Thank God. It's back!
So I admitted a woman direct to the surgery floor today. Middle aged, with abdominal pain. Pretty run-of-the-mill. She was a transfer from a rural hospital from a doctor who was concerned about her high white count and tender belly, but didn't have a CT scanner to further investigate her pain. She had been in pain for two days... not too impressive, and although her abdomen was tender she didn't have any peritoneal signs (in english, that means she didn't have any of the physical signs that we look for when really bad things are happening in the belly). So I admitted her, started her on empiric antibiotics (again for the med newbies: antibiotics that cover pretty much most of the bugs that could possibly be making her sick, often used when you have no idea what you're dealing with) and arranged her CT scan.
A few hours later, mired in the day-to-day floor scut, I had all but forgotten about her. Then I got a page from the radiology resident, sounding excited. She had a ruptured appendix. And it had ruptured but good. She had an abscess that stretched from the caecum to the Pouch of Douglas, and then back up to within a few centimetres of the sigmoid colon. Trust me... that's a lot of pus.
So I found myself in the OR. Not altogether unusual on a surgery rotation, right? But here's what was unusual. With the patient prepped and draped and me, the chief resident and the staff surgeon standing around her, someone handed me the scalpel. And told me to cut. Oh... my... God. I opened the abdomen. And cut through the fascia. And, after copious amounts of pus were drained from her belly, I mobilized the appendix. And, after the base of it was secured by the chief, I removed the appendix.
So standing there, at an hour of the night when most of the sane world is asleep, holding this angry-looking appendix that looked like a bullet had passed through the end of it and smelled like pus, I found it. That feeling. That "holy-crap-I-can't-believe-they-let-me-do-this" feeling that was all but a distant memory after two soul-crushing months of surgery. So there I was, clutching this disgusting appendix and grinning like an idiot behind my surgical mask.
I found my enthusiasm for medicine. Welcome back. I've missed you.