I could not have predicted how I would respond to seeing a surgery for the first time. I expected nausea, or dizziness at the sight of someone being opened up before me. I did not expect, as I stood one foot away from Dr. Isenberg laparoscopically removing a woman’s cancer, I would be so calm. There I was, day one, thrown right into the OR, watching surgeries and colonoscopies back to back. Instead of feeling freaked out, and looking away, I looked right into the woman’s body. If not for a medical student, I would have been clueless as to what was going on. He was also following Dr. Isenberg at this time in his rotation. He answered my questions when Dr. Isenberg could not, pointing out the anatomy as we watched it on the screen. It was like watching the images in my textbook come to life, there was the liver, brick-red, the small intestine, stuffed like yarn into a thimble, the gallbladder, almost hidden under the liver, and the large intestine winding around it all. As strange as it sounds, the large intestine is beautiful; it doesn’t look like a large ribbed tube, it’s center is smooth and salmon-colored, with tons of fat sacks attached to the sides hanging like droplets. The doctors who were performing the surgeries—I followed around three doctors in the colorectal department—would move through the colon using bowel graspers to hold these fat pockets and separate the colon from the connective tissue that kept it in place. I found myself in awe of how the doctors knew exactly what steps were needed in order to help the person lying on the table in front of them. I saw many surgeries my first week, but only two types of surgeries: those for colitis, and those for colorectal cancer. If a person has ulcerative colitis removing the entire colon will cure that person. When the colon is removed, the person will generally get  “J-pouch,” which is when the small intestine is used to create a new rectum. When this procedure is done, the person will also often be given an ileostomy, having a bag temporarily attached to their side to collect the excretion so it doesn’t pass through the area that is healing. I’ve seen about three of these surgeries, and each time I am astonished to see the colon outside of the person’s body. It looks so different, and so large, and when I look back at the person lying there, they seem so skinny without it. The procedure to remove a cancer generally does not result in removal of the entire colon. The doctor will remove the tumor and affected area. I was allowed to feel this after it was removed, with gloves on of course. I pressed my hand on the unaffected part of the colon, then worked my hand down, pressing until I reached a lump. It was about the size of a golf ball under the mushy exterior of the colon, and it definitely felt like it should not have been there. It was the strangest feeling. Somehow I was angry at this ball of cells, it was wrong and because of it, this young woman had to go through such a big surgery, with her parents waiting there, nervous should anything go wrong. She had to be lying there, allowing an anesthesiologist to intubate her, allowing a doctor to cut, and cauterised, and inject to save her from this incorrect ball of cells. There she was, though, at the end of the surgery. Dr. Isenberg helped save her life.

When I follow around Dr. Isenberg, watching as he diagnoses and heals patients, it’s hard not to wonder how I would feel if I were the patient. What would I do if I had to have a bag attached to my side because I couldn’t use my colon properly? How I would react, I can’t even imagine. Even more, I think about how our bodies work. Watching a piece of someone’s body being completely isolated from themselves is unreal. It’s terribly scary to think that all we are is extremely complex biological machines, cells working together to maintain our survival. Watching someone being cut open, I am in disbelief that this is what is inside of me. I feel distinct, as everyone does. Everyone is told that they are special. We don’t see the insides of ourselves, and like we can create what we look like on the outside, it almost seems like we can create what is on the inside too. Our our pain, our love, our gut feelings make what lies inside feel more like a magical space, where light and darkness, life and happiness, angst and fear congregate. It is a hollow pocket in the world that belongs to us and only us. But seeing each person opened up, seeing their inside, textbook pictures becoming real, I am unsettled. At that moment, I feel unprotected; at that moment, I feel exposed and insecure, as if it is me on that table and I am looking inside myself and see nothing magical, nothing special, nothing but my machinery. I don’t even know how I feel about it, or how I’m supposed to feel it, but in some way, in the city of Philadelphia, all by myself, I feel a little less lonely. Everyone around me is the same on the inside. Behind whatever is on the outside we all have the same machinery. The same organs, the same body; we all are searching for meaning, trying to fulfill that magical space inside.

-Rachel Saunders, Thomas Jefferson University Hospital

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