7 bere 2024
When is it unwise to do an operation. If I do a challenging one and succeed am I good, or lucky, or blessed by God. If I do a challenging operation and hurt someone am I bad, unlucky, cursed, negligent…
I saw a woman in the last few days that was having a lot of abdominal pain. She had some varices (enlarged serpigenous veins) on her abdomen from an inch above her umbilicus up to nearly her zyphoid. She said these were very painful. In the bottom area I had the feel that there may be a small hernia and she definitely was more tender there. I got a small fluid wave on tapping so I think she has ascites too. So by deduction she also has cirrhosis. This can cause a back up of the usual venous drainage and make other veins, like the abdominal wall, dilate and take up extra flow. So this becomes a high risk person to operate on and a risk of getting into bleeding that is difficult to stop and ultimately could kill her. I’m hesitant. But if she is having pain primarily at a small hernia I can fix that and try to take out these veins too. So through translation of a student nurse I tell her about all this and that she could die from the operation. She wants to proceed, that’s why she came to the hospital. I think i can safely take it out so I book her.
So today Im looking at her on the OR table and thinking, what was I thinking the other day. My courage is smaller today. I tell Phillipe the anesthetist to warm up blood to give her if we get into a lot of bleeding. I choose an assistant who is very good at assisting and will be a great help if I get into lots of bleeding. I scrub at the OR sink with the bar of soap on the side counter and then put on my sterile cloth gown and sterile gloves. I incise lower than all this mess and come up slowly underneath where I can see different structures bettter. I slowly dissect around one side and see large vein after another. There is slight bleeding but it is a small vein outside the vericosities. As I slowly go up and peel this mass of veins up towards me, I find a small perforating vein from the inside. I tie it three times and then divide it. The whole rest of the veins go flat. Wow, that was all fed by one smaller vessel! Now I have more courage, I work faster now and find a second perforator near the top, likely the outfllow vessel. I’m able to take off the whole thing and loose less than 1ml blood. What do I feel- relief, gratitude to God for helping me not cause bleeding, and more relief! Should I have done the surgery, I don’t know. One day I had the courage, today i didn’t but did it anyway. Thank you Lord God for helping me do it well without harming her.
This was Auds birthday too and she adds the following.
Thanks everyone for the wonderful birthday wishes. It was awesome to get them over here in hot, dusty Chad.
My day ended up to be fantastic. I started off the day feeling just a tad sorry for myself but decided to have a good day anyway. People started wishing me a “Happy Birthday” right off. I rounded on the maternity ward and it went smoothly. I’m really enjoying the nurses that I’m working with which makes the mornings more fun.
I came back to my place and had a bite to eat which was delicious local food. Several people stopped by to eat and chat.
