Thursday, July 12, 2007

midnight ramblings

It's midnight and I just got home from a laparotomy for a bowel obstruction. One band, one snip, ten minute case. I love bowel obstructions. What i don't like is doing them at 11pm. This was a case I actually posted at noon. Not an emergency, necessarily, but I didn't want this lady to wait another night. I'd given 48 hours of nasogastric suction and her films still sucked and she was starting to develop some tenderness. I figured they'd be able to get me on at least by 5. No sir. I ended up being something like the fifth add on and by three o'clock, the OR whittles down to two functional rooms. So I waited. And waited. I went home. Ate a turkey burger, a la Foreman gourmet. Finally I get a call at 10pm. Drive all the way back for a ten minute snip snip jobberoo. Now I'm wide awake. Amstel light in the fridge. You make the call.

Also did a sweet little elective femoral hernia today. I approached it from below the inguinal ligament, reduced the hernia into the femoral space and plugged it with some mesh with prolene sutures securing it to coopers ligament and the inguinal band. Anyone else repair these via a preperitoneal approach? Laparoscopically? Im all ears. Incarcerated femoral hernias, I agree, ought to be approached either anteriorly or preperitoneally, but for these elective jobs, it seems a lot faster and easier to stick a plug in infra-inguinally. Inguinal. Inguinal. Ingwinal.

Ran into one of my old patients today, hospitalized for a severe nose bleed of all things. I took out his spleen emergently last October after he'd sustained a few broken ribs when he fell against his coffee table. He was on coumadin (of course) and he came in white as a sheet, his hemoglobin 3.5. He has this terrific wife and four sons who are all like 6'4" and we became quite close during his recuperation. He was one of those tough guy, no-nonsense sort of dads, you could tell. The nurses all hated him because he was a demanding pain in the ass, but I liked him. He got better. In the office, a few weeks later, he was his usual surly, dryly sarcastic self at first. But towards the end of the visit, he held up his hand. Hold on a second, he said. Its important to me... that you know..... how .... how grateful I am..... his voice breaking down.... I hugged the old son of a bitch, my eyes burning a bit. He's my buddy. That goddam coumadin is still vexing him but he's doing all right.

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