Thought of the Week: The Minutiae of Mortality

Someone close to me underwent a surgical procedure the other day to have her gall bladder removed. She’d been having abdominal pain for years, but after a sudden, severe and inexplicable attack she decided to have a scan. They discovered two gallstones, each over 2cm across, lodged in her gall bladder, and evidence that a third had lodged itself in the bile duct at one point (hence the attack). Worlds of fun.

This is about the most pleasant picture of gallstones I could find.

This is about the most pleasant picture of gallstones I could find.

It turns out the gall bladder, not unlike the appendix, is not a critical system in human anatomy. Its purpose is to store and concentrate bile, releasing it in a wave when needed to digest fatty foods. Without it, the liver still produces bile, and the bile still enters the intestine; it just doesn’t do it in one big go. You might need to watch your fatty foods, but you ought to be watching them anyway.

Also not unlike the appendix, it can become inflamed if blocked, and may need to be surgically removed. In the appendix it’s often calcified fecal matter than can cause this obstruction; in the gall bladder, it’s gallstones. In her case, they were cholesterol stones, formed from crystallization of the natural cholesterol that aids in the production of bile. It’s curious because this has nothing to do with “high cholesterol”, or the deposit of fatty acids in blood vessels. Cholesterol is naturally present in the liver and gall bladder, and the concentration of bile might actually serve to cause the formation of stones in the first place.

In any case, it was pretty quickly decided that the gall bladder needed to be removed, and within a matter of weeks she found herself at the hospital, signing waivers and waiting to have her abdomen cut open. It was to be a laparoscopic procedure, which means two small incisions instead of one: one for a tiny camera, and one for the actual surgical instruments. (In this case there were actually four holes, because they were repairing a hernia as well.) There was just a small chance that complications might arise, leading to full open abdominal surgery, but it was unlikely.


…the vein might have collapsed…because I suddenly noticed the saline solution wasn’t dripping.


The thing is, even “minor” surgery isn’t minor. Someone is taking a very sharp knife and cutting open your body, and then stitching it back together with needle and thread. There’s blood pouring out, flowing out and dripping into the body. There are any number of variables that could lead to horrible consequences; a slight slip of the hand and a major artery is severed, and you bleed to death in the operating room without ever knowing what happened. And that’s really the terrifying thing, and the thing that was terrifying her: once you’re in there, you’re out of control. Despite all promises and reassurances, there’s no knowing that when they put you to sleep (because that’s what they’re doing – there’s no choice about it), you’ll ever wake up again.

Hope you're not squeamish around needles.

Hope you’re not squeamish around needles.

And so I was there for her, of course, trying to be brave and strong (and failing, I’ll admit). This person is not stupid, and false reassurances don’t help. You can’t just say, “It’ll be all right,” when you know as well as they that there’s a chance – even if it’s less than 1% – that it won’t. And the thing is, I was fine going into it, thinking about the surgery and imagining the procedure (they wouldn’t let me watch, of course). I was fine watching the IV needle go in, as the nurse moved the needle around under the skin, lifting it and lowering it to get it into the right vein. I was fine as I watched her sign the paper that gave her life to a complete stranger.

There was just one point where I stuck.

In preparation for the surgery, she had had to have a blood sample drawn, and it was the same vein the nurse was using now for the IV drip. And I think the vein might have collapsed or something, because I suddenly noticed the saline solution wasn’t dripping. Then I noticed that blood was slowly flowing back up the tube. For her, it was pain; for me, it somehow symbolized everything that could possibly go wrong wrapped up in one neat, little needle. My mind suddenly filled with collapsing lungs, ruptured arteries and severed internal organs…I was light-headed, hyperventilating and dizzy. I was freaking out.

In the end it was nothing; the nurse came over, flushed the system, and the IV began flowing normally again. A few minutes later she was gone into the OR, and I was left waiting for the next three hours, wondering if more IV drips had stopped or not. None did, of course; the surgery went fine, and she’s now (painfully) recovering. But it’s funny how so small a thing can be what triggers the severe import of a situation to you. It was like that when she gave birth to our child; the whole thing was hideously unreal, but that one trickle of blood as they rolled her off the gurney…that was what hammered it home that they had just cut a living being out of her.

I love you, sweetie; you were really brave.


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5 thoughts on “Thought of the Week: The Minutiae of Mortality

  1. Hope she is feeling far better now!! 🙂 it was a nice read and informative too. Just felt worried for her.

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