Removing a Woman's Stomach

Dr. D. Rohan Jeyarajah
Director of Surgical Oncology, Methodist Dallas Medical Center

ToughestCase2_RohanJeyarajah Dr. D. Rohan Jeyarajah photography by Adam Fish

I was asked to see this young mother. She was 24 years old, and during her pregnancy she had had a lot of trouble with nausea and vomiting. At that time, it was thought to be all pregnancy related. But after she had the baby, her symptoms continued. Her doctor gave her an endoscopy and discovered a stomach cancer.

Before she came to see me, she had already been told that she had cancer by the gastroenterologist and the medical oncologist, but she had not received a complete plan on how to treat it. I had heard about her, about this young woman who had just had a baby, and I was like, “I’ve got to meet her.”

But it was so challenging for me to walk into that room, to face this family. Her mom and dad were there, and they were pretty young because their daughter was only 24. The husband didn’t come because he was “having trouble dealing with this.” I just remember seeing the deep, deep sorrow in her mother’s eyes, because she knows her daughter has this horrible condition. I have two boys and a girl myself, so I saw what I would be feeling if my daughter were to have anything happen to her.

Of all of the fields, medicine is the most human field. There’s so much reading into nuances, reading into phrasing, reading what someone’s face looks like. You can take so many cues from that, and this is not something that we teach well in medical school and residency.

But my patient was a strong young lady who was positive about everything. It was unfortunately a pretty horrible cancer, in that lymph nodes were involved. She wanted everything to be done in order to try to live for her child.

This was one of those cases where some people may have said,  I don’t think surgery will ever be in your future because it has already spread. I told her that we needed to come up with the most aggressive plan possible, and that was chemotherapy followed by surgery.

As a patient, your tendency might be to tell me that you want me to take all of my experience as a doctor, and then take all that has been published and apply it to your case. But do you know what my litmus test is? I ask myself whether this is something that I would do for my mom or my sister.

So she had chemo and lost her hair. I would kid around with her and say, “Wow, your husband must be really confused because he comes home to a different woman every night. Now you’re a redhead!” She’d always laugh. I may not be able to change what’s going to happen, but I can change the way it happens. If I can make it even a tiny bit easier, then I’ve done my job.

After she finished chemo, things looked better, and so we decided to do the surgery. I eventually met her husband. I was kind of worried that he may not be able to relate to me. I’m of Sri Lankan descent, so I’m very dark-skinned, I have a funny accent, and I dress funny. I’m not afraid to wear color. As a surgeon, you want the patient and the family to feel trust in you, so I was happy when he eventually seemed bonded to me.

During the operation, I discovered quite a bit of tumor. It would have been easy to back off because it was a bit risky to do the resection. I had to take out her whole stomach and the end part of her esophagus, and as far as we know, we got everything.

From the human standpoint, walking out and telling this family that we were able to get it out is the best feeling in the world, because for that moment, everyone is just so elated. For a surgeon, it all comes to this one point in time.

As of now, she’s cancer free. Time will tell how this story is going to unfold, because it’s still unfolding. But now she’s doing really well. She’s eating, and she’s at home with her baby girl, who is about 9 months old.

—As told to K.L.