Having spent a big chunk of my career operating on people with advanced and caught-just-in-time colon cancer, I learned late to do colonoscopy, by taking a course in flexible sigmoidoscopy at an ACS meeting in Washington DC during 1980’s. I served my small rural hospital and did as many as I could do by persuasion, usually with a nurse anaesthetist administering sedative or light anaesthesia . I got better and did colonoscopies peering down the eyepiece. Next hospital had a video scope and I included colonoscopies in my general surgical practice. I moved on again, after going to Canada to learn laparoscopic cholecystectomy and appendectomy , small bowel procedures and liver biopsy. I returned to another rural hospital, where I shared colonoscopy services with a gastroenterologist. At this juncture, I wanted to learn gastroscopy. We set up a learning plan with other surgeons, who had been used to doing them in remote places. I never quite became solo on the simpler procedure , due to our rules of engagement. I never did the number needed to deem me proficient, I became gravely ill.

I became a patient with acute myeloid leukaemia. Over the next year , I had 3 transplants and spent a lot of time neutropaenic and weak in a hospital bed!

As a physician I knew what I would tolerate and when I would argue. Levaquin gave me bilateral tendinopathy and ruptured both Achilles tendons partially. I refused another Levoquin, which was pushed on me, inspite of having found a paper to account for my painful swollen feet and ankles. It took 6 months to return to walking easily. They finally gave me Penicillin. Snow shoeing was a good form of locomotion.

I had to write a plea to the insurance company to pay for a second transplant, when I had failed the first donation by picking up Epstein Barr Virus from the donor. They bridged my third donation( which worked), by giving the second transplant from the first donor, which failed quite quickly, but got me through a month, during which the third donation was obtained.

Residents came and went. One brought me DVDs of Bollywood movies, that I loved. Another decided , when I made him work up my numb feet, “ to get to know me better”. He made a precise effort to sit down and ask me to tell my story. We became short lived friends as he rotated off Oncology.

Rt upper quadrant pain was frequent. I had normal LFT’s and ultra sounds. When I asked for hot packs, the chief resident sent me for repeat of the same tests. I refused after I asked” Will you operate tonight?” She said “no”. So I said, please sanction a hot pack . I was better in the morning! The right upper quadrant pain came from post radiation adhesions of rt colon over the liver. This was found 13 years later at right colectomy. The severe neutropenia encountered prior to second transplant, brought on an empyema, for which I had granulocyte infusions to get me through open drainage. When the chest tube was removed, the chief resident came in heartily and without any kindness, whipped it out, re covered the wound and left before I could draw breath! I was furious!

I ended up with a “rub” and would invite medical students to listen!

The third transplant was done without radiation. I point blank refused any more. After consultation with Seattle colleagues my transplant team infused Etoposde, for which I chewed ice for 4 hours. That completely ruined my teeth and gums. Recovery took 10 years!

Recently, I was found to be anemic. I had had 2 colonoscopies, which were inadequate due to my sluggish colon and poor prep. This year, a Stage 3 poorly differentiated carcinoma of the caecum was found. I am allergic to Betadine and had been refusing CT with contrast due to iodine allergy and had to wait for an MRI pre op. Insurance company has been very unfriendly about this. (Their final word is still pending.)I went through with a laparoscopic right colectomy and ileocolostomy. I must have had very sure and delicate surgeons. There were 33 negative nodes and the 4 cm cancer was contained within the colonic serosa. Post op, There were no beds outside of the Post Anaesthaesia Unit, so I comfortably listened to my neighbours groaning in unrelieved pain, passing blood rectally and suffering through inadequate WiFi. I had a fair night and was able to leave after 30 hours and go home. When the residents visited me in the morning. They looked at my monitor, observed my wounds and poked my side with a couple of fingers. I was appalled they did not use a stethoscope to hear my breath sounds and took my word for the bowel sounds. I challenged the chief resident who said “ we have new ways of knowing how you are doing”!!!!!!

My thought was : these surgeons that say that will never be able to work outside a well heeled medical centre.

The irony is , that although I had worked hard to cajole and persuade people to have colonoscopies, get good preps and remove polyps, to prevent colon cancer, my own situation was confounded by multiple issues and I could not sail straight into prevention. I had to rely on the expertise of my medical and surgical team!

The appearance of the residents , as callous , probably was not the whole story. I would have preferred to have the engaged variety of physician, that I hoped I had been! Maybe they will warm to their patients, when not dealing with such a relentless schedule. The medical ones had a gentler touch.

Clare Wilmot MD is a retired rural General Surgeon