The worst case you'll ever have to do
I spent a lot of time thinking before writing this post. It’s partially because it is a polarizing issue amongst people and also because it very personal to me. If you are at all squeamish, you might want to skip this week. I know I write about a lot of gross stuff: blood, feces, severed human limbs, but this is different. I’m not kidding. This is exponentially worse (both mentally and physically). Today’s post is about the awful reality of suction D&C surgery.
For those of you unfamiliar with the procedure, a surgeon goes into a uterus and removes contents via a suction device that resembles the extension piece for your vacuum cleaner. It is done for a variety of reasons, but the most common is to remove what clinicians call “products of conception.” In less tactful terms, they go in and remove a fetus.
My first professional encounter with suction D&C happened mid-way through my first rotation. My preceptor came to me and said, “You don’t have to do this. It’s okay if you want to opt out.” While kind of her to offer, I knew there’d be a time when it wouldn’t be optional so I figured I’d better experience it and how I was going to handle it. By the time this case came up, I’d see plenty of nasty stuff. (One day I even drew the short straw and got stuck in the penis warts room. Ick.) I figured nothing I saw in a suction D&C could be worse than anything I’d already seen. I was horribly wrong.
First off, my patient was awake. Though heavy medicated, she was still aware of what was happening. She was distraught, and why wouldn’t she be? She’d just lost her baby and now had to be awake while we got it out. **Side note**Part of the reason I went into surgical tech was because I wanted to help people working in medicine, but have a really hard time handling people in pain. This patient’s anguish was heart breaking and nearly sent me into an anxiety attack before we’d even positioned her. We began the procedure and I was handed the tubing for the suction machine. It was CLEAR. Let me repeat that. THE SUCTION TUBING WAS CLEAR!!! At that moment, panic set in. As if the emotions weren’t enough, I had a front row seat to watch what was once a living entity being forcibly removed-in pieces-through clear tubing. I choked back tears and tried to think of it as tissue. We’re just removing some tissue. No big deal. And this approach worked for a few minutes until I saw something recognizably human in the tubing. THAT was the first and only time I have nearly puked into my mask.
The only way I made it through the remainder of the case was by turning around and refusing to look at the tubing while the surgeon was working. I went home that night feeling like something had broken inside of me. I understood this was not an elective thing-the baby had died and we had to get it out, but I couldn’t come to grips with the barbarity of it all. That night as I slept, I relived my own personal nightmare of years ago lying in the Emergency Room where I’d lost my child. A thoughtless nurse left the kidney basin holding the still identifiable tissue of my baby on the steel table next to my head. I could see into the kidney basin and it is still to this day one of the most devastating moments of my entire life.
Over the next few days, I evaluated what I’d seen, the medical necessity of it, and how it would factor into my surgical tech career moving forward.
First, I decided that I would never work for a hospital that performed elective suction D&C procedures. I am pro-choice, but due to my history, I don’t want to be a part of other people’s decision to abort if I can reasonably avoid it.
Second, I decided that I would not refuse to be a part of medically necessary suction D&Cs. Some people opt out citing religious reasons, but this isn’t an option available to me (if I want to be honest). Often times these procedures aren’t just about saving someone physically, but also mentally. The grief of carrying a lifeless fetus until it expels naturally is enough to break even the strongest person. I wouldn’t wish this on anyone ever.
No one said that being a surgical tech would be easy. In school, I didn’t fully grasp the enormity of that statement. It wasn’t until I was faced with something that challenged me on an emotional and physical level that I had to consider what it meant to be a part of the surgical profession. We are threatened with the risk of death on a daily basis. We see people in their most weak and vulnerable states. Their conditions confront us with the reality of our own humanity. To be a surgical tech, is to be able to take our own fears and transform them into the empathy and kindness that will help our patients thrive during surgery and into recovery.
So while I’m not one to volunteer for the suction D&C cases when they come up on the schedule, I understand that on some level, I may be the perfect person to scrub them. My personal experience with that type of loss allows me to channel my own grief into the compassion that I wish had I experienced so many years ago.
Until next time, stay sterile, my friends.
