case of operation. The Surgeon's Story

"At 12 a.m., a phone call: "Please come to the gynecological department of the municipal hospital. The woman’s stomach opened and we don’t know what to do next.”

I go to the operating room. Immediately I learn that the head of this department, an experienced head, is on leave. The students are operating. The abdominal cavity is covered with a small cross section. A young woman, a cosmetic cut, when they made this cut, thought they would meet a small ovarian cyst, and found a large peritoneal tumor that goes deep into the small pelvis. And here they stand over their open stomachs. Shear - conscience does not allow, to isolate the tumor - are also afraid: the area is very dangerous and completely unfamiliar to them. Neither there nor here. and stupid. This story has been going on for 3 hours!

Everyone is looking at me, waiting for an exit. I have to calm them and encourage them with my appearance, so I smile and talk very easily and relaxedly. I open my peritoneum over the tumor and enter the abdominal area. The tumor is ugly, dense, almost immobile, goes deep into the pelvis, where the eye can not penetrate, but only to the touch. You can or can not remove this tumor - you will not immediately say, you need to start, and there will be visible. Very deep, very tight and very dark. There are vital organs and major blood vessels. Separate the upper pole from the general artery.

The easiest part of the operation, not very deep, and the wall of the artery is dense, it is not easy to hurt it. It even turns out to be beautiful, elegant, a little “for the public.” The result is unexpected. From the sight of a pulsing artery in my assistants begins hysteria. It seems to them that we have entered some terrible hole from which there is no way out. It affects three hours of previous tension. The gynecologist stands opposite, her eyes are enlarged. She cried out, “Enough! Stop to! There will be bleeding!” She grabs me by the hand, pushing me out of the wound. He is screaming all the time. Her hysteria is contagious. There are a lot of people in the operation. Doctors and nurses are here, even the nurses are here. And from her cries they begin to boil. Everything is collapsing.

I am covered by anger. “Silence,” I say to her, “Close your mouth! Tra-to to to to!“She is really silent. An elderly surgeon suddenly grumbled with a quick speech: “Thank God! Thanks to God! The man smells, the man smells. I heard such words, such words... Everything is well, Everything is well! It is OK!” And they calmed down. have believed.

Go further and deeper. I need long scissors, but they don’t exist, and with the scissors I’ve been given, you can’t work in depth. His own hands hide the field of sight, nothing is visible. In addition, the branches of these scissors differ, the tips do not connect. You can’t make a delicate movement (and it’s here, in such a narrow space). There is no blood supply either. The assistants are falling from their feet and do not understand anything. And again they say supplicantly, overwhelmingly, but without hysteria, convincingly: take a piece and go. There is no blood, no tools, we are bad assistants to you, you see where you got. What if he bleeds if he dies?

At this time, I am just separating the urethra, which is tightly attached to the lower surface of the tumor. A millimeter, a centimeter, in the dark. Sweat on the forehead, on the back, on the legs, tension hell. The ureter is separated. Even deeper the tumor attached to the extra-abdominal part of the rectum. There is only a feeling. I need normal knives. I cut bad slices. I force one assistant to put on a rubber gloves and push the patient’s finger into the rectum. My finger touches her finger from the side of the stomach and cuts her finger. And all the time at the base of the scissors - a wide, ugly and dangerous movement.

The tumor from the rectum is still separated. Only the patient is worse, almost five hours on the table with an open stomach. The pressure drops, the pulse divides. There is no blood at the transfusion station. Why is there no blood at the blood transfusion station? I scream somewhere in space to be brought immediately, to open their veins and to have the blood be this moment, immediately! “We have already gone,” they say.

So far there is nothing to move. You cannot allow bleeding, in no case: we will lose the patient. And the place is damned, bleeding - a small pelvis. All that has been so far is not the most difficult. Now I have come to the terrible. The tumor was infiltrated into the lower wall of the internal pelvic vein. The vein lies in the bone marrow, and if its wall explodes - the gap will easily go into the depth of the marrow, you will not sew there. However, I do not have to think about it. The tumor is almost in my hands, the assistants calmed down, the worst they can’t see. A heavy rough stone hangs on a thin venous wall. Now the rock is freed from above, and from below, and from the side. With one accidental movement of his, he can pull and blow the vein.

But the main danger is me and my bad scissors. I slide my finger in front of the rock - into the bottom, in the dark, to somehow highlight the dull front pole and slightly pull the tumor onto yourself - from the dark to the light. Yes is. It seems to be moving, moving. Something is already seen. And in this moment - a terrible whispering sound: blood shed from the depths of the small pelvis. The bleeding!! to

The assistants shout desperately, and I grab the towel and squeeze it into the depths from where it flows. I push my finger! I stop, but this is temporary - while I give, while the towel is there. There is no blood to replace it. You need to think about what to do, evaluate the situation, find a way out, some solution.

Then I realize that I am in a trap. There is no exit. To stop the bleeding, you need to remove the tumor, nothing is visible behind it. Where does it flow? It is impossible to remove it. I don’t see the boundary between the wall of the vein and the damned stone. Something else can be seen above. Deeper in the dark? Sweatshirts and brands do not fit together. There will be no gentle, tiny cut. Crash, a woman will die.

A whirlwind and war runs in my head: “Why did I do this? Where did you go? Asked not to go. He was wise and wise.” And the blood, though not fragile, flows from under the tight wipes. Instead of anything else, a beautiful young woman dies. You need to quickly find the trap, quickly - time goes away. Where is the trap? What is Chess? The surgical solution is quick, clear, risky, any! And he is not! No is!

And then a hot heavy wave hits the head from the inside; the beard throws, the head hits through the ceiling – up, up, and strange, unknown words rise out of the afflicted soul: “Lord, strengthen my hand! Give me reason! Give me!” Something came from there. The second breath? The body is dry and cheerful, the thought is fresh, sharp and the eyes on the tip of the fingers. And the absolute certainty that I will do everything right now, I don’t know how, but I’m the master of the situation, it’s clear. It went quickly, easily. I remove the vein from the tumor. It just goes! Smooth and clean, as in medicine. All of. I have a tumor on my hand. The bleeding stopped.

Blood was brought here. Absolutely well. I said to them, “What are you moaning about? You see, everything ended well.” And they worship. Tatsat alcohol (I fought a lot, such and drink great). Only I do not drink. They are happy again.

The patient woke up. I bow to her and drop tears on her face."

by Emil Eisenstein. Dispenser: Passions and Repentance of the Chief Doctor (1997)