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The Accidental Diagnosis

Author: superashdoc, Posted on Sunday, July 23 @ 23:51:42 IST by RxPG  

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General

Surgery is my favourite subject.And surgeons are my favourite people.
Surgeons always seem to have that persona of a maverick-a carefree attitude.Howerver when they are at the O.T table they are an efficient and enterprising machine as they meticulously and with least fuss perform the trickiest of operations.

I had a great surgery posting as an intern.Towards the end I was allowed to assist many procedures in the O.T-one of them being of a fat lady called sangeetha.Well,she wasn't really that fat.........she was more.........-obese maybe is a better word.

She spelled trouble the minute she entered the ward.Her complaints were severe right flank abdo pain which was now around the umbilicus.She had had fever,cough and some diarrhoea.My JR beamed with happiness and looked around at the swarm around him.Swarm is a term we used for the final MBBS students.They always crowded around you like a swarm of bees buzzing repeated questions.Their thirst for knowledge was never-ending and your every movement was under scrutiny.

The swarm then shouted -APPENDICITIS.-and felt mighty pleased with themselves.I wasn't pleased at all.It was the second day of double emerge(sunday-monday combo) and I hadn't slept a wink the earlier night.I sent all investigations and acompanied her for USG.

The radio SR saw less of the screen and more of the lovely female JR sitting next to him as he wrapped up the scan in 3 minutes flat .APPENDIX-of course! he said.

It so happened that our Prof Nagarkatti was at logger heads with the anaesthetist Dr.Harnagle.The CR knew that harnagle madam would never give consent due to cough and so we hatched a plan.....
We converted Sangeetha -elective appendectomy into an emergency!And we took her on table at 10 pm .Prof.Nagarkatti was ecstatic at having fooled the anaesthetists and called my CR-'my dear chap' twice.He even handed me an eclair which I politely refused.I hate eclairs.

My JR was the operating surgeon with my CR and myself assisting.2 final year students had stayed behind to witness the surgery and were very excited. After opening the abdomen ,we entered peritonium and exposed the small Intestine.Moving distally,the appendix was brought into view-nice and pink ;in short-normal appendix.I looked at my JR who looked in turn at my CR who looked at me.Then we all looked at our Prof.

Prof.Nagarkatti gave a knowing smile."Mild inflammation",he said.'You kids won't notice it.In my long career and due to my vast experience I can discern such things .Cut it off"Then Prof washed out and left.

Rejuvenated,we continued.My JR skill-fully removed the appendix ,buried the stump and looked triumphantly at the two students.They looked awe-struck.Then one of the boys said"Excuse me sir,but I wanted to see the uterus.I have never seen it in a live person".

"O sure ",my JR said magnanimously.He then retracted the opening further and brought the uterus into view.
"See here,this is the uterus.These are the cornu,the fallopian tubes and this is the right ...squiiiishhh!!!!!!!!!!!!" Some brown fluid leaped out of the abdominal cavity and landed upon the JRs spectacles. Some of it landed on my gown as well.

"What's this ?"My CR demanded.

A five minute exploration solved the mystery.The brown fluid was from a ruptured chocolate cyst of right ovary!!
There had been no appendicitis.Only ovarian endometriosis.We then hurriedly called up the Gynaec CR on call who came and took care of the cyst .And we quietly closed up the abdomen after a thorough peritoneal wash.

Was this the end?Of course not.I had to be awake all night to re-write all the history and the findings making it a case of ovarian cyst.

And the next day when Dr.Doctor-our unit head came on the rounds.Prof Nagarkatti proudly described to him how we had diagnosed and successfully operated a gynaec case in the surgery ward..................



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