Initial incision and exploration
Professor,specialist and resident..me :)
Holding the tumour.
"There's this whole ritual around going into the OR for a transplant that makes me feel like a high priest going into the temple: I cleanse myself, the patient is cleansed, and we go to a sterile environment.
The donor heart arrives in a cooler, and it feels like frozen turkey. It's about the same color, too. And slippery. Sewing it in should take less than forty-five minutes. To make sure no air gets in, the final sutures are put in underwater — under blood, actually. It's sort of like having sex: You need to feel the stitch. You sense the tip of the needle, and it has to feel correct — you're not going in too far, or missing the tissue, or getting too small a bite. As you're sewing, the heart starts to fill with blood. You have to time the last suture just right, just as the blood gets to the top.
The real anxiety comes when both clamps are removed and the blood starts flowing with pressure through the heart. That's when I can't help but wonder if I just killed someone. The new heart jumps around, trying to get its rhythm, like a fish flopping in a bucket of blood. Sometimes it can't. It just fibrillates, beating spastically, and we have to shock it.
The first five minutes are the most critical. If the heart turns from cream to pink, the color of a juicy steak, we're optimistic. There's this incredible feeling of bliss, like we've just reached our Zen moment. The high fives come out. But if it turns dark red and looks bruised, it's damaged, sometimes irreversibly. Then we close the skin up with number-two nylon, and I go out to tell the family I'm sorry."
Dr Mehmet Oz, World renowed Cardiac surgeon.
We had a patient come in diagnosed with a tumour in the abdomen scheduled for excision. On examination the mass was partially small and mobile.
After we opened her up I was so shocked to see the size of the tumour...literally it was the size of a fist.The worst part of it all was that it was so attached to the surrounding organs by adhesions that the Professor couldnt tell where the source of the tumour was...the pancreas was wrapped around it...was apprehensive about cutting off the bile duct by mistake...so he decided to go for a Whipple.
In the Whipple operation the head of the pancreas, a portion of the bile duct, the gallbladder and the duodenum is removed. Occasionally a portion of the stomach may also be removed. After removal of these structures the remaining pancreas, bile duct and the intestine is sutured back into the intestine to direct the gastrointestinal secretions back into the gut and allow the patient to have normal functions...the tumour was extremely vascular and it took a really long time to carefully dissect it out without causing serious bleeders..After almost four tense hours the tumour was out...the anastomosis was done...the drains inserted to prevent collections of fluids in the abdomen postoperatively and we closed up the skin.
It was the most thrilling experience ever...to be a part of helping someone in that way is something I cant describe...it pushes you...drives you...and brings you a sense of exhilaration...Im so grateful everyday for learning and for being given the privilege to continously keep that learning process undergoing until enshalla one day many years from now I will master it to an art.
The patient is recovering well el7amdilah and her prayers to the Professor on the round the next day just humbled me because this is what its all about...we strive to learn...to help...to improve ourselves as people and physicians everyday...and through all the personal struggles we have in our daily lives...the work problems and challenges we face as the beginners of the long road ahead of us...those prayers are what keep us going.
