1 out of 100

Last May 18, to remove her gall bladder, Medy underwent a laparoscopic cholecystectomy (lapchole or LC, for short), a surgical method developed in 1989.

This is the way Medterms describes LC: “Removal of the gallbladder (cholecystectomy) by laparoscopy. LC is performed through several small incisions. The laparoscope, a small thin tube, is put into the abdomen through a tiny cut made just below the navel. The surgeon can then see the gallbladder on a TV monitor and do the surgery with tools inserted in three other small cuts made in the right upper part of the abdomen. The gallbladder is then taken out through one of the incisions. LC permits a shorter hospital stay and shorter recovery time with less pain [than an open or traditional cholecystectomy]. Possible complications may include bleeding, infection, and injury to the bile duct, intestines, or major blood vessels. Although the rate of common bile duct injury appears increased, this rate is still sufficiently small to justify the use of LC in the treatment of symptomatic gallstones.”

An accident (called a “cholecystectomy surgical misadventure”) during an LC occurs roughly once out of every hundred operations. (The rate varies between 0.55 to 0.94 percent or less than one in a hundred cases.) This rate is “still sufficiently small,” unless you happen to be the one out of the hundred.

During Medy’s LC, the surgeon placed a drain or tube as a precaution, to ensure that any unwanted fluids left would be removed. This was the first sign to me that God was paying special attention to Medy. The drain was a wise decision on the part of the surgeon, even if it went against an October 2007 article in the British National Library for Health, claiming that such a drain was unnecessary: “Drain use after LC is controversial. This review [of all randomized clinical trials worldwide until March 2007] found that the drain use after LC increases wound infection and delays discharge from hospital. Currently, there is no evidence to support the use of drain after LC.”

For the next nine days, Medy had bile leaking out of her body through the drain. Initially, the surgeon thought the leak merely came from “liver weeping” (a medical metaphor for “extravasation of protein-rich lymph on the liver surface”), not a real cause for concern.

In fact, having received an assurance that there was nothing to worry about because the leak would soon stop by itself, I spent the nine days giving three public lectures, hosting a dinner, going to my three offices, and coordinating a national workshop for journal editors. That was the last time that I would ever be that busy and also the last time I would not be camping out in a hospital.

On the tenth day after LC, the bile leak dramatically increased.

In the afternoon of May 29, Medy underwent a diagnostic endoscopic retrograde cholangiopancreatography (ERCP) to find out what was going on inside her body. What the doctors discovered was chilling. Medy’s common hepatic duct had been transected (i.e., cut transversely or perpendicularly). In other words, there was no connection between the liver and the duodenum, which meant that the bile coming out of the liver was going everywhere except where it was supposed to go.

The December 2008 issue of the ANZ Journal of Surgery contains a study of such accidents. According to the article, “Bile duct injury is an important unsolved problem of laparoscopic cholecystectomy, occurring with unacceptable frequency even in the hands of experienced surgeons. Underestimation of risk, cue ambiguity, and visual misperception (‘seeing what you believe’) were important factors in misidentification. Delay in recognition of the injury is a feature consistent with cognitive fixation and plan continuation, which help construct and sustain the duct misidentification during the operation and beyond.” In other words, all over the world, even with the best surgeons, LCs go wrong.

That evening, the doctors decided to have an emergency operation early the next morning. I was asked to obtain at least two units (or bags) of type A positive blood, Medy’s blood type. Unfortunately, Makati Medical Center had run out of such blood in stock.

During times of crisis, you get to know who your friends are. Responding to our calls for help, Luna’s friends immediately came over to give blood. Employees of China Bank, where Medy worked, came trooping in to give blood. My friends who were corporation managers or school administrators asked their employees and students to donate blood.

Not everybody, however, who wanted to give blood could do so. There were all sorts of restrictions (infections, colds, fever, hypertension, diabetes, tattoos, menstruation, anemia, underweight, and so on). Would-be donors kept getting rejected.

It did not look like we could get the blood through donations; we had to buy it. Near midnight, Luna went to the Philippine National Red Cross office in Quezon City, where she found a long queue of people asking for A positive blood. Time was running out. (To be continued)