Schwab: If surgery’s not high-stakes enough, what of a baby’s?

By Sid Schwab

Implicit in the ability of a surgeon to do good is the potential for harm. If dwelling on it can be paralyzing, ignoring it is dangerous.

Imagine being parents of a perfect newborn. The joys and worries of pregnancy have resulted in a beautiful boy. He coos, wraps his hand around your finger as you feed him. You’ve never felt such love.

Then, at six weeks old, your baby begins vomiting, keeping almost nothing down, not gaining weight. Hypertrophic pyloric stenosis, the surgeon calls it, speaking Greek, or Martian, telling you an operation is needed. Like a raw doughnut tossed into a fryer, the circular muscle at the bottom of the stomach has grown, too fast, preventing the stomach from proper emptying.

Pyloromyotomy is the curative operation. Think of a tight ring over a gloved finger. The aim is to cut and open the ring, but not the glove; to see the glove fabric bulge up through the ring, indicating it’s free. But if the fabric itself is pierced, it’s a bad thing. The glove is the inner lining of the stomach, so a hole in it causes stomach contents to leak.

It’s necessary to divide the entire muscle or the operation won’t be effective; too deep, there’s the hole. The local anatomy is tricky, increasing the chance of damage, and everything is tiny. If recognized, a hole is sewn up. The danger is in not noticing. That can be deadly. And it’s up to me.

In a fog of fear, the parents listen. I tell them about the possible problem and what’s done to avoid it. I caution that their child might still vomit for a few hours, but in all likelihood, he’ll be home in a day or two, doing fine. They agree, of course.

There’s something outlandishly disproportionate about a little baby on a big table in a huge OR. I could cover the entire person with my two hands. All the machinery, the tools, the drapes, the surrounding team seem grotesquely outsized. It’s like a joke, except it’s real and the stakes are high.

Ignore the reality and focus on the job at hand. Tiny incision, toy-like instruments, fine little sutures at the end. It goes perfectly.

“S#!t,” I say, as the phone jars me awake at 2 a.m. It’s my usual response, whatever the call. Now a nurse informs me the baby has a fever of 103 degrees, and his abdomen is rigid, an ominous sign. “I’ll be right there,” I tell her, forcing words through my suddenly constricted throat. It’s easy to describe how I felt, because it happens again whenever I think about it. Had my wife awakened, I’m certain she’d have seen me appear ghost-white. My stomach was acid; my hands were ice. I could barely tie my shoes, those cold hands shaking, not following commands. An algid force gripped my neck; I could hardly swallow.

After splashing water on my face, I ran to my car. As I drove, hands so tightly on the wheel that they were getting numb, I told myself I’d do whatever was in my power to save the child, whatever it takes. Stay by his side till it was over. And then never, never, ever, ever do a pyloromyotomy again.

And if he did poorly, I’d never operate again. This was a baby. Someone’s precious baby. Not waiting for the elevator, I took stairs two at a time to the pediatric floor, saw the nurses standing by, felt as if a million eyes were on me, accusing and angry. (They weren’t. But that’s how it seemed.) And there he was. Fussy face flushed with fever, but moving around actively, looking otherwise OK. His belly was soft as, well, a baby’s belly. An X-ray appeared normal. Whatever that fever was, it was gone by morning.

Nearly limp, still shaking, I drove home barely able to control the car, wrung out like a wet sock. Exhausted, I crumpled onto the bed, relieved, but absolutely spent. An hour or so later, I dragged myself to work. And next time a pediatrician called me about a kid with pyloric stenosis, I took a deep breath, recalling that night, and said. … “I’ll be right there.”

And now, for a sad return to current events, read this eulogy for America. Vote for decency and against Trumpic cruelty in November, or it’s lost. There’s nothing more to say: tinyurl.com/nomore2say.

Email Sid Schwab at columnsid@gmail.com.