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.But when a client sets the stage for a procedure as Elaine had, the pressure upon me to perform at my peak is so much the greater.I knew exactly what I needed to do and had done it many times before, but it was with an extra degree of nervous energy that I paused with my scalpel above Max’s belly that day.Bolstered by Elaine’s vote of confidence, I made a bold incision.What I found was not a surprise.About a third of Max’s liver had found its way into his chest cavity.Part of the spleen and a few loops of bowel had followed.It was a simple thing to pull these back into his abdomen.I could watch, through the gaping hole in the diaphragm, the pink lungs fill with air as the assistant squeezed the breathing bag.I could see how much easier they were able to fill.And I could see the heart beating vigorously inside the pericardial sac and could feel its vitality with my gloved finger.The edges of the rent in the diaphragm were pulled together with strong sutures, by my placing the needle through the muscle tissues carefully between breaths.After tying the last knot in the suture line on the diaphragm, I tested the seal by inflating the lungs to capacity with the breathing bag and listening for bubbles to escape through the suture line.There were none—no leaks.What remained was to place a tube into the chest cavity.The tube exited through the skin; it allowed me to evacuate the residual air around the lungs and any blood or fluids that might accumulate.Finally, I closed the abdominal wall and sutured the skin.The surgery had taken over two hours to complete and I was drained.But Max was recovering nicely and already breathing more easily.I was pleased with the day’s work.As promised, I called Elaine and reported that the surgery was over and had been successful.I expected to keep Max in the hospital for at least two days, until the amount of material sucked from the tube in his chest had subsided enough to allow its removal.Elaine brought Megan in to visit Max and me on Friday.While it was wonderful to see her, the effect on Max was not what I expected.Instead of perking him up, Megan’s visit seemed to increase his stress, shooting his respiratory rate up and tiring him noticeably.The day after surgery I was able to remove a few milliliters of fluid and a couple of syringefuls of air from Max’s chest.By that Friday, the amount had decreased even more.Even so, Max was not bouncing back as quickly as I had expected him to.I decided that he needed continued care over the weekend, and I told Elaine I thought he should stay with me.She seemed relieved.When I came in to the hospital on Saturday morning, I found Max’s breathing to be labored again.What worried me just as much was the look of anxiety that had crept back onto his face.I suspected air or fluid was leaking into the chest cavity.But when I aspirated the tube with the syringe, nothing came out.I needed X-rays to evaluate the problem, and I needed help to take them.Fortunately, Susan was willing to come from home to assist me.When, in less than an hour, I was once again placing Max’s chest X-rays up on the view box, I was shocked to see a pattern almost identical to the films I had taken before surgery.There was the same light density at the bottom of the film, the same intestinal gas pattern where it shouldn’t have been, the same discontinuity to the diaphragmatic shadow.“Oh no,” I said, letting out a deep sigh.“It looks like the whole incision line in the diaphragm has broken down.We’re going to have to go back in.”“You’re kidding!” Susan had enough track record with my sense of humor to think I was pulling her leg.“No, Susan.I wish I was kidding, but I’m not! And what’s worse, I don’t think it should wait till we’re open again on Monday.I think we ought to do it today.”“Okay.But we will need extra help, won’t we?”“Yes.We’ll need at least one more person.You can scrub in to assist me.We’ll need someone to ventilate Max and monitor the anesthesia.”“Lisa’s out of town, you know.”“Oh shoot,” I responded.The anesthesia for a case like this was especially difficult, and Lisa was the only licensed technician at the hospital at that time.“We’ll have to call in Ginny.We can walk her through the procedure beforehand.You call her and I’ll call Elaine.”This was not a call I particularly relished.Ms.Farmer was expecting a routine update on Max’s continuing recovery.What she was going to hear instead was that another frightening surgery was necessary.I picked up the phone with a measure of dread.But I needn’t have worried.Elaine was her usual unflappable and controlled self when I told her the news [ Pobierz całość w formacie PDF ]