A Hard Day in the Operating Room – Nancy L. Glass, MD, MBA

I barely slept last night, tossing and turning, thinking about how today’s case would go. It wasn’t that unusual for me to sleep fitfully before a challenging case, but this one was different.

As I walked out into the Holding Area in my scrubs, my red stethoscope draped around my neck, I saw Theresa and Matt holding Stephanie, their eyes red, their faces puffy. I knelt on the floor in front of them, creating a private space for the three of us and this one very special little girl. We were oblivious to the noise and chaos around us in that moment.

“You know I’m going to rock her to sleep,” I began, but then I stopped, because there was nothing else to say. Theresa sobbed, and Matt’s jaw tightened. It was all I could do to maintain my composure. I waited until they were ready to hand the baby to me, and then I put her over my shoulder and patted her back. She nuzzled in toward my neck, warm and baby-fragrant, and after a final round of kisses, I walked away with Stephanie, leaving Theresa and Matt in the care of one of our kindest nurses.

The beginning of the anesthetic was routine: I rocked Stephanie to sleep singing “Twinkle Twinkle Little Star” as she breathed strawberry-flavored anesthetic gas through a mask and then placed the monitors on her chest. When she was sufficiently anesthetized, I placed the breathing tube in her throat and started an IV in her hand. Those tasks were simple, because I had done them thousands of times before. I had a reputation for having “really good hands.” I had a reputation for careful anesthetic planning, nerves of steel, and the ability to respond decisively in a crisis.

Any other day, I might have been focused on the “slickness” and finesse of my technique; I had high expectations for myself. None of that mattered to me on this particular day. My technical and cognitive skills offered no comfort to me. What I had to do on this day was much, much harder.

This was at least the tenth time I had anesthetized Stephanie, who had been diagnosed with a malignant eye tumor at the age of three months. She had received multiple rounds of chemotherapy. During that period, I anesthetized her every month so that her ophthalmologist could perform a detailed exam of her retinas and inject chemotherapy directly into her eye. But at the age of six months, her right eye had to be removed in a desperate attempt to save her left eye. I was there that day too: a sad day, but at least she could still see in the other eye. I remember that her parents had family portraits made the week before her eye removal, the last time she was whole. They brought me a picture then, still on the bulletin board in my office.

Unfortunately, the cancer spread to the left eye too, despite the aggressive treatment she had received. And so, on this gloomy day, we were in the operating room to remove her second eye—to render her blind forever, at the tender age of fifteen months.

Stephanie’s ophthalmologist, a young mother herself, recused herself from the enucleation procedure (eyeball removal), and asked a colleague to perform the surgery for her. She was present to support the parents, sitting with them in the waiting room, but she couldn’t bear to do the procedure herself. Totally understandable to me.

I didn’t feel like I could not do her anesthetic. Her parents trusted me and asked me to care for Stephanie. I had a reputation for coming in and doing “request cases” even if I was off or not scheduled for OR work. That was the case on this day, but there I was. I felt an obligation, a commitment, to help this family on their hardest day yet. Because that’s the kind of physician I would want caring for my loved ones, the only standard that matters to me.

Conversation in the operating room that day was muted: no jokes, no music, no banter, a subdued atmosphere. A few minutes after the operation began, the surgeon said, “I’m ready to cut the optic nerve, if anyone needs to step away.” The scrub tech backed out of the room into the sterile core, and the circulating nurse stepped just outside the main OR door, watching through the window. It was just the two of us, he and I, with Stephanie. He picked up a heavy pair of scissors off the Mayo stand, and began to chew on the thick, tough nerve. I could hear the crunching and feel the toughness of the nerve as the vibration of the scissors traveled down to the OR table where I held Stephanie’s little hand in mine. Finally, he cut through the nerve. He pulled out the eyeball and placed it in a specimen cup, covering it gently with a moist gauze. We sighed in unison. I will never forget the sound and feel of that optic nerve being cut.

Stephanie emerged from the anesthesia calmly, and I carried her to the Recovery Room, still a little groggy. The nurse brought her parents into Recovery right away, so that she would hear their voices as soon as she regained consciousness.

Stephanie’s second enucleation was one of the hardest anesthetics I ever performed. I was able to do my job, to render her unconscious for the procedure, keep her safe during surgery, and awaken her without pain. Anyone could have done that. I had the reputation for being able to do the toughest cases, the cases no one else wanted to do. But on this day, I was powerless to do what I really wanted to do: to turn back the clock, to help her through even more chemotherapy, to alter the relentless progression of her cancer. My reputation didn’t help me at all on this dark day, because all I had to offer Stephanie was my presence, some snuggles, and my caring. And on that wretched day, being there for Stephanie and her parents had to be “good enough.”

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Bio: Nancy Glass earned a BA in German literature, an MBA, and a Master’s of Liberal Studies from Rice University; an MD from Baylor College of Medicine; and will graduate with her MFA in Writing from the Vermont College of Fine Arts in January 2023. Now Distinguished Emeritus Professor of Pediatrics, she spent more than ten years practicing pediatric hospice medicine at a not-for-profit hospice in Houston after nearly three decades practicing pediatric anesthesiology as Professor of Anesthesiology and Pediatrics at Baylor College of Medicine and Texas Children’s Hospital. She has been published in Intima: A Journal of Narrative Medicine and was the winner of the 2022 Manuscript Contest in General Nonfiction held by the Writers’ League of Texas; she is now working to finish a collection of her pediatric hospice stories. She enjoys hiking, birdwatching, knitting, baking sourdough bread, and listening to classical music.