Death by bypass

We're going to kill our patient tomorrow. First we're going to exsanguinate him of every drop of blood in his body. Next, we're going to stop his heart using pretty much the same concoction they execute death row inmates with. Finally, we're going to deep-freeze him like Walt Disney.

Then we're going to save his life.

Isn't urology cool?

I'm on cardiac surgery now, and it's gotten to the point where triple-bypasses are as glamorous as splinters. The VA, being a center of excellence, has an almost unsurpassed open heart program, complete with their own cardiac suite, dedicated nurse practitioners, and special "heart hug" pillows that vets use to support their broken breastbones when they cough after surgery. Tomorrow, though, we're doing something different - we're helping my future colleagues, the urologists, in a case of kidney cancer so advanced that it's spread to the heart.

Contrary to popular belief, surgeons don't particularly like blood. They're not afraid of blood, like most people, but they don't wallow in it either (with the possible exception of trauma surgeons). The goal of any surgeon is to operate in a bloodless field, which may seem like a rather pointles goal for a person whose job in life is to cut people open. But once you get past the skin, which teems with tiny blood vessels, you can actually do quite a bit of exploration of the body without dropping more than a thimbleful of blood. If you see a vessel, tie it up. If the body's a sidewalk, then surgeons are like little kids who try to tiptoe around the cracks and avoid the network of of blood vessels that supply your body.

The problem with our guy tomorrow (there's always a problem) is that his tumor has spread out a serpentine finger from his kidney through his kidney vessels, into the body's largest vein and directly into the right atrium of his heart. Taking it out would normally be a bloody mess, involving the clamping of many arteries leading to many important organs (including the liver and the other kidney).

It's strange to think that the elegant solution to this mess is to just turn the patient off. But we'll see how it goes. Should I be bothered that this kind of stuff turns me on?