Wednesday, February 3, 2010

The mega colon.

It's freezing out, and I'm on my way to work.
Doing a laparoscopic total colectomy, and expecting a slow and quiet day. Today's surgeon has, in my humble opinion, already got one foot in a retirement village. He seems to know it too cause some hotshot surgeon has been especially imported ... yes from another country, so God help us ... to assist/do the procedure. I have no great expectations for the day and I'm almost sure it's gonna be long, slow and hopefully very boring. Brought my sudoku along just in case ... oh and quitely slipped a mills & boon into my bag when no-one was looking. (Yes, we all have our skeletons ...)
I don't make a habit of "relaxing" in theatre, but on a long 7 hour haul, with proper preparation, the course mapped out on auto-pilot, and everything going smoothly, even a control-freak like myself can relax for about 15 minutes. Bear in mind that I sit in a little spot squashed between the patient and the DATEX, within arms reach of any resuscitation stuff. Super-sensitive ears listening to the blips of the heart from start to finish. My species can detect any changes just by listening ... even in our sleep.

Laparoscopic procedures are minimally invasive to the patient, but usually quite difficult. Imagine removing an entire colon, with minimal bloodloss, using 4 little holes, and your hands never actually inside the abdomen!!! Never seizes to amaze me how these guys seem to know exactly where they are, exactly what they are looking at, and how they manage to orientate themselves. No wonder they sometimes think the sun stops shining when they sit down...

What does all this mean to me??
Well if all goes according to plan and nodody screws up, it means that the fluid-shifts and losses are minimal, which is very good (less calculations for me). Also the postop recovery is much easier and less painful. But intra-op, besides the standard basic anaesthesia rules, lung ventilation is a little more tricky as a whole lot of extra pressures come into play. The patient is put into a head-down position, with her abdomen blown-up by CO2 gas to resemble that of a term pregnant tummy. So the poor little lungs get squashed up nice and tight, and among other things, its my job to ensure normal gas exchange throughout, using a few ventilation tricks and a couple of drugs.

With the milk of amnesia administered, the endotracheal tube secured, and the desired "altitude" attained, we are ready for surgery to begin.

Today I have decided to take the bull by the horns. Time to chuck that bloody chip off my shoulder! Been the new kid on the block for long enough! Time for the old, spunky, me again... and to hell with everyone else.

I boldly introduce myself to the freshly imported, just about shake his arm out of its socket ( I love seeing the shocked look on people's faces when I do that) and act very much in charge. He doesn't look shocked though, but smiles warmly ... WOW... strange surgeon smiling at me ... thats a fresh change from the last 6 months! He instantly gets a new fan.

Surgery is slow, but precise. The guy is brilliant, its obvious that he loves what he does.
On my side we are cruising steadily on auto pilot. No troubles thank God. I quietly pull out my M & B, and enjoy a few pages behind the screen,( with my ears on the monitor of course), when WOW calls my name. Oh shit, within seconds I asses the situation and find nothing amiss ...
Patient is correctly positioned, fully relaxed, vital parameters normal with enough fuel on board, so what's wrong??

Yes?, I ask. He says something in rapid greek. My own language once again makes me look like an idiot. Excuse me but could you repeat that slowly please? Then, in perfect english, comes the sentence that finally knocks all remnants of that chip, forever off my shoulder.

Thank you for the perfect anaesthetic, I am very very happy with your anaesthesia.

Well blow me over!!!!!!!!!! Don't know what I expected, but that was certainly not it! That little sentence, set me free! I finally escape from the cage in which I have both locked myself in, and allowed others to imprison me. Can't explain the soaring feeling....

I wish all God's blessings upon the lady, now minus her megacolon, for facilitating the brief crossing of this man's path with mine. Although I never strictly doubted myself or my capabilities, his words soothed ... no, cured, an injured soul.

Didn't know I was quite so easy to "fix".

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