Today in the OR, I had a crummy revelation. As you might know, I have GERD (aka reflux, aka heartburn). It’s been developing for years, but I was officially diagnosed in December; since then, I’ve been treating it diligently with medication and avoiding things like eating too late, eating before exercise, or eating spicy or drinking hot foods. It’s been going well, but I just learned that my GERD has a new enemy now: hunger.

I had a bagel with hummus for breakfast and a few sips of water. When the second surgery began at 9:30, I didn’t expect it to last for 8 hours. It was a crazy surgery, basically five pelvic operations all rolled into one. Personally, as a novice med student, I don’t do much — my primary job was to hold the uterus on a stick — but standing still and applying constant pressure while dodging a robot is still a physical task. The not sitting, not drinking, not peeing part is okay as long-distance running has been good training for that. However, the hours pile up, and my stomach wasn’t having it.

See, there are three phases to digestion: cephalic, gastric, and intestinal. The gastric phase is when the stomach puts in work to spit out most of its acid, and intestinal phase is when the intestine neutralizes the incoming acidic load. The cephalic phase is not supposed to be a big deal. It’s like the warm-up stage, where the sight, smell, taste, or thought of food stimulates stomach secretions in preparation for incoming food. It’s not much, just a tiny bit of acid for the first few bites. Once the food arrives, the food buffers the acid and all is well.

However, when I’m stuck scrubbed in and lunchtime ticks past, there’s no respite. My symptoms flare up, and there’s no food, drink, or medication to calm down my stomach. I have to swallow more to keep the acid down. Some of it is mucus plugs, but much of the swallowed content is air, so I start burping too. There might be a weird bitter taste in the back of my throat too. Then comes the sensation I despise and dread, the burning throat deep down in my chest. It’s like a sore throat from an infection, but lower and more visceral. It sucks. It’s like my stomach got hungry and started gnawing at my own body. The burning throat is a doubly horribly feeling because then I know that damage has been done to my esophagus, and it’s requires that much more effort to guard my throat until it can heal again.

That moment in the OR felt so real to me. I readily acknowledge I’m sick, and now I’m learning real-time what it’s like to cope with it on a daily constant basis. It steers how I live my life right down to the very basics: how I eat, when I sleep, where I keep my meds. GERD is an exceedingly common disease and people say it’s a pretty low-impact disease, but I’d disagree. It’s a runaway condition. If you have it too, fight hard to control it quickly or you’ll be like me: scared that I’ll have trouble with something as simple as scrubbing in for a few hours.