Tuesday, June 28, 2005


The smell hit me first. It had that sweet pungent smell of old blood and recent decay. As I opened the abdominal incision, the dark, murky fluid continued to drain, revealing the cause of the infant's illness.

His black, necrotic bowel lay shining inside his abdomen. Distended. Edematous. Parts of it had already autolysed, as the bacteria in the enteric contents had eaten through the bowel walls. Whatever bowel I touched disintegrated in my hands like wet tissue paper.

I stopped and looked up. My eyes met those of my staff, who stood on the other side of the table shaking his head.

"This kid doesn't have a chance."

I nodded.

"Will you close up? I'll go talk to the family."

I closed the abdomen, taking care to sew the fascia tightly to prevent leakage of the abdominal fluid. We've just finished what we call a "Peek and Shriek": Surgeon shorthand for an operation that's aborted after realizing that a patient is beyond surgical help.

As I transported the infant back to the NICU, I ran across my staff.

"How did it go with the family?"

It never goes well.
Nobody's ever prepared to hear the news that their loved one is going to die.

We gave a brief report of the operation to the neonatologist and left the NICU. We rode down the elevator in silence, lost in our own thoughts. And walked into the OR room for our next case.