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- Apr 2, 2002
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So its really interesting and awe inspiring to realize that my attendings treat thier family just like they would treat the indigent patient off the street. My last case as a chief was on my Asst. Prog. Directors wife. She had acute cholecystitis and she was admitted to our teaching service with at WBC of 18.9 on my last day in town (had graduation ceremony a couple of days prior but offically still a resident for another week). I was literally on my way out of town and my Prog Director called me and asked if I would help do my Asst. Prog Directors Wife with her. So of course I said yes, took the next off ramp and went back to town, stopped by the small affiliated suburban hospital near my place so I could look up her labs/immaging.
The CT scan showed this massive, long, thick walled GB that extended damn near to the umbilicus.So the next day I went to the hospital fully expecting do nothing but drive the camera while my PD did the case or in-case we opened hold the Harrington. When I went to pre op the Asst PD pulled me aside and told me to do a good job. I was like WTF I know I havent driven a camera for a few years but come on I'd prob be ok driving for the boss or holding retractor. When I finally get to the OR and Scrub my PD was scrubbed in, which I expected but she was having the techs open up the Open set as well.That is was abnormal for us.
When I scrubbed and after we draped I stood patiently waiting for the PD to take the operator spot she looks at me and says you going to start anytime soon? I was like HOLY S***! So I get in and this thing looks nastier live then it was on imaging. I put the camera in about 2cm below the umbilicus and this fundus is looking me right in the kisser and the whole fricking thing was wrapped omentum and adheased to the colon and it was huge. I have seen uteri that were smaller. I was wishing I had told the PD I was well out of town and no way to make it back. So I start attacking this thing slowly, I think I might have been dissecting one cell layer at a time to get this thing freed up. I finally free up the omentum and colon only to find out it's adheased to the Duie as well. So I get this ting off the Duie and get cephlad retraction and start going lateral to medial and idenify the structures and get the critical angle with a short thick cystic duct...so thick infact that I did not feel confident that 10mm clips would hold so I tie off the duct with an proline suture and a knott pusher (I still placed the clips though) then dissect this monstrosity off of the liver and the pouch is just bearly able to hold it.
After we finished the boss looks at me smiles and says "see we werent kidding when we said we would'nt graduate anybody we were not willing to operate on our family".
I couldnt get my self to leave town till the next day after we discharged her. So I'm sitting on an empty appartment in a brand new town, waiting for the movers to bring my stuff 3 days later then promised, too tired to go out and too tired to sleep so I thought I would share my last case as a Chief with you guys.
The CT scan showed this massive, long, thick walled GB that extended damn near to the umbilicus.So the next day I went to the hospital fully expecting do nothing but drive the camera while my PD did the case or in-case we opened hold the Harrington. When I went to pre op the Asst PD pulled me aside and told me to do a good job. I was like WTF I know I havent driven a camera for a few years but come on I'd prob be ok driving for the boss or holding retractor. When I finally get to the OR and Scrub my PD was scrubbed in, which I expected but she was having the techs open up the Open set as well.That is was abnormal for us.
When I scrubbed and after we draped I stood patiently waiting for the PD to take the operator spot she looks at me and says you going to start anytime soon? I was like HOLY S***! So I get in and this thing looks nastier live then it was on imaging. I put the camera in about 2cm below the umbilicus and this fundus is looking me right in the kisser and the whole fricking thing was wrapped omentum and adheased to the colon and it was huge. I have seen uteri that were smaller. I was wishing I had told the PD I was well out of town and no way to make it back. So I start attacking this thing slowly, I think I might have been dissecting one cell layer at a time to get this thing freed up. I finally free up the omentum and colon only to find out it's adheased to the Duie as well. So I get this ting off the Duie and get cephlad retraction and start going lateral to medial and idenify the structures and get the critical angle with a short thick cystic duct...so thick infact that I did not feel confident that 10mm clips would hold so I tie off the duct with an proline suture and a knott pusher (I still placed the clips though) then dissect this monstrosity off of the liver and the pouch is just bearly able to hold it.
After we finished the boss looks at me smiles and says "see we werent kidding when we said we would'nt graduate anybody we were not willing to operate on our family".
I couldnt get my self to leave town till the next day after we discharged her. So I'm sitting on an empty appartment in a brand new town, waiting for the movers to bring my stuff 3 days later then promised, too tired to go out and too tired to sleep so I thought I would share my last case as a Chief with you guys.
