Tuesday, December 4, 2007

Thank you, Dr. Drew Wagner!

Y'know, as I posted my thanks to the hospital the other day for the cancer care I received this year, I knew I was overlooking someone. I asked a couple of people who it could be, and they too didn't see anyone missing from the cancer team.

Then it hit me: oh yeah, I forgot the miracle surgeon who relieved me of that stinky kidney in the first place! Until he did his work, the oncology team couldn't start theirs. (See, their work was to get rid of all the metastases throughout my body. But that wouldn't have been too productive as long as the source of trouble was still there.)

Dr. Drew Wagner is the surgeon who did the deed for me. He does the really fancy stuff, laparoscopic kidney removal. Three little incisions to stick the instruments through, and a 2-3" bikini incision (yes, I have a bikini scar, and no you can't see it) through which they remove the culprit.

Now, here's the thing, and I really want you to get this: they inflate the belly to give themselves room, then they stick the tools in through the tiny incisions, and do the work by watching it on a TV. They remove the organ (which is large) by basically snipping it off, putting it in a Baggie, zipping it up, and sliding it out through the bikini cut.

Of course, they have to do this with surgical precision, in the dark except for the flashlight they stuck in there. And here's the thing: the TV is 2D, but your guts (including the location of blood vessels etc) are 3D. And p.s., you don't get to accidentally bump into anything with your knife.

In my case, it got a bit tougher than that. Here's how my sister wrote about it in my cancer journal (March 7, 1:29 a.m.):

The procedure took longer than expected for two reasons: 1) the adrenal gland was involved with the tumor and was also removed (as planned) making for two surgeries in one for all intents and purposes; and, 2) the tumor had attached to the wall of the bowel as well as the psoas muscle which embraces the side of the lumbar spine and had to be very carefully peeled away from both surfaces. Dr. Wagner was concerned that he might have to effectively start all over with a more commonly used incision but was remarkably able to perform the very intricate procedure laparoscopically.
"More commonly used incision" is a bit of an understatement. It's a very large incision, and they have to (permanently) remove a rib. It hurts like hell and takes 6-8 weeks to recover. Instead, I was out of the hospital in 2 days and off all pain meds in less than a week.

I had a unique opportunity to experience what laparoscopy is like. Beth Israel Deaconess has an amazing simulation and training center, where students can actually handle laparoscopic equipment. The very first training exercise involves holding two long-armed gripper tools, and all you have to do is use them to pick up some little white beans and put them in a cup. A foot away, and several inches higher.

That's plenty rough when you can see what you're doing. But when you're good at it, they put a drape over the plastic box that contains all this, and you lose all depth perception because now you're watching it on TV.

Then, don't get nervous or anything, but just remember that while you're trying to do this, the patient is bleeding (or might be) and every extra minute under anesthesia adds risk. So don't screw up. Oh, and pick up that bean you just dropped, because it rolled under the pancreas and it's really a piece of tumor. Or something.

And don't nick any blood vessels or other organs.

And then they tell you that this is the first of the laparoscopic training hurdles. You don't get to move to the next machine until you can move 50 beans from lower left to the cup in one minute, with no depth perception.

Until I tried this myself, it had never dawned on me that a surgeon has to be damned athletic as well as smart. And when I think of this guy going into my inflated belly through these little incisions and delicately peeling that super-aggressive tumor off the bowel, and off that muscle attached to my spine.... both of which the tumor was on the verge of invading... and then the adrenal gland got away, and had to be chased down ... well, the surgery took 5.5 hours,* almost had to convert to the rib-removing version, and yet I went home two days later.

Is this guy good, or what?

My gratitude: well, as that cancer journal excerpt said, when I finally got back to my room all I could say was "Mommy, they hurt me!", and I meant it. And when I (groggily) laid eyes on my cane, I (groggily) considered using it to whack the surgeon. But he moved faster than me, and took it out of my reach. (I am not making this up.) It seems somewhere along the line he developed quick reflexes and manual dexterity.

So thank you, Dr. Drew. You are an amazing guy, and I'm really glad your fingers work that well.

* See comment for update.


  1. So when is your book coming out?

    Jon and I had to put Rudolph on pause we were so enthralled.

    True story.

  2. *Update: The good doctor sent a correction that illustrates the personality behind that kind of performance. My journal said the surgery took 5-1/2 hours. This soft-spoken, gentle surgeon wrote to thank me for the post, and added:

    "[Being the stickler that] I am, I went back to see just how long the procedure was on our system: you were in the operating room for a total of 5 hours but the actual surgery time was 4 hours 15 minutes."

    Don't you just love that there are kind, gentle people who are positively obsessed (but gently so) with getting things just right? Whenever I hear (or make) grouses about the healthcare system, people like this come to mind. My goal in advocating for change is to make people like my care team be the ONLY thing worth talking about in health care. To have an absolutely grand world of care, I'd like to see hordes of people like my team, and no obstacles that get in the way of seeing them. That's something worth creating in the world.


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