Mistake

From James:

Have you ever been glad you made a mistake? I was sure the elderly man had
a gallbladder problem. I mean, I'm no ultrasound expert, but there was
obviously something inside that gall bladder that shouldn't have been there.
Besides, he was complaining of pain right over that spot that was worse when
he ate. And his bilirubin was elevated, another sign that could point to
gall bladder problem.

I was hesitant to operate, though, because he was a friend. In fact, he is
the chief of our neighborhood here in Bere. Totho Timothée. His brother
has AIDS and is a motorcycle taximan who takes us often back and forth to
Kélo when our car isn't running or the rainy season makes the roads all but
impassible for anything except a moto.

But, I finally decided it was the right thing to do. I was sure he needed
an operation for his gallbladder. I was wrong.

I stand to his right side. Franklin has given him a "high spinal"
anesthetic so I can make a somewhat relaxed incision right below his right
ribs. We pray and I start cutting with Abel and Jacques assisting. I've
decided to splurge today, since it's a gall bladder, and have set up the
electrocautery. Soon the smell of barbecuing human flesh fills the room as
I burn through the abdominal muscles before entering the peritoneal cavity.

We also are using the air conditioner since it's about 110 degrees
fahrenheit outside. Jacques, however, having just recently arrived from
Togo where it's relatively cooler, is having a hard time as the sweat runs
in rivulets down his face. I usually don't notice until afterwards when I
pull off my gown and find my scrubs are soaked with my own sweat.

I have Abel retract the liver gently and I get a good look at the
gallbladder. It looks normal. I pinch it between my fingers. It feels
normal. I'm starting to feel sheepish. Especially since on entering the
abdomen I found a lot of ascites fluid and now I see that he has advanced
liver cirrhosis. Of course the bilirubin was elevated! I'm starting to
realize I was wrong to operate on him and it could've maybe even endangered
his life. Better close and get out of here before I do more harm.

Then I notice something out of the corner of my eye that gives me pause.

"Jacques, pull the stomach back a little again. Yeah, just like that."

I see a small black spot on the first part of the small intestine coming
right out of the stomach. Before my brain can even formulate it's idea of
what it is, the spot confirms itself by opening up right before my eyes and
letting out a stream of clear, gooey liquid.

A duodenal ulcer just perforated before my very eyes! Abel quickly
aspirates up the stomach acid with the suction tip and I call for some
suture.

I place some interrupted sutures along the edge of the ulcer and leave them
untied till I have a whole row ready to close the wound. I then pull some
of the omentum back from the stomach edge and lay it across the perforation.
I tie the sutures across the omentum patching up the hole. I irrigate and
suction and then close up the muscle, fascia and skin of the abdominal wall.

I've just witnessed a miracle to save our friend, Timothée's life. If I
hadn't mistakenly misread the ultrasound I wouldn't have operated. If I
hadn't mistakenly thought it was the gallbladder I wouldn't have made the
perfect incision to allow me to see and close the ulcer. If I'd have waited
half and hour more it would have perforated letting stomach acid all in the
stomach to burn and irritate the intestines and cause all kinds of
complications. If it had happened a day or two before I did the operation,
he'd probably be dead...especially with having already liver cirrhosis.

Sometimes it's ok to make a mistake!