The Surgical Wound

Redoing what you thought you did perfectly can be an invitation for ego wear and tear and gossip . Here’s why this should not apply to reopening up wounds and other wisdom from the OT 

“The dressing is not completely dry,” the doctor in charge of the floor informed me about Mary’s wound while I was on my morning rounds. We had operated on her back three days ago to relieve severe nerve compression. She also had significant spinal instability, which we had to fix by inserting some screws and rods. “I was going to discharge you today,” I told her, “but your wound doesn’t look great.” I peeled off the dressing to notice a yellowish soakage on it mixed with a tinge of blood.

“But I feel perfect!” she interjected. “On the outside,” I warned her. “We don’t know what’s going on inside.” I pondered at the deeply philosophical statement I had just made – and I wasn’t even a mental health professional. Oftentimes, we may seem unperturbed externally but there is a tsunami going on internally. I wondered if surgical wounds and human emotions had a similar modus operandi.

“It’ll settle down, won’t it?” she tried to convince me, eager to get back home. “Let’s dress it again and take a look in the evening,” I offered instead, because I don’t discharge patients if their wound isn’t dry. We took a swab from the wound and sent it for culture, starting her on antibiotics.

Very rarely do patients have some discharge from a surgical wound. This discharge is often superficial, originating from a little fat degenerating in the subcutaneous tissue, and it settles down on its own. Sometimes, if it’s infected, it could be pus, which is what one needs to be wary about, but that also often subsides with a course of antibiotics if it is depthless. It is the deep-seated ones we need to be cautious about. And like emotional wounds, we can’t tell the difference until it’s too late.

When I returned in the evening, the dressing was soaked a little more. It also had a slightly offensive smell to it, I realized, as I pulled the gauze off the wound and brought it to my nose to take a sniff, much to the disgust of the nurses and interns around me. “If it’s your mess, you must be ready to get your hands dirty. Only then will you be able to clean it up,” I gave them some insight, as the creases on their nauseated faces eased out. I pressed on the edges of the wound and the discharge was purulent.

“We have two options,” I told Mary. “Either we give you intravenous antibiotics and hope that it subsides, or we take you back to the operating room first thing tomorrow morning, wash it out, and then administer antibiotics.” Mary finally realized that this was getting serious. “What would you like to do?” she threw the ball in my court. “I don’t like not knowing what’s going on,” I said categorically. “Instead of allowing it to fester, it’s better to open it up, drain the pus, and clean it up,” I opined. “Infected wounds are like bottled up emotions,” I told her, doubling up as her shrink. “If you don’t make space for it, it’s going to blow up sooner or later, and that has a larger price to pay.”

Taking patients back to the operating room, especially in private practice, is considered taboo. It means acknowledging that something has gone wrong, which we need to fix. In the world of mental health, it is considered a step in the right direction, but in the surgical world, people – patients, relatives, colleagues, or administrators – will often scoff at you. It dents your reputation (as if that was ever a real thing) and everyone gossips about it (but it’ll never fall on your ears) that you didn’t do it right the first time around.

I’m very aggressive as far as opening up wounds is concerned. Especially if they belong to others. Especially if I’ve inflicted them. My theory is simple: If you’re going to war every day, you will have to take a few bullets. But with time and experience you get better at dodging those bullets. It’s not that they won’t strike you; they hit spots where it’ll hurt less.

The next day, we took Mary back into the operating room, flipped her on her tummy and made an incision into the previous wound. Frank pus, the kind that results from an acute inflammatory reaction, came out under pressure. We cleaned the cavity with a bunch of solutions and washed everything out for it to look anew again. “I wonder where this came from,” my colleague asked while we were closing her back up. “However much you audit it, sometimes you’ll never know,” I replied. Just like our feelings, I thought to myself.

When she came for a follow up the next week, we removed her stitches. The wound was clean and dry. It had healed cleanly, with a small footprint of us having been there. “Scars are actually beautiful things,” Mary told me. “The hurt is over, the wound is healed,” she crossed her heart. “Amen,” I went along in the name of God. I’m glad we did the right thing. Over the past decade, I’ve taken several patients back to the operating room, and I promise you, it’s not because I’m a bad surgeon. Never have I regretted the decision.

Mary was the last patient I saw that day. And like most evenings before I leave, I put my feet up on my desk and cross them over to ponder for a few minutes on the day gone by. The first thought to strike – Why do I treat my own wounds so differently from those of my patients? What pain or doubt or fear am I concealing? Would I be okay ripping into my own wounds with that much ease, tearing them apart to examine them closer?

PS: I only speak metaphorically, of course, in case there are some kind hearted aunties out there wondering, “Beta, are you okay?”

I’m fine.

 

 

 

21 Comments on “The Surgical Wound
  • Vipul shah says:

    Dearest Dr Mazda Sir ,

    Although I am not old Aunty if you have not given your P S note , I would definitely asked you sir , what’s going on in your inner brain ???🧠

    Good you said you are Fine 🙏🙏

    Coming back to wounds of Mary , You very nicely explained & made your readers understand that anything can happen post surgery & mentally be prepared for any eventualities……🌹

    Small Small details makes you understand the complicated & complexities of your super fine work Sir 🥰

    Gid bless you again & again for enlightening your dear readers & Followers 🙏

    Reply
  • Vipul Shah says:

    Dearest Dr Mazda Sir ….

    Sorry forgot to appreciate your super fine Autograph on your patient’s wound 🤣🤣🤣🤣🤣

    And also read GOD instead of typo goof up Gid 😭😭😭

    Reply
  • Bruce Blewett says:

    Hi Mazda An excellent article and so true about all aspects of life. You do something and it’s not quite right and you go back and refine it until you are satisfied.

    Reply
  • Prashant Punia says:

    Good one sir, struck a chord.. thankfully the infection didn’t strike the (spinal)cord 🙏🏻

    Reply
  • Temitayo says:

    Dear Doctor Mazda,

    As I was reading the piece above, I couldnt but help reflect deeply as I was in a similar situation ten (10) months ago.

    Thank you for your expertise and dedication in treating my severe disc compression and spinal instability caused by acute inflammatory infection. Your skill as a neurosurgeon helped me overcome a challenging phase in my life. Recovery post surgery is unbelievable! You can hardly tell I was bed ridden this time last year.
    Praise God, Bless you Dr Turel Mazda.

    Reply
  • Nimish Shah says:

    Super article Doc , we learn daily from you !!!

    Reply
  • Kersi Naushir Daruvala says:

    I will never know what is going on in your head, but I am definitely sure I am in capable hands as long as you are concerned. May Ahura Mazda guide you always, but you remain safe for us.

    Reply
  • Leah G says:

    Another beautiful piece Dr Mazda! I’m always amazed by your ability to weave together very technical information with humor, candor, humanity and love! Today you spiced it further with some big philosophical questions that I am now pondering about my own clients!

    Thank you and be thou blessed, “always and in all ways”, as my son JP likes to play with these words!

    Reply
  • Ibrahim aliyu yerima says:

    Dr. This is very educating,thank you

    Reply
  • Arun Pushkarna says:

    Every time I think you’ve reached the pinnacle of expression you top it up with another masterpiece, Mazda.
    You certainly as God’s chosen one.
    So much to learn from you!
    It’s such a delight to address you as son!
    No parent could be prouder of his child – as a professional, a wordsmith, and above all as a lovely human being.
    Your last paragraph…. straight to the heart!!

    Reply
  • Rita singh says:

    Great one. I had a similar stubborn stitch after my knee replacement surgery. It wasn’t ready to heal after several changes of dressing. Now it’s been almost 7 years since my recovery, yet I still feel afraid when the skin and stitch have a funny feeling of stretch and a little throb. Thanks for a very interesting write up again.

    Reply
  • Farokh Bharucha says:

    Excellent write up Dr Mazda and a eye opner to

    Reply
  • Dr. Rafat Ansari says:

    The patients health is the priority of the doctor in charge…no ego…no nothing comes to mind to set it straight again…to even redo the procedure!!
    Responsibility comes b4every thing…
    So wen mom had this need fr surgery,i only wanted the best fr her ..The Almighty guided us to ur hands. Timid as she is…yet I was confident ud do the best…
    People scare u with such thoughts regarding brain n spine surgery….but in the best of hands it’s like cakewalk!
    No sympathies needed is what I say to all the attendants, she’s been to the top most neuro surgeon in r country!!! She’s doing so well!!
    Thanks doc!

    Reply
  • Dr Shashi Singh says:

    You write so well ,Your wrie ups are as polished as your Neurosurgical skills.SUPERB!!!

    Reply
  • Marzin R Shroff says:

    Superb article. It’s not easy to admit something has gone wrong. And perhaps the entire medical profession is guilty of this. But not you
    You’re a rockstar Mazda.
    God Bless your tribe

    Reply
  • Setu Ram says:

    HAIs are life threatening. Period.
    You had to be aggressive in rooting it out.
    Festering emotional wounds are the same.
    Rip the scab off and let it drain. Then move on.
    Thanks for not being full of yourself like some of your ilk.

    Reply
  • Dr parvin Desai says:

    Yes totally agree. A senior plastic surgeon at a conference once said if a patient has a complication we must address it ourself not tell our assistant d o the dressing n fob of the patient. Well done.

    Reply
  • Hutoxi Doodhwala says:

    Enjoyed this article too. You have compared a person’s mental turmoil very well with a festering wound. So proud that you took the responsibility of seeing your patient’s well being above everything else. May you be amply blessed and always emerge victorius in all your endeavours.

    Reply
  • Dr Mayuri says:

    Dear Sir, You are Lord Dhanwantari to us..You saved my mom from severe brain haemorrhage and coma.Within the span of 2 weeks you did 2 major brain surgeries on her.I can relate with this story how u must be feeling when you have to do second brain surgery within 2 weeks after removing biggg brain tumour..Its miracle..Our family is always grateful to you as you gifted us rebirth of my mom.

    Reply
  • Vispi mistry says:

    Beautifully written piece as always Mazda
    Your decision to open her up again was spot on.
    Mire power to your pen and scalpel.

    Reply
  • Tasneem says:

    I like the authentic simplicity with which Dr Mazda writes.

    Reply

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