Swapping the scalpel for the pen: a surgeon writes

Kevin Pringle

The first poem I wrote about a patient was when I was working in Iowa City at the University of Iowa as a professor of Paediatric Surgery. Matt was a classmate of our younger daughter Fiona in Junior High (roughly equivalent to New Zealand’s Intermediate). He developed a tumour on one of his ribs, which I attempted to remove, unsuccessfully.

Bittersweet. Bitter more than sweet.
I did my best, and felt I let you down.”

– from “Matt” by Kevin Pringle

To remove the tumour, I had to remove two adjacent ribs.  Because Matt was still growing, I couldn’t stabilize the chest with a synthetic patch, as that would have resulted in a serious scoliosis. I devised a muscle flap and used parts of another rib to provide the required stability. The operation was a success, but Matt died of complications of the subsequent chemotherapy. My response to this was to write a poem which described what happened to Matt, and in particular my feelings about my part in his treatment.

Our children knew Matt and I felt it best that they heard the news from me, rather than on the grapevine. Fiona’s comment was “He was a funny guy, but now he’s dead”, and that stuck with me, becoming the first lines of the poem.

‘He was a funny guy,’ Fiona said,
and now he’s dead.
I didn’t get to know him all that well.
Just the sort of “know” that
Seeing the heart (in flesh) can tell.
But his humour still remains…

I had spent a lot of time thinking about and planning the operation to remove Matt’s tumour.

Ewing’s sarcoma, we called it.
I have a funny feeling that
Matt
Called it other names…

It sort of  “snuck up” on him,
Masquerading as other things
Nowhere near as serious.
It ate his whole sixth rib,
Invaded nerves and caused him pain.
And with the diagnosis, the deadly game
Began…

When I opened the chest cavity and saw all the pleural seedlings, I knew that I could not surgically remove his tumour: “operate for cure”. I called the Paediatric Oncologist and discussed the options and then broke scrub, leaving the team looking after Matt while the Oncologist and I sat down with Matt’s parents. We discussed the options and I then returned to Theatre and completed the operation.

I opened up your chest and saw the mass:-
A challenge.
But then I saw the pleural seeds.
The tumour, then, had spread,
And I couldn’t keep my bargain.
I couldn’t go for “cure”…

The plan was to attempt a bone marrow transplant in the early days of that sort of treatment. Unfortunately, Matt developed a particularly nasty Staph Aureus sepsis at the time had had essentially no white cells. He had vegetations on his aortic valve and one of them broke off and went down his left main coronary artery, causing a massive heart attack. In some ways, that was a blessing. He still had viable tumour in his brain and along his spine. He would have died a much more miserable death. That said, as I say in the poem, I had undertaken to remove his tumour, and failed to do that.

A technical triumph:
To devise and successfully complete,
The resection of the mass,
One rib, and parts of three others,
And three lung segments,
And fill the (w)hole with muscle.
‘Twas both high and low for me.
Bittersweet. Bitter more than sweet.
I did my best, and felt I let you down.

Writing a poem was my way of finding a way to frame and accept what happened with Matt. On other occasions, I have worked off that sort of disappointment with physical activity, almost to the point of exhaustion. Once, I had a 2 year-old with a very high cervical fracture that divided his spinal cord  just below the brain stem. He was saved by a paramedic who used a technique that I had taught him the week before the accident. When I saw the extent of the spinal cord injury and realised that we had salvaged a brain that was still, very tenuously, connected to his heart but to virtually nothing else, I went home and split the best part of a cord of firewood.

Postscript: Matt’s father is the Canadian novelist David Morrell, whose work includes First Blood (filmed as Rambo) and The Brotherhood of the Rose. In the wake of his son’s death, David Morrell wrote Fireflies: A Father’s Tale of Love and Loss. David has said: “Of all the books I’ve written, this one has received the most response, mainly from parents who have lost children and who take some comfort from what I say about grief.”

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Kevin Pringle ONZM, M.B., Ch.B., F.R.A.C.S.: Kevin attended Medical School at the University of Otago, Dunedin, NZ, graduating in 1970. After training as a paediatric surgeon he spent many years in the USA, including 7 years at the University of Iowa, where he became Associate Professor of Pediatric Surgery. He returned to New Zealand in 1987 , and has held several senior clinical positions since then, including Senior Lecturer in Paediatric Surgery at the Wellington School of Medicine, with a Joint Appointment as Consultant Paediatric Surgeon at Wellington Hospital, Professor of Paediatric Surgery at the School of  Medicine & Health Sciences, University of Otago, Wellington, Clinical Leader for Paediatric Surgery at Capital & Coast DHB, and Head of Department of Obstetrics & Gynaecology at the University of Otago, Wellington. He recently retired from hospital practice, but retains a part-time appointment as Emeritus Professor of Paediatric Surgery in the Department of Obstetrics and Gynaecology at the University of Otago, Wellington, New Zealand.