Category: GHHS

GHHS, Narrative

The Stone Baby

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Sarani G. Pachalla, M3, Class of 2025

As the surgeon carefully zapped through the final fascial connections, I felt the weight of the mass shift into my hands. My eyes went wide. It was 13 centimeters long, slate-gray, traversed by gnarled, maroon vessels, dotted with pale yellow, fluid-filled cysts, yet solid. I gingerly passed the mass to the surgical technician, who announced that it weighed 2950 grams. As the circulator wrote down the number on the board, I recalled my conversations with Mrs. G.

As a third-year student on the emergency general surgery service, I had seen her the day before for a possible bowel obstruction. Having not passed a bowel movement in days, she was extremely uncomfortable. Yet, she was in remarkably high spirits. Although the conversation was interrupted by her waves of nausea, we spoke about her daughter, grandchildren, and her recent journey with breast cancer. On physical exam, her abdomen was bloated, doughy, and tender to palpation. I remember auscultating high-pitched bowel sounds like fingernails on a champagne flute. Later, when I opened her chart, I found that her care was transferred to the gynecology/oncology service. Her chest radiograph showed bibasilar opacities. The CT of her abdomen and pelvis showed significant ascitic fluid and a large left-sided pelvic mass, and the gynecologists stated her presentation was consistent with Meigs Syndrome. She was scheduled for an exploratory laparotomy in a few hours.

Ascites, pleural effusion, ovarian fibroma: the triad of Meigs Syndrome flashed across my screen, refreshing my memory. This syndrome is an extremely rare presentation of a benign ovarian mass. I had memorized it for my board exam alongside many other triads, but I never thought I would see it, let alone in one of my patients. When the senior residents on both services agreed I could observe, I hastily made my way to pre/post to see Mrs. G.

“I knew I had a stone baby in there,” she laughed. It struck me how one could be so magnanimous in the face of something so baffling. “Make sure they weigh it. I’m curious.” I promised her I would. I noticed her shifting awkwardly, and I hoped that the surgery would ease her discomfort. We chatted more about her grandkids’ ballet recitals and soccer careers until we rolled back to the OR.

The resident confidently made the first incision. Then, as she pierced the peritoneum, the team began to drain liters of ascitic fluid. I exhaled, realizing I had been holding my breath. It was satisfying (and a little disturbing) how in an instant, the surgeons could remove the physical manifestation of the discomfort Mrs. G had been living with. It was also exhilarating to bear witness to something I had only seen in lectures and review videos. The surgery proceeded dynamically. The attending physician asked questions to us students, allowing us to connect concepts with reality. As she called out anatomical landmarks and coached the residents in surgical technique, I was in awe of her expertise. I craved to achieve the mastery it takes to understand every side of a condition, from the patient experience to the pathophysiology to the treatment.

I could not wait to see Mrs. G again. Albeit groggy from anesthesia, she was much less uncomfortable. When I told her that her stone baby weight 6 pounds and 8 ounces, she replied, “talk about a weight lifted.” Despite the fact that my role was so miniscule in the grand scheme of her care, I felt a genuine sense of fulfillment from my proximity to it.

GHHS, Narrative

Delayed Delivery

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Azeez Baig, MS3, Class of 2025

Heading into my last shift of labor and delivery, I took some time to reflect on what many of my fellow colleagues and superiors have described as one of the most distinct memories of their medical education. Whether it was the adaptability necessary to complement the unpredictable nature of labor, the privilege to share the momentous experience of childbirth with families, or the multidisciplinary team all working towards a common goal, the labor and delivery unit served as a reservoir of education not only limited to academic, but personal growth.

My reflection was abruptly suspended, as I entered the workroom and was met with a board demonstrating nearly every bed full with laboring mothers. Shortly after, our triage beds also reached capacity. A lively start had already begun for myself and the rest of the night team.

The prior shifts leading up to this night were busy, but steady. Tonight was unlike any prior night. The amount of births that occurred over an entire night was the amount of births we had completed just a few hours in. As I bounced between triage, deliveries, and cervical checks, there was a constant amidst the exuberance. One patient I was following was scheduled to have a non-emergent c-section, and other laboring mothers with concerning monitoring led to her waiting hours longer than anticipated. Prior to entering the room, I could hear a flurry of Spanish between a few family members, and could sense uneasiness. In addition to the patient, I was met by her parents and the father, who was particularly vocal. He expressed frustration with the delay, questioning whether we had forgotten about his wife. A day as unparalleled as the birth of one’s child should proceed exactly how a mother envisions, and feeling forgotten is the last emotion we want our patients to associate with their experience. Acknowledging their frustrations, I apologized for the time spent wondering about our commitment to their care. Explaining the volatility of the service, including the urgency of delivering some mothers with concerning fetal monitoring and the shortage of team members, I saw the irritation dissipate from the room. As they thanked us before leaving, I was met with a wave of understanding and appreciation, a stark contrast from the initial energy in the room.

Experiences like this not only remind me of the privilege I have to study medicine, but also emphasize the values I hope to uphold as a future provider. While there is a standard of mastery of clinical medicine that I expect of myself, the physician-patient relationship is the foundation upon which all high-quality care is built. Accountability is a powerful tool to establish rapport with patients and, consequently, trust. Providers across disciplines are accustomed to the unpredictable nature of healthcare, where delays in care can be perceived as part of the ebb and flow of medicine. For patients, each tick of the clock can create a lasting memory, shaping their perception and relationship with healthcare.

While providers cannot alter the inherent unpredictability of medicine or the policies guiding their practice, they wield significant influence over a crucial domain – their mindset. Embracing this allows us to harness the unquantifiable facets of medicine that profoundly impact patient care. Elements such as active listening, genuine acknowledgment, and the conscientious avoidance of paternalism become potent tools within our grasp, enabling us to elevate the human dimension of healthcare.

As my last shift in the unit came to an end, my aforementioned suspended reflection resumed. However, I found myself far from my initial train of thought. Rather, I was left pensive, fixed on that patient. What I learned, the deliveries, the team, the clinical knowledge, was blurred by how I felt. The gratefulness, appreciation, and empowerment emanating from that patient served as the epitome of the type of health care I hope to provide for my patients. With the various players that comprise the team of healthcare, I strive to put my patients voice at the forefront, recognizing the impact of emotions on experience.