Case Study #7: Colon Cancer

Operating Room

Day: 0
Time: 10h55
Place: Operating Room

Fred enters the operating room and quickly notes he is the only one not wearing a mask. He looks around to see a horrendous amount of gleaming silver utensils laying on a dark green table. He is then asked to shift over to an even more uncomfortable bed. Looking up, he sees an upside down head.

“Ok, Mr. Johnson. My name is Dr. Ben Ng. I will be monitoring your anaesthesia during surgery. Right now, I’m going to place this mask over your nose and mouth. I want you to take deep breaths in through your nose and out through your mouth. Let’s see how many breaths you can do.”

Fred tries to respond after the first breath and suddenly feels weightless. By the fourth breath, Fred’s eyes are closed and his breath is slow and steady.

“Charlie, the patient is asleep. Just give me a few more minutes to get an esophageal airway in and another IV. Then we should be ready to go.”

Dr. Baker looks up from the back table where he is selecting a couple of tools he likes to use. “Ok, I need a couple of more minutes to set up shop as well.”

Time: 11h07

“All right, Charlie, patient is asleep, stable, and ready for surgery.”

“Thanks, Ben. Let’s pause right now and discuss the surgery and what approach will be taken today.”

The scrub nurse and circulating nurse gather closer, and Ben stands to hear Dr. Baker review Fred’s history and the surgical approach to be taken.

“Any questions?”

“Other than the usual cytology specs, do you want anything specific?”

“No, his colonoscopy samples were able to stage the cancer. The MRI gave a well-defined area to be removed, but the MRI also showed some areas of metastasis that we will not be dealing with today. The tests that I ordered should be sufficient with no extras. Any concerns or questions?”

All members of the OR team shake their heads ‘no’.

“Ok, let’s get started, then.” Dr. Baker reaches for the scalpel and begins cutting into the anterior abdomen of Fred Johnson, between the abdominal erectus muscles, to access his large intestine.

Time: 13h30

“Hi, Eric. The surgery went very well. Fred is in the recovery room. The cancer was extensive, like the MRI showed, but I believe we got most of it. He’s going to be pretty sore for a few days. The anaesthetist placed a special IV in his back to help with pain. There is a large drain to get rid of any bleeding that may occur, as there is always a bit. He has an ostomy that is attached to a bag, but the nurse will explain more about that to you later.”

“Oh dear,” Eric responds, looking distressed. He glances up, “Thank you, Dr. Baker. Fred will be so disappointed to hear he has a bag. It was his biggest worry.”

“It’s hopefully temporary. The cancer had spread, as I explained. I took a number of samples all around the area, so we’ll know in a couple of days whether Fred will need chemo, radiation or other additional treatment.”

“Thank you, again. Can I see him?”

“I’ll let the nurses in recovery know that I have talked with you and that you can visit. He is going to be very sleepy for the next little while. His voice may be weak as well.”

“Fred is not much of a conversationalist at home, so I am used to the one-sided conversations.”

“All right, then. A nurse will come and get you in a few minutes.”


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