Manic Monday has taken on a new meaning. People have nightmares. We worked through one.
I started work on Monday morning at 8 am. I finished work on Tuesday evening at 8 pm. 36 hours! We operated non stop for 12 of those hours. All of which were at night. 10 pm to 10 am. One break around 7 am.
I will not discuss the case in detail owing its sensitive nature. What I can tell you is what I went through, how we managed and how I felt.
We started Monday with our regular cases which went off smoothly, other than a minor glitch which was solved on table itself. That was a warning. Towards the afternoon, we got to know that we might have to re-operate on a patient from out of town. She was on her way and was not doing well. We planned to do an X ray and decide if it was required.
We had a plan. Go in, find the problem area, do minimal handling, leave abdominal drains and come out. Murphy's law was in full force. Nothing went right.
10 p.m. We started laparoscopically, found the rent in the oesophagus, tried to get at it, tried and tried. The liver was getting in our way, the spleen was oozing blood because its capsule was stretched to tearing, the camera kept fogging up, the omentum was playing policeman in the abdomen sealing everything off. 12 midnight. We got a stitch in. It wouldn't hold. Cut through. We stitched again, it cut through again, and again. We lost length of the oesophagus in the abdomen. We were literally pulling it from the thorax into the abdomen through the hiatus. 1 a.m. I know this is getting technical but there is no other way to say it. Once we knew we had lost a lot of length, we also unfortunately knew that now we couldn't just leave abdominal drains and come out.
The only option now was to open. Open and do what? We weren't entirely sure this time, but we knew we had to open. We did. 2 a.m. We tried to reach, we cleared blood, we started giving blood to replace losses. We endoscoped to look from above and find the defect. We did. We took a stitch. It gave way again. We decided to try the circular stapler. 3 a.m. We struggled and managed to insert it somehow through the oral cavity for the orvil. We fired. It gave way. We now had two rents, one in the oesophagus and one in the stomach where the circular stapler was fired from. 4 a.m Boss was exhausted and running out of options. We stood there with our mouths hanging open, knowing that this was not ending anytime soon.
Stenting the oesophagus was an option. Somewhere in the timeline we tried to get hold of a stent. All the company people were sleeping. Stenting would not happen this night. 5 a.m. We asked for help cause we needed an extra set of hands. We called the on call R.M.O. (Resident Medical Officer) No answer. People sleep at 3 a.m. We tried calling the surgical registrar for the O.T. No answer.
6 a.m. Blood pints given 4 FFP 1. We needed help and we knew it. They say a great surgeon is one who knows when to call for help. It was decided to do a thoracotomy and get the oesophagus through the chest and anastomose (join) it to the jejunum (intestine) bypassing the stomach.. We needed a thoracoscopic surgeon and we called for one. The one we called said he had prior commitments later that morning but would come in at least and also advised us to call one more surgeon so that in case he had to leave, the other could take over. Smart idea. I respect that man and this was just one more reason to. We called and the other thoracic surgeon also came.
7 a.m. My first break. My anaesthestist watched me falling asleep on my feet and rightly told me to go wash and come back. I did. Ate breakfast which was a roll ordered last night for dinner. Had to get something in for energy.
The surgeons had arrived and taken over. Literally. We were too exhausted to be the lead team. We assisted. Chest cut, neck cut, oesophagus mobilised, nasogastric tube inserted. The tube came through the food pipe into the abdomen. What more could go wrong. We were no longer flustered. We just continued on instinct.
10 a.m. Skin closed with 4 drains. One ICD for the chest, One abdominal drain for the abdomen, one neck drain for the neck, one subcutaneous for the wound..
Unfortunately, the day did not end there. The regular cases posted were to be operated and we had commited to them so we did. It took longer than normal but we did it. 8 p.m.Finally we were done.
If you get nothing else from this post, get this. The level of respect for boss has gone up skywards. He just did not give up. I pray that she makes it. She's in the ICU now. Will follow this up once she's better (fingers crossed)
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