. Costello.

(At this point, I would like to say: I have seen patients poop intraoperatively. In surgery, shit happens…literally. It's not a huge deal. You just clean up and move on. This time, there was no moving on. Okay, now back to our story.)

The shit-storm hit Dr. Costello squarely in the chest. I thought after the first hit that it would stop, but the deluge of dung kept coming and Dr. Costello, still in shock, made no attempt to dodge the mess. My second thought after, “Oh my god that’s a lot of poo.” was “This could not have happened to a more deserving individual.” Dr. Abbott was relishing the moment of karmic revenge, but finally took pity on the now sodden Dr. Costello. She looked down at his misery and said, “Oh sorry. Maybe I should stop pushing?” Dr. Costello was PISSED! He stripped off his gown and gloves and left the room, presumably to hose off somewhere (hopefully outdoors). No sooner had he left, the room erupted in riotous laughter. The tension of the past six hours evaporated and we finished the case feeling strangely relieved and slightly vindicated.

The account of our room’s exploits (along with the horrible smell) spread throughout the OR well before we even finished closing. I won’t lie. After the humor wore off, the aftermath of the shitastrophe wasn’t pretty. The room was so contaminated that the case set to follow had to be rescheduled and it took an army of OR employees cleaning the room just to get the stink to dissipate from the adjacent hallways.

It has only been a few months since this happened, but the “epic robotic poop case” is already well known throughout the OR. Was the epic awfulness of the entire encounter worth it? Heck yeah! I have worked with Dr. Costello several times since and apparently, the experience made an impact. He has been perfectly lovely and helpful ever since that day. So I guess the moral of the story is, don’t give people shit if you can’t take it because sooner or later it will come back to you. Or maybe the moral is: assholes come in all shapes and sizes, but the worse ones are those that spew crap. I haven’t decided, but in either case-always wear eyewear and impervious gowns, cause you never know kids. You never know…

#colorectal