The Clinic
4
Some one was shaking her gently. "Heather, wake up, it's time to get ready for your surgery." It was a woman's voice. She felt confused for a moment and then she remembered. She opened her eyes. Michelle was there, bending over her and smiling gently. Heather smiled back in return.
"Good morning" said Michelle, brightly, "Did you sleep well?"
"Good Morning, yes, thanks, I slept quite well but I still feel a bit fuzzy-headed," Heather replied.
"That's the aftereffect of the sedative, it should wear off shortly. Well, we have a lot we need to do so let's get busy." Michelle told her.
Michelle sent her to the bathroom to empty her bladder and brush her teeth, cautioning her not to swallow any water. When Heather returned she found that Michelle had once more readied the enema equipment. She got into bed. This time Michelle had her kneeling on the bed with her butt in the air. There came the familiar sensation of the nozzle being inserted into her rectum and the liquid began to flow. If anything, it felt better than before.
Soon, the nozzle was withdrawn and Heather was sent into the bathroom again to empty her bowels. That being done she took another shower with the special scrub brushes she had been given. When she finished she returned to her room.
"We're almost ready for you now," Michelle told her. "Remove your gown and get back into bed"
Once again Heather did as she was instructed. She could feel a rising excitement. Michelle left the room, only to stick her head back in a moment later, "If you like, we can videotape the whole thing for you. Would you like that? She asked.
"That would be wonderful." Heather replied, thinking that it was just getting better and better.
The door swung open, as Michelle held it open a gurney was wheeled in by two young men, a third man carrying a camcorder followed them into the room. The gurney was positioned next to her bed and the bed raised to the same level. She was helped to scoot over onto the gurney and draped in a warmed green sheet. Her own sheet was pulled out from underneath the new sheet and to finish the package the bottom sheet from the gurney was wrapped around her. The rails were raised and a strap was placed across her knees. The head of the gurney was elevated slightly and she was wheeled out of the room.
It was just a short distance down the hallway to the operating room's double doors. They stopped there next to an equipment cart. Michelle told her she would be starting an IV on her now. It took only a moment to gather the needed supplies. A rubber strap was wrapped around Heather's left wrist and she was instructed to make a fist. Michelle lightly slapped the back of Heather's hand a couple of times to make the veins stand up. After selecting the vein she would use she wiped the site with a betadine swab, followed by alcohol. Michelle picked up a small syringe, uncapped the needle and anesthetized the area with a local anesthetic. Taking the 18 gauge IV catheter in hand she skillfully inserted it into the vein, Blood appeared in the flash chamber and Michelle slowly threaded the plastic catheter into the vein. The needle was withdrawn, leaving the catheter in place. The IV tubing was connected and checked to make sure it was flowing. The site was covered with a clear Opsite dressing and the loose tubing looped around and secured to Heather's forearm with tape.
Heather's hair was covered with a pale green cap. Kyle, dressed in surgical attire approached her, he was carrying a syringe. "Good Morning, Heather. How are you doing, feeling nervous?" he asked.
"Just a little," She replied
"Well, this should help with that, Just a little something to relax you." he said as he connected the syringe to a port in her IV and injected the contents.
It took a few moments, but then she began to feel a warm, floating sensation, it was very pleasant. Kyle bent over her, "Better?" She nodded in reply. "All right then, we're going to move you into the OR now."
They wheeled her gurney, feet first through the door to the operating room. The gurney was positioned alongside the table and Heather was helped over onto the table. The gurney was taken out of the room. Heather looked around; there was much activity in the room around her. A woman, already gowned and gloved was busy arranging instruments on a table at the back of the room. People bustled around her. The armboards were attached to the table and her arms were gently but firmly strapped to them, outstretched. She felt a wide strap being placed across her legs jus above the knees. Kyle spoke to her comfortingly telling her what he was doing as he placed EKG leads on her chest. A rapid beeping sound became audible as she was connected to the monitor. He placed a clip on her left first finger, telling her it was to monitor the oxygen in her bloodstream. A blood pressure cuff was wrapped around her right upper arm.
"Heather, I'm going to put a mask over your nose and mouth, its just oxygen and I want you to take nice deep breaths for me. Ok?" Kyle told her. She just nodded in reply.
Once the mask was strapped in place she found that, by turning her head slightly she could see the breathing bag slowly filling and emptying in time with her breathing.
Michelle was bending close to her ear, "How are you doing, sweetie?"
Heather mumbled that she was fine, and everything was better than she had ever dreamed possible.
"We need to put a catheter in you. Do you want us to wait until after you are under or do you want us to do it now?" Michelle asked
"You can put it in now." Heather replied.
She felt the strap across her legs being removed and then someone moved her legs so that the soles of her feet were touching, the frog leg position. The sheet covering her was raised to expose her perineum. Her genitals were cleansed with an antiseptic solution and then covered with sterile drapes. Gloved fingers gently separated her labia and her urinary meatus was located. The lubricated catheter was slowly but firmly inserted into her urethra. Heather could feel a slight burning as it slipped inside. A bit of extra resistance was encountered at the urinary sphincter but with a firm pressure the catheter slid past and into her bladder. Her pale yellow urine quickly began to flow from the catheter into the drainage bag. The retention balloon was inflated, and finally a piece of tape was used to secure the tube to her inner thigh. Her legs were returned to a normal position and she was once more strapped down.
"Ok, Heather, we're going to put you under now. Keep taking nice deep breaths and you should start to feel sleepy real soon." said Kyle. He picked up a syringe containing a milky looking fluid, inserted it into a port on her IV and began to slowly inject the contents. Michelle lightly placed two fingers over Heather's trachea, exerting gentle pressure to keep Heather from aspirating her stomach contents.
"Heather, start counting back from 100" Kyle told her.
"100, 99, 98," She began, she was feeling so sleepy, "97, 96, 95...94......94.....9..." her voice trailed off, she was asleep.
Working quickly, Kyle tilted her head back to maintain an open airway. He took another syringe and, after connecting to her IV, injected the contents. This was a strong skeletal muscle relaxant that quickly paralyzed Heather. The breathing bag hung motionless as Heather stopped breathing. Kyle then squeezed the bag several times in rapid succession to fully oxygenate Heather. He looked to the pulse oximeter reading that showed that she was at 100% oxygenation. Kyle then took away the mask away, Heather’s lips were slightly parted showing a small glimpse of her even, white teeth. He used his fingers to open her mouth and with his other hand picked up the laryngoscope. The curved blade was inserted into her mouth and slid easily over her tongue and into the back of her throat. By lifting up on the scope he was able to see the opening of her trachea and the slack vocal cords. Michelle handed him the endotracheal tube and he carefully inserted it into her trachea. He used a syringe to inflate the balloon that held the tube in place and provided a tight seal. Heather’s airway was now secure. He applied several pieces of tape to fasten the tube in place. She was ready for the surgery to begin.
Michelle went to the door and told Sidney that he could start to scrub. Once again at the side of the table she opened a prep kit and poured betadine into the basin. Another of the assistants in the room removed the sheet covering her to expose her body. Michelle donned a pair of sterile gloves and taking the scrub brush began to wash Heather’s abdomen. She started at the incision site and worked outward in an ever-expanding circle over the sides of her hips and up onto her breasts. In the cool air Heather’s nipples had begun to erect, Michelle and the others could not help but notice that they were large. Her pinkish-brown areolae covered most of the surface of her breasts. Finishing her scrub, Michelle wiped away the soap and dried Heather’s body. To complete the prep betadine was sprayed on her from her nipples to mid-thigh.
Sidney entered the room, dripping hands held out in front. The scrub handed him a towel so he could dry himself. Next came the gown that Michelle tied up behind him and then sterile gloves. He looked at Heather, lying nude and prepped on the table. “She really is beautiful isn’t she? She is going to make such a wonderful patient.”
He and his assistant working together soon had Heather covered in sterile drapes that left only the operative site exposed. The tops of the drapes were clipped to the IV poles at the head of the table creating a kind of tent over her face. Meanwhile, Kyle had taped her eyes shut and was now watching the monitors that told him all was well with Heather.
The instrument table and Mayo stand were moved into position and Sidney held out his hand into which the assistant placed the knife. He had decided to use a pfannensteil or bikini cut for this surgery. He knew that Heather enjoyed looking at her scars and wanted to have as many different ones as possible. The knife traced a path across her lower belly from one iliac crest to the other just at the level of her pubic hair, a thin line of blood welling from the incision. Sidney was handed another knife after placing the first knife in a waiting basin. The first knife was just used to make the skin incision. He made another incision along the same line deepening the wound to the muscle layer. His assistant wiped away the blood and they both applied clamps to the bleeding points so that the cut vessels could be cauterized. Once the vessels were clamped Sidney touched each clamp with the electrocautery until he could hear a slight pop indicating that the bleeder had been cauterized. He then used his fingers to strip back any remaining tissue from the muscle layer. His assistant placed a pair of retractors at the top and bottom of the incision and rather forcefully pulled the wound edges apart. Sidney used a knife to cut vertically through the muscles and expose her peritoneum that he then opened using a clamp to raise the thin but strong membrane and a scissors to cut it open. Her moist intestines were now clearly visible.
“Now, I’m going to explore her abdomen”, he said inserting his hand deep into her. His hand probed around feeling for all of her abdominal organs. He was giving a commentary on what he was feeling. “She has some adhesions from her appendectomy and her laparoscopy, her liver feels normal, so does her spleen, stomach, pancreas all feel ok. Left kidney is good so is her right. I’m checking her colon, ascending feels good, there’s the hepatic flexure, transverse feels normal, splenic flexure is good, descending and there’s her sigmoid it’s all good. Ok, let’s run her small bowel.” Starting at the cecum, the area where the small intestine connects to the large intestine he began gently pulling the small intestine through his fingers feeling for any abnormalities, he continued this until he reached her stomach and had felt every inch of her bowel. “Well that all feels pretty normal,” he said.
He was next handed several large cloths that he used to pack her intestine up and away from her pelvic organs. He had Kyle put the table into a slight head down position which also helped move her bowel out of the way. His assistant placed a large self-retaining retractor into the wound and opened it which spread her belly wide open now her pelvic organs were plainly visible. Both her ovaries appeared normal with no evidence of a cyst but he decided to remove her left ovary anyway. He placed clamps between her ovary and uterus and dissected the ovary free of the ligaments that held it in place. He tied off the ovarian artery and vein and removed the clamp. Watching closely he inspected for any sign of bleeding, there was none. He had the retractors removed as well as the lap sponges that had held her intestines out of the operative field. He then asked for a packet of sterile talcum powder. This was something that Heather had discussed with him at one time. Talc was a known cause of adhesions, or scar tissue inside the abdomen and she had asked him to sprinkle some inside her before he closed her up so that she would always have a reason for more surgery.
He closed her peritoneum, then her muscle layer then the subcutaneous layer and finally the skin. Knowing how she liked her scar he had decided to use suture rather than staples. Kyle had backed off on the anesthetic agents so as the drapes were taken away Heather was beginning to stir. Her abdomen was washed off and a dressing applied to her wound. Her surgery was finished. She was moved to a gurney and taken to her room to recover. As she had requested she was still intubated and a ventilator was waiting at her bedside.
The first sensation that Heather became aware of was the sensation of having something hard in her mouth, it was gagging her. She began to struggle weakly and then she noticed pain in her abdomen. Michelle noticed that she was becoming agitated.
“Heather,” she said moving close and taking her hand, “ your surgery is over, everything went fine, you still have your breathing tube, don’t fight it, just breath normally. OK?
Heather visibly relaxed, suddenly it all came back, she had had major surgery! She felt the sensation of the respirator breathing for her. She smiled around the endotracheal tube
END
"Good morning" said Michelle, brightly, "Did you sleep well?"
"Good Morning, yes, thanks, I slept quite well but I still feel a bit fuzzy-headed," Heather replied.
"That's the aftereffect of the sedative, it should wear off shortly. Well, we have a lot we need to do so let's get busy." Michelle told her.
Michelle sent her to the bathroom to empty her bladder and brush her teeth, cautioning her not to swallow any water. When Heather returned she found that Michelle had once more readied the enema equipment. She got into bed. This time Michelle had her kneeling on the bed with her butt in the air. There came the familiar sensation of the nozzle being inserted into her rectum and the liquid began to flow. If anything, it felt better than before.
Soon, the nozzle was withdrawn and Heather was sent into the bathroom again to empty her bowels. That being done she took another shower with the special scrub brushes she had been given. When she finished she returned to her room.
"We're almost ready for you now," Michelle told her. "Remove your gown and get back into bed"
Once again Heather did as she was instructed. She could feel a rising excitement. Michelle left the room, only to stick her head back in a moment later, "If you like, we can videotape the whole thing for you. Would you like that? She asked.
"That would be wonderful." Heather replied, thinking that it was just getting better and better.
The door swung open, as Michelle held it open a gurney was wheeled in by two young men, a third man carrying a camcorder followed them into the room. The gurney was positioned next to her bed and the bed raised to the same level. She was helped to scoot over onto the gurney and draped in a warmed green sheet. Her own sheet was pulled out from underneath the new sheet and to finish the package the bottom sheet from the gurney was wrapped around her. The rails were raised and a strap was placed across her knees. The head of the gurney was elevated slightly and she was wheeled out of the room.
It was just a short distance down the hallway to the operating room's double doors. They stopped there next to an equipment cart. Michelle told her she would be starting an IV on her now. It took only a moment to gather the needed supplies. A rubber strap was wrapped around Heather's left wrist and she was instructed to make a fist. Michelle lightly slapped the back of Heather's hand a couple of times to make the veins stand up. After selecting the vein she would use she wiped the site with a betadine swab, followed by alcohol. Michelle picked up a small syringe, uncapped the needle and anesthetized the area with a local anesthetic. Taking the 18 gauge IV catheter in hand she skillfully inserted it into the vein, Blood appeared in the flash chamber and Michelle slowly threaded the plastic catheter into the vein. The needle was withdrawn, leaving the catheter in place. The IV tubing was connected and checked to make sure it was flowing. The site was covered with a clear Opsite dressing and the loose tubing looped around and secured to Heather's forearm with tape.
Heather's hair was covered with a pale green cap. Kyle, dressed in surgical attire approached her, he was carrying a syringe. "Good Morning, Heather. How are you doing, feeling nervous?" he asked.
"Just a little," She replied
"Well, this should help with that, Just a little something to relax you." he said as he connected the syringe to a port in her IV and injected the contents.
It took a few moments, but then she began to feel a warm, floating sensation, it was very pleasant. Kyle bent over her, "Better?" She nodded in reply. "All right then, we're going to move you into the OR now."
They wheeled her gurney, feet first through the door to the operating room. The gurney was positioned alongside the table and Heather was helped over onto the table. The gurney was taken out of the room. Heather looked around; there was much activity in the room around her. A woman, already gowned and gloved was busy arranging instruments on a table at the back of the room. People bustled around her. The armboards were attached to the table and her arms were gently but firmly strapped to them, outstretched. She felt a wide strap being placed across her legs jus above the knees. Kyle spoke to her comfortingly telling her what he was doing as he placed EKG leads on her chest. A rapid beeping sound became audible as she was connected to the monitor. He placed a clip on her left first finger, telling her it was to monitor the oxygen in her bloodstream. A blood pressure cuff was wrapped around her right upper arm.
"Heather, I'm going to put a mask over your nose and mouth, its just oxygen and I want you to take nice deep breaths for me. Ok?" Kyle told her. She just nodded in reply.
Once the mask was strapped in place she found that, by turning her head slightly she could see the breathing bag slowly filling and emptying in time with her breathing.
Michelle was bending close to her ear, "How are you doing, sweetie?"
Heather mumbled that she was fine, and everything was better than she had ever dreamed possible.
"We need to put a catheter in you. Do you want us to wait until after you are under or do you want us to do it now?" Michelle asked
"You can put it in now." Heather replied.
She felt the strap across her legs being removed and then someone moved her legs so that the soles of her feet were touching, the frog leg position. The sheet covering her was raised to expose her perineum. Her genitals were cleansed with an antiseptic solution and then covered with sterile drapes. Gloved fingers gently separated her labia and her urinary meatus was located. The lubricated catheter was slowly but firmly inserted into her urethra. Heather could feel a slight burning as it slipped inside. A bit of extra resistance was encountered at the urinary sphincter but with a firm pressure the catheter slid past and into her bladder. Her pale yellow urine quickly began to flow from the catheter into the drainage bag. The retention balloon was inflated, and finally a piece of tape was used to secure the tube to her inner thigh. Her legs were returned to a normal position and she was once more strapped down.
"Ok, Heather, we're going to put you under now. Keep taking nice deep breaths and you should start to feel sleepy real soon." said Kyle. He picked up a syringe containing a milky looking fluid, inserted it into a port on her IV and began to slowly inject the contents. Michelle lightly placed two fingers over Heather's trachea, exerting gentle pressure to keep Heather from aspirating her stomach contents.
"Heather, start counting back from 100" Kyle told her.
"100, 99, 98," She began, she was feeling so sleepy, "97, 96, 95...94......94.....9..." her voice trailed off, she was asleep.
Working quickly, Kyle tilted her head back to maintain an open airway. He took another syringe and, after connecting to her IV, injected the contents. This was a strong skeletal muscle relaxant that quickly paralyzed Heather. The breathing bag hung motionless as Heather stopped breathing. Kyle then squeezed the bag several times in rapid succession to fully oxygenate Heather. He looked to the pulse oximeter reading that showed that she was at 100% oxygenation. Kyle then took away the mask away, Heather’s lips were slightly parted showing a small glimpse of her even, white teeth. He used his fingers to open her mouth and with his other hand picked up the laryngoscope. The curved blade was inserted into her mouth and slid easily over her tongue and into the back of her throat. By lifting up on the scope he was able to see the opening of her trachea and the slack vocal cords. Michelle handed him the endotracheal tube and he carefully inserted it into her trachea. He used a syringe to inflate the balloon that held the tube in place and provided a tight seal. Heather’s airway was now secure. He applied several pieces of tape to fasten the tube in place. She was ready for the surgery to begin.
Michelle went to the door and told Sidney that he could start to scrub. Once again at the side of the table she opened a prep kit and poured betadine into the basin. Another of the assistants in the room removed the sheet covering her to expose her body. Michelle donned a pair of sterile gloves and taking the scrub brush began to wash Heather’s abdomen. She started at the incision site and worked outward in an ever-expanding circle over the sides of her hips and up onto her breasts. In the cool air Heather’s nipples had begun to erect, Michelle and the others could not help but notice that they were large. Her pinkish-brown areolae covered most of the surface of her breasts. Finishing her scrub, Michelle wiped away the soap and dried Heather’s body. To complete the prep betadine was sprayed on her from her nipples to mid-thigh.
Sidney entered the room, dripping hands held out in front. The scrub handed him a towel so he could dry himself. Next came the gown that Michelle tied up behind him and then sterile gloves. He looked at Heather, lying nude and prepped on the table. “She really is beautiful isn’t she? She is going to make such a wonderful patient.”
He and his assistant working together soon had Heather covered in sterile drapes that left only the operative site exposed. The tops of the drapes were clipped to the IV poles at the head of the table creating a kind of tent over her face. Meanwhile, Kyle had taped her eyes shut and was now watching the monitors that told him all was well with Heather.
The instrument table and Mayo stand were moved into position and Sidney held out his hand into which the assistant placed the knife. He had decided to use a pfannensteil or bikini cut for this surgery. He knew that Heather enjoyed looking at her scars and wanted to have as many different ones as possible. The knife traced a path across her lower belly from one iliac crest to the other just at the level of her pubic hair, a thin line of blood welling from the incision. Sidney was handed another knife after placing the first knife in a waiting basin. The first knife was just used to make the skin incision. He made another incision along the same line deepening the wound to the muscle layer. His assistant wiped away the blood and they both applied clamps to the bleeding points so that the cut vessels could be cauterized. Once the vessels were clamped Sidney touched each clamp with the electrocautery until he could hear a slight pop indicating that the bleeder had been cauterized. He then used his fingers to strip back any remaining tissue from the muscle layer. His assistant placed a pair of retractors at the top and bottom of the incision and rather forcefully pulled the wound edges apart. Sidney used a knife to cut vertically through the muscles and expose her peritoneum that he then opened using a clamp to raise the thin but strong membrane and a scissors to cut it open. Her moist intestines were now clearly visible.
“Now, I’m going to explore her abdomen”, he said inserting his hand deep into her. His hand probed around feeling for all of her abdominal organs. He was giving a commentary on what he was feeling. “She has some adhesions from her appendectomy and her laparoscopy, her liver feels normal, so does her spleen, stomach, pancreas all feel ok. Left kidney is good so is her right. I’m checking her colon, ascending feels good, there’s the hepatic flexure, transverse feels normal, splenic flexure is good, descending and there’s her sigmoid it’s all good. Ok, let’s run her small bowel.” Starting at the cecum, the area where the small intestine connects to the large intestine he began gently pulling the small intestine through his fingers feeling for any abnormalities, he continued this until he reached her stomach and had felt every inch of her bowel. “Well that all feels pretty normal,” he said.
He was next handed several large cloths that he used to pack her intestine up and away from her pelvic organs. He had Kyle put the table into a slight head down position which also helped move her bowel out of the way. His assistant placed a large self-retaining retractor into the wound and opened it which spread her belly wide open now her pelvic organs were plainly visible. Both her ovaries appeared normal with no evidence of a cyst but he decided to remove her left ovary anyway. He placed clamps between her ovary and uterus and dissected the ovary free of the ligaments that held it in place. He tied off the ovarian artery and vein and removed the clamp. Watching closely he inspected for any sign of bleeding, there was none. He had the retractors removed as well as the lap sponges that had held her intestines out of the operative field. He then asked for a packet of sterile talcum powder. This was something that Heather had discussed with him at one time. Talc was a known cause of adhesions, or scar tissue inside the abdomen and she had asked him to sprinkle some inside her before he closed her up so that she would always have a reason for more surgery.
He closed her peritoneum, then her muscle layer then the subcutaneous layer and finally the skin. Knowing how she liked her scar he had decided to use suture rather than staples. Kyle had backed off on the anesthetic agents so as the drapes were taken away Heather was beginning to stir. Her abdomen was washed off and a dressing applied to her wound. Her surgery was finished. She was moved to a gurney and taken to her room to recover. As she had requested she was still intubated and a ventilator was waiting at her bedside.
The first sensation that Heather became aware of was the sensation of having something hard in her mouth, it was gagging her. She began to struggle weakly and then she noticed pain in her abdomen. Michelle noticed that she was becoming agitated.
“Heather,” she said moving close and taking her hand, “ your surgery is over, everything went fine, you still have your breathing tube, don’t fight it, just breath normally. OK?
Heather visibly relaxed, suddenly it all came back, she had had major surgery! She felt the sensation of the respirator breathing for her. She smiled around the endotracheal tube
END
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