Mistakes

I'm in way over my head and it's all I can do to not panic. I'm not a surgeon after all and the mistakes I've just made prove it. Now, can I save this lady's leg and kidney?

I had opened the belly of a woman with a large lower abdominal mass. A huge smooth lumpy, solid but not hard mass fills her entire pelvis. I identify the right ovary and tube with what appears to be a fibroma sticking out behind and a huge fibroma filling the rest of the belly.

I start to remove the uterus but it's difficult because there's no room to manouver to get down the side to the base. I do most of the right side and then move over to the left. That's where I start to make mistakes because I misdiagnosed the problem.

It's already taken an hour and a half with no muscle relaxation and trying to keep all the intestines out of the already cramped pelvis. I'm moving down the uterus staying close to it like I've been trained to avoid the ureters when I cut through...the ureter.

Mistake number two...the first one I won't discover till later.

I realize I'll have to repair it later so I tag it and keep moving. Finally, I get low enough where it's time to separate the bladder from the cervix.

It's stuck. As I try to free it, I enter the bladder which is weird because their doesn't seem to be really any uterus behind it.

Mistake number three.

I decide to open up the uterus and take out the myomas to free up some space and try to identify things better. I open it up and find thick, jelly like contents.

It's a huge mucinous ovarian cyst that has attached to the uterus and ovaries making it seem like fibromas.

I shell it out and suddenly, the normal sized, half taken out uterus appears in the right pelvis. I then look back at what I thought were the enlarged uterine vessels and realize I've probably cut the femoral vessels.

I ask Simeon to feel the left leg. He's says it's a lot colder than the right.

I'm getting desperate. In my ignorance I've probably cost this lady her leg and kidney. We're already two hours into the surgery, the leg is without blood for 30 minutes already and I still have to take out the uterus and the rest of the ovary before clearing up room to try and do something about the artery and vein and ureter and bladder.

I'm fighting off panic. I want to rush. I have to make myself turn on autopilot.

Do I have what it takes?

I've been praying almost continuously that God won't make my stupidity or ignorance or whatever you call it be the cause of such a catastrophe.

Somehow, while the panic rests under the surface, I feel somehow that I'm not alone in this. That I have a mentor, an attending physician with me but who says, I'm not going to take over, I've given you what you need and I'll walk you through it.

I suture up the bladder in two layers.

I search for the femoral vein first. I find both ends of a large severed vein in the right place (now the anatomy is clear) and clamp them with vascular clamps before cutting off the sutures and trimming the ends. I find the proximal end of the artery but can't really find the distal end.

I take some very fine suture and painstakingly put in the sutures starting from the back side and working around to the front. Odei and Taiana, my assistants are fighting a neverending battle to help me against the intestines and the oozing blood and fluids and the vein itself that doesn't want to stay close enough to suture.

In the meantime, Simeon has done a hemoglobin and it's 6 so he's ordered a blood transfusion.

I release the clamps and a huge clot bursts out followed by dark blood rapidly filling the operating field. We suction and mop up desperately as I reattach the clamp. I suture a bit more where the leaking was and try again.

The same thing. I'm trying hard not to get desperate and just quit.

Finally, we release the clamps again and there's no bleeding.

I start the search for the distal part of the artery. I just can't seem to find it. What I thought was the artery turns out to be the vein as I release the clamp I thought was holding the artery to try and attach it better. I know it's the vein because dark blood immediately begins to gush out again.

We repeat the same process until it's definitely stopped. I hunt and hunt for the artery. It has to be here.

Finally, I find and clamp it and start the slow process of suturing with fine suture.

We are four hours into the sugery, two hours without blood to the leg.

I release the clamps on the artery. There is no bleeding, but no real pulsation either. It's probably clotted up. I don't know what else to do so I head to the ureter.

I always wondered what we were going to do with all those ureteral stints that someone put in the container of supplies we got two years ago, but I'm glad for them now. I open one up, slide it into both ends of the severed ureter making sure it goes all the way into the bladder, and suture up the ureter around it.

Finally, we close up the abdomen and I check her leg.

Is it my imagination, or does she have a faint pulse in her foot? The leg is still cool. Only time will tell.

We put her on some Heparin and Diclofenac, the only blood thinners we have and pray for the best.

I don't know how to explain it, but as I walk out, instead of feeling stressed and annoyed, I almost feel refreshed, at least spiritually, even though my body is tired, it has been a time when I knew God was with me. He didn't say, well, you caused the problem so you're on your own.

Rather, he encouraged me, kept me from giving up and led me through.

(Today, two days later, her leg is a little swollen, but not bad and she has a good pulse and can move her leg normally. Her urine is clear, her intestinal function has returned and she's starting to take liquids...Al hamdullilah)