Detachment

 

The doors fling open and they wheel her in on a trolley. Eyes taped shut, tube down her throat, flimsy hospital gown barely hiding her modesty. We slide her carefully onto the operating table and position her for the operation.  I know her, not well; enough to say hi and smile though. She’s young; shiny hair, slim limbs and smooth skin. Her belly is enormously distended in a grotesque parody of pregnancy; except there is no baby in there. Instead there is a tumour inside which has completely blocked the colon; gas and liquid shit backed up behind the tumour unable to escape. She came into hospital yesterday with constipation, feeling embarrassed and sheepish, hoping that an enema would sort her out. Instead she had a CT scan which showed us the tumour. Her caecum is distended and at the point where if we do not operate soon then it will perforate, sending litres of liquid bacteria-containing shit into her peritoneal cavity.  If that happens then the outlook is much worse. Fortunately there are no signs of spread outside the bowel, if all goes well we can cure her, I think to myself. I paint her belly with a red coloured antiseptic liquid, taking care to apply it evenly and making sure that there are no missed bits. At the head end the anaesthetist is adjusting some dials to get her settled for the operation. We carefully cover her nakedness with sterile green drapes, leaving a rectangular piece of abdomen exposed. We do our final checks and the scrub nurse passes me a scalpel in a sterile bowel. I pause for a moment, I need to detach myself from her as a person to do the next bit. Usually this comes naturally to me and I do not even think about it. Today is different, it’s hard. I look at the smooth unblemished skin which I must cut. It seems a violation, sacrilege, like painting graffiti on an ancient monument; yet cut I must. I summon up some detachment, somewhere deep in the surgical centre of my brain some neurones fire and the detachment comes, not before its time. I notice my assistant and the scrub nurse looking quizzically at me, I’ve no idea how long I have been in this reverie. I pick the knife in my right hand and a large white swab in my left. Now I can do it. I make a long sweeping cut down the centre of her abdomen. Bead of blood well up from the skin edges, we swiftly mop them up with swabs and I swap the blade for a hand held diathermy. The machine buzzes, lights flash briefly and the bleeding is stopped.  I cut through the fat layer and reach the shiny white fibres of the linea alba. There are fewer blood vessels here and swiftly we enter the abdomen. As I cut through the peritoneum, vast coils  of slipper, distended small bowel spill out on to the drapes. The colon follows, paper thin and tensely blown up with gas. I insert a needle into the colon, attach into to a suction machine and suck out as much gas as possible. Now I can see what is going on. I feel the liver, its nice and smooth  – no signs of cancer there thankfully. I feel down into the pelvis, there is an abrupt change in the diameter of the colon and at that point I feel a small hard, walnut-sized cancer- just as the scan predicted. My assistant pulls in the retractor and I use a swab to retract the distended colon towards me. I can now see the white line of Toldt, the surgeons’ equivalent of a cut-here line. I swiftly mobilise the colon and tie the blood vessels feeding it. We wash the bowel out, litres of liquid shit emerges from the other end of the tube. Once it runs out clear we cut out the cancer and then staple the ends  back together. I close the wound taking care that the skin incision is a neat as possible. A clean white dressing covers the wound and then we are done. Carefully I peel the drapes off and the person underneath emerges once more. We carefully rearrange her gown to preserve her modesty and gently move her back onto her bed.

Next day I see her on the ward. She look little pale against the yellow print on her hospital gown. She’s feeling a little sore and bit sick. I tell her it all went well, no unpleasant surprises – a tiny smile flickers across her face.

 

April is Bowel Cancer Awareness Month

Every year about 2,500 people under 50 are diagnosed with bowel cancer in the UK

Never too young