Operation Baghdad

I don't think I realized until today the full extent to which doctors can do battle in their patients bodies.

Surgeons have an old habit of labeling bodies who haven't yet been cut "virgins". It's an attestation to purity - to flesh unsullied by the scarring that results from previous invasions.

The body, you see, is both smart and dumb. It's smart in that it responds to being severed by stimulating immune cells to form a fibrinous body glue to knit tissues together. But it's also stupid in that the reconstruction can go awry, causing body parts to stick together that ordinarily don't.

Surgeons rely on the microscopic "planes" between organs to guide their dissection, kind of like how the sections of an orange are delineated by fibrous coating. When the planes are disrupted, though (for instance, if someone's had previous abdominal surgery), the normally discrete structures become matted and stuck together by "adhesions" created by a tenacious inflammatory response.

Outwardly, our patient today looked like any normal twenty year old girl, except for the scars on her belly indicating her six previous surgeries. Internally, she looked as if a bomb had gone off. It took us an hour just to get into her abdominal cavity, where it usually takes less than ten minutes. Portions of her bowel had attached themselves to her abdominal wall like little landmines, daring us to make a mistake and cause intestinal damage. Her transplanted kidney was encased in a concrete wall of fibrinous tissue, obscuring the ureters which we desperately needed to find to allow the kidney to drain.

But not unlike a sculptor who can envision a figure within a chunk of marble, Dr. K chipped through the scar and found his way through the maze of intestine, identifying that pesky ureter despite the body's rude attempt at disguise. It took him eleven hours, in total.

So I am less inclined today than yesterday to rush my patients into surgery. For the first fledgling years of surgery, before one really knows what it's all about, I guess you're like an eager teenager yearning to enlist. Every surgery is a fresh opportunity, and each new patient visit is a chance to book another surgery. Now I kind of understand Dr. K's battle weary talks with his patients, where he counsels them honestly about the risks of surgery, never pushing them one way or another.

As in many wars, the body can at times be its own worst enemy.