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Hardest days


Posted by Lisa Ryujin, MD (a fourth year Ob/Gyn resident from Kaiser Permanente Oakland currently on a global health elective in Daet, Philippines with Bay Area Surgical Mission).

Yesterday was the hardest day of our mission. Our first case was a suspected endometrial cancer, and when we finished the surgery, we cut open the uterus and confirmed, but there was not time to stop, we had other cases waiting. The next case was a 26 week sized uterus who wanted a myomectomy to preserve her fertility, another hard case. Then, simple appearing ovarian cyst removal that ended up being ovarian cancer. We had to pause and think of our mission, do no harm, we had not consented her for a hysterectomy, and her spinal anesthesia was quickly running out. One of the local nurses ran out of the operating room to find the patient’s mother to ask for permission to take the uterus and the ovaries with the hope of low stage an cure. We waited as the patient got more uncomfortable. By the time the nurse came back to give us the permission, we had almost run out of anesthesia making the surgery impossible. The anesthesia crew was wonderful and put her under general anesthesia and we completed the case. The last case was difficult – 18 cm bilateral ovarian cysts. After a long day, we had to go round and I had to sit down with two patients and their families and tell them that they had cancer, with a translator, in a foreign context. It was one of the hardest days of residency and it and it made me respect and wish for our oncologists.

After the discussions with the families I rounded on the rest of the patients and took a shuttle home. It was a hard day and I fell asleep immediately.

This morning when I woke up and went to round before our surgical cases, I was amazed how wonderful they were doing. Even though it’s been exhausting, it’s been one of the best times I’ve had in medicine.


The team
We brought everything we could possibly need on this mission: drugs, equipment, and even an ultrasound, we ran out of shoe covers first...

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