when it won't stop

I used to be able to count on two hands the number of times I had taken patients to the operating room for abdominal exploration without having a pretty clear pre-operative diagnosis confirmed by CT scan. Now I have lost count of the number of abdominal explorations I have done here without knowing what I would find. I'm frequently surprised. Yes, it makes life interesting...but I miss being able to anticipate and plan before finding myself in the operating room faced with trouble. Sometimes big trouble. Which brings us to Saturday afternoon, operation number four...exploratory laparotomy (abdominal exploration).

this was my weekend...plus another couple C-sections and several non-operative consults

He said he had been having abdominal pain for awhile- since Ramadan (a couple of months). He had well-healed scarification (traditional medicine) markings visible on his upper abdomen and had been treated with various medications at various dispensaries and wasn't getting better. Four days before he came to our clinic he developed severe pain. His family told him to just keep taking medicine, but he insisted on coming to the hospital.  I saw him in clinic and he was clearly very ill with peritonitis (severe abdominal tenderness). 

His story was pretty typical for a perforated stomach ulcer...but something seemed a little off. He didn't have fevers and his stomach wasn't quite as rigid/distended as most perforated ulcers I've seen here. But, he had severe abdominal pain and I could see free abdominal fluid on the ultrasound.  So, after resuscitation, I took him to the operating room for exploration.I made my incision and found blood. Several cups of old mixed with new blood. That was a surprise. Then I felt the mass. A large mass coming from the whole right side of his liver. Oh no. I looked at the liver and saw nodules and scarring: cirrhosis. Bad, very bad. I looked back at the mass...it had burst open and was bleeding, bleeding, bleeding. My heart sank. Defeat. I knew it was a losing battle. I couldn't take out the mass. It was too big. His liver was too diseased. Trying to suture the tumor to stop the bleeding would be impossible, like trying to sew oatmeal. It was mush. So I packed the tumor to slow down the bleeding and closed. He survived a few more hours in the ICU, just enough time to say goodbye to his family. 

We bring our years to an end like a sigh. The years of our life are seventy, or even by reason of strength eighty; yet their span is but toil and trouble; they are soon gone and we fly away. So teach us to number our days that we may get a heart of wisdom.

Psalm 90:9b, 10

I welcomed eleven new babies into the world this weekend. Another young man died from severe burns. The extremes of joy and sorrow can be exhausting and heart-breaking. But, there is something about the seeing the daily realities of birth and death that reminds me that life is short and this world is not my home. And that's a ok with me...I think 70 years is plenty of time to spend here.

He will wipe away every tear from their eyes, and death shall be no more, neither shall there be mourning, nor crying, nor pain anymore, for the former things have passed away.