So it was a lovely Monday in 2024. I had a major surgery in the afternoon ; surgery to remove Fibroids . This was a repeat surgery and the fibroids were huge . The patient in her early 40s had no child and the plan was to preserve the uterus by all means but I had to face the reality and deeply counsel the patient to consent for a hysterectomy(removal of uterus) if things went south . When I'm met with the decision to preserve the uterus or the life of the patient , I would choose the life at all times - what’s the use of a uterus on a dead body ? These are rare life threatening scenarios but they do happen . She promptly understood and signed for a possible hysterectomy. We were well prepared, she had been transfused and optimized and we had 4 extra units of blood ready at standby and our very strong theatre team .
Remember I mentioned that it was a repeat surgery; she had had a similar surgery a few years ago but the fibroids recurred - we encountered horrible adhesions as we started . The small intestine was plastered on the uterus and tubes and I had to be very meticulous to avoid injuring the bowel . This took me close to an hour including very careful repair of the bruised gut serosa(outer covering of intestine) . Thankfully the bowel wall was intact . The bladder was also on my way and I separated it very carefully. Uterus was huge and totally distorted by the very large fibroid balls ; a number were very low towards the cervix and believe it or not one was attached deep into the left cardinal ligament (lowest deep supports of a uterus )- I had to clue how I would remove it and suture the fibroid bed . My assistant warned me that ‘hapa kitaumana doc , let’s just remove the uterus’. Khadija ni nani , I decided that she was childness and we would do our best to remove the fibroids and ‘reconstruct’ the uterus . This time we had already bled out a pint yet we hadn’t even touched the fibroid balls .
So we injected vasopressin into the uterus - a drug that reduces surgical bleed . We couldn’t tie the uterus below to temporarily occlude the major vessels because the lower level was a mess . Off we started removing the fibroids . It was a blood bath . I really wanted to save the uterus ; my team thought I was mad. This time round , more than 2 pints were down on the floor , the suction machines ,our drapes and theatre gowns . I was determined ; we had already started transfusing at this stage . I breached the uterine cavity (where the baby sits) and the inside looked like a sac full of potatoes ; innumerous balls - hapa nikasalimu amri and accepted that I needed to quickly start removing the uterus because she was bleeding out and I wasn’t going to achieve any meaningful fibroid removal if I was to continue. If I was continue i would literally strip her entire endometrial cavity leaving her with no chance of ever conceiving and endless heavy painful menses requiring transfusions every month . So off we changed our plan and I embarked on uterus removal which was done in an extra 2 hours. Bleeding was fully arrested and we ended our surgery after more than 4 hours of struggling . I knew that the post-op counselling was going to be brutal for the patient but hey she was alive and healthy.
As I removed my macintosh , noticed that my entire chest was soaked in blood . As I struggled with the myomectomy , I was literally hugging the uterus with my life as I dug on some deep fibroids . Blood managed to seep through mackintosh margins and my shirt was soaked . I didn’t feel a thing because I was 200% focused on the surgery and oh the adrenaline of the operation and the speed to ligate vessels and control bleeding .
I peeped under the scrubs shirt and my bra was soaked . As a breastfeeding mother I got traumatized and disturbed . I moved to a bright room to examine myself before cleaning in the theatre female changing rooms and the blood missed my nipple by a whisker . Part of my areolar was blood stained . With the usual bites by my daughter and the active breastfeeding, I knew that I wouldn’t miss an open pore/bite on my nipple. All manner of infections crossed my mind but luckily my blood stained skin was intact . Will I breastfeed my child ? Have I put her at risk ? What about intimacy ? My goodness !!! I didn’t know whether to celebrate the successful surgery or the danger I almost myself into by throwing my body and soul into a case . I washed off carefully to avoid spreading the blood and gave my assistants the bra to soak in bleach . Throwing the piece of inner wear wasn’t an option because it was a favourite memorable gift from my mum . Coincidentally this was a day that my husband somehow had both our cars so he was to pick me . He knew that surgery would end latest at 7.30pm not knowing that he would have to wait longer till 10.30pm at the parking lot. All that wait and then the wife walks in without a bra coming from a theatre with an all-men team 😝. I had to call before going down to alert him that I had a small mishap in theatre and declare that I was bra-less 🤓. I took a picture of the bra before it got soaked in bleach and sent him. If I had a temperamental non-understanding spouse I would have probably had it rough. For a whole week I was too traumatized to breastfeed my daughter on the affected breast .
Fast forward the patient recovered well but got very affected by the news that we removed her uterus to save her life . She was bitter initially and clinics were tense but I never once opened up that our bloods almost mixed ( for lack of a better phrase) . I’m sure she wondered why I kept on ordering tripple serology tests for her with every visit ; I just needed to be sure that we were safe . So as you look at your surgical wound and criticise your surgeon , know that sometimes we risk our lives in the commitment to give our all to our patients. I always say that for every surgery we do , we almost always carry a part of each patient’s DNA home to our families . Medicine is indeed a calling !
P.S -This was my first macintosh accident and I have since enhanced my infection prevention measures by making sure that I wear larger fitting macintoshes and that I put my safety first all round including wearing long gyanecological gloves . I’ll be a mother and a wife for decades to come but a doctor to individuals for a few days at maximum .
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