How to Do a Liver Transplant by Kellee Slater Page B

problems.
    One of my calls was about a patient who had been vomiting profusely and had not moved their bowels for a number of days. I listened to their story very professionally and carefully examined their abdomen. I noted that it was as tight as a drum and that they looked quite unwell. I evaluated the x-rays and decided that the correct diagnosis was a blockage of the large bowel. The only thing left to do to confirm my stunning diagnosis was to examine inside the patient’s rectum by putting my finger up there. I pulled on a rubber glove and plunged in. I felt like I finally had used my clinical acumen when my finger confirmed what I had brilliantly suspected; there was indeed a large cancer just inside the anus. My chest puffed out with pride as I congratulated myself on being really great. I was feeling good, I was feeling special, and when a doctor feels like this, it is never actually good for anyone. Buoyed by the knowledge that I was indeed a magnificent doctor, I then decided I needed to biopsy this cancer. Now, considering I was already pretty sure about the diagnosis, a biopsy was not absolutely essential but I felt that this additional step was sure to impress myboss (who I was actually yet to meet). ‘He will think I am the best registrar ever when I prove this is a cancer with a biopsy,’ I thought. I triumphantly took the tiny biopsy and sent it away to the lab for analysis. By that time it was after midnight, so I decided I would inform my new boss about my diagnosis in the morning. This was my last job for the night, so I went home and drifted into a contented slumber.
    I was awoken an hour later by a blaring pager. It was the resident ward doctor.
    â€˜I just wanted to let you know that the patient you were just seeing is bleeding profusely from their anus,’ she said. ‘Their blood pressure is low and I am going to start giving them a blood transfusion.’
    I flew back to the hospital to find my patient lying in a pool of blood. My tiny biopsy, that I had done safely many times before on other people, had inadvertently bitten through a blood vessel that wouldn’t stop bleeding. This bleeding complication can happen with any procedure, but why tonight I asked myself mournfully. With my tail firmly between my legs, I had to call my new boss in the middle of the night and let him know that on her first day as a registrar, a doctor he had never met had biopsied a patient he had no idea was in the hospital, and ask if he could come in and help her do an emergency operation. A few expletives were uttered and in he came. It was four o’clock in the morning and I was berated every minute ofthat three-hour operation to remove the patient’s cancer. The surgery was always going to be required at some point but it would have been preferable for it to at least be left until daylight hours. I was constantly reminded that this took the prize for the most spectacular start to a job that any registrar had ever had. I learned a golden rule of surgery that first day: never do anything that is not absolutely essential in the middle of the night, just in case there are complications. Also, never, ever feel too good about yourself because surgery has a real propensity to bring you back to earth quickly.
    It took a while to redeem myself after that night but I was careful to do everything right and I worked like a dog. One of my new bosses was an amazingly experienced bowel surgeon who had become famous for the prolific amounts of work he managed to get through each day. He had such a passion for operating on the bowels that working for him was a complete and utter joy. He loved his job so much that his catch cry was to declare with gusto that it was not a good day ‘unless we have made a bag’ – a colostomy bag, that is. He had seemingly boundless energy and it was not unusual for him to be supervising three junior doctors in three different operating theatres at once. The