Saturday, September 15, 2012

HOW TO DO A CHOLECYSTECTOMY?


HOW TO DO A CHOLECYSTECTOMY?

I have written more operation notes of cholecystectomies than stories about other stuff thus breeding displeasure within myself at not being able to be more illustrative in an intriguing manner instead of the repetitive express jottings in the patient files. I think it is the bane of not being the premier rather than a subordinate. The following is an attempt to win a point!
The patient had a calculus in her gallbladder even though the sexagenarian declared emphatically that she “had never consumed a stone in her life!” The pathological presence of the villainous stone inside her body continued to befuddle her even in the face of the most lucid explanations delivered repeatedly at the top of my voice to defeat the demon of presbycusis! It was an example of condescending to one’s grandson’s nonsensical babbling with the flashing of an endearing smile because she did exactly that after calling me one! The same grin in her plump face while she lay supine on the operating table, however, surrendered to the propofol infusion that swiftly whisked her into unconsciousness. The endotracheal tube totally killed it!

The brown colour of the drying betadine paint on her skin was a display of antisepsis. The drapes hid every part of the old lady other than her oversize belly. There was never a quiver when the scalpel ran parallel and below her right rib cage incising six centimeters of skin because an injection named Atracurium had paralyzed her. The insensate wound bled but only a little like the gradually collecting droplets outside a chilled glass. A diathermy probe searchingly burned the more prominently oozing vessels. Two inches depth of yellow fat was separated to reveal a glistening aponeurosis like the skin of a fish. That was incised and a piece of red meat otherwise called Rectus Abdominis showed up to be divided by using the diathermy probe again. A little amount of smoke vitiated the OT air but was soon sucked in by the vacuum suction in my hands. Another layer of muscles which happened to be the anatomist’s posterior rectus sheath was then similarly disunited. A thin flaccid sheet of tissue called peritoneum was lifted with a pair of forceps and one rent made and extended to finally open the Pandora’s box! It was as yellow within as outside! There lay spread out across the whole cavity a carpet of sunshine gold which was so thick as to weigh several kilograms of spongy fat and that’s what's otherwise called the omentum underneath which the bowels seek shelter.
Three mops were placed to push the stomach and intestines away from the swollen pear-shaped organ called gallbladder. Two metallic instruments each shaped like a large question mark bearing the name of Deaver’s retractor were used to widely hold apart the wound so that the premier surgeon could fight the crucial battle at the Triangle of Calot.
The gallbladder, henceforth to be called GB, is like a fruit that hangs from its stem called the common bile duct and it should be removed taking care to never injure the latter because if one does that, the whole person turns yellower every passing day to thus wither away!

The short-statured and elderly skilled surgeon, who stood the most erect with a stool to add to his height while his two assistants stooped, tied the duct of the GB and the artery, that supplied blood to it, with silk sutures and snipped gingerly at the ends of those structures. The GB was thus released from its stem but it could not be so easily plucked off. It needed more pluck to gently tease it away from under the liver to which it remained adherent. Many times during this maneuvre it may bleed more than desired and thus be uncomfortable for the surgeon and breath-catching for the on-lookers. But on the concerned occasion, the old lady was spared any blood loss. It was a virtuoso performance and the surgeon whistled a tune!
He held up the GB high in the air and eyed it with a sneer before dropping it into a tray shaped liked a bean. It was one of the thousands he had removed in his lifetime. He was a sexagenarian!
I took his scalpel and cut open the GB and there lay within it the large, oval shaped whitish stone stained with bits of green.
The abdomen was then sutured air-tight so that when the old lady woke up next morning with an ache in the wound she saw a large white bandage plastered onto it rather than nauseatingly undulating intestines!

5 comments:

"M" said...


hmm....gud one...perhaps now even a layman can perform a cholecystectomy.....but it wil b difficult 2 win da battle of triangle of callot's....as i feel da narration of da battle a bit obscure as well as closure of da "PANDORA".As a matter of fact,i also lik 2 differ on fish skin appearance...as it has mor resemblance to da skin of chicken rather dan fish 2 me..and burned smoky smell is somwhat similar to chicken "KHORIKA"!!!!!!!!!!!! Never da less..it s a marvelous depiction of da connoisier's observation!!!!!

Dr.Mayurakshi said...

ROFL moment..."The patient had a calculus in her gallbladder even though the sexagenarian declared emphatically that she 'had never consumed a stone in her life!'"

Dr.Mayurakshi said...

If operation notes were allowed to be so creatively written, a publisher's booth would crop up right next to the OT! And it would make for such fun reading in between surgeries.

Gaurav Das said...

Mr. M, thanks for the criticism and the praise as well! ;)

Gaurav Das said...

Mayurakshi, I can never forget that dialogue in my life! It is more than a year now. :)