Update on the pancreas

It has been an interesting week. I have been treating the patient with the pancreatic pathology. It has been great for me because I have been assigned as the lead "doctor" on this case. So I work as the main contact for all the consulting physicians and the primary care doctor,  so they all page me for updates and to see what I have been doing for his condition. He had a procedure on thursday that was very cutting edge and not a common run of the mill surgery. The GI doctor used a scope to perforate the stomach to view the pancreas. Then he proceeded to asses and remove as much necrotic tissue as he could. He also made sure that previous stents that were placed were still functioning. It turned out that they were both clogged. So he drained both of the previous stents and placed 3 new stents. He also place a nasogastropancreatic tube to flush the pancreas with saline and antibiotics through out the upcoming weeks. The patient has a tube coming out of his nose. We will continue to flush the pancreas through this tube.

Unfortunately he could only remove 20% of the necrotic tissue which means there is going to have to be a surgery this week. So surgery will be called in to remove the pancreatic necrotic tissue. The good news is that there was no cancer found and there was some viable pancreatic tissue. The patient was feeling much better following the surgery so there is a small chance that his body could heal the pancreas on its own but the odds are rare given the large amount of necrotic tissue left. Following the procedure his hemoglobin was low which occurs from blood loss, when I noticed this I ordered a unit of blood to be transfused. We transfused him which brought his hemoglobin up.

I spent a lot of time with his family explaining what was going on and letting them know what to expect. They were very grateful and said that I was the only "doctor" that even talked with them and was honest with them. They said everyone else was aloof and very quick and would not stick around to answer questions. With my lower number of patients that I am managing I do have a little more time than their other doctors but I have noticed the general trend is to spend a little time as possible with the patients and try to get out of the room quickly. This leaves the family and the patient scared and in a cloud of confusion. I certainly do not want to give any false sense of hope or doom so I basically explain the full spectrum of possible outcomes in terms that the family can understand. I often have to simplify the terms but it gives the family and patient a sense of what is going on.

We are all feeling more optimistic this week regarding his condition. We were relieved that we could not find any cancer. Maybe the outcome will be better than we expected but he could still take a turn and decompensate quickly, so we are on guard. This case has been great for learning and I have learned a ton through managing this patient. I guess this is why we train in this manner, it is the best way to figure out how to be a doctor. We will see what this week brings.