The day I survived surgery

In as calm a voice as I could muster, I said to the medical officer at the other end of the line: ‘I need four units of packed red blood cells, one litre of fresh frozen plasma and one unit of cell separator platelets as soon as possible.’

‘Please!’ I added, slightly hysterically, because I was looking at a patient bleeding his life away.

The monitors indicated very low blood pressure and an extremely low haemoglobin level.

I really didn’t want to be in the operating theatre. For more than 10 years, I have successfully dodged such invitations, by saying jokingly that I faint at the sight of blood.

The truth is that a medical oncologist has very little to do inside an operating theatre where the surgeons rule. But this patient and his family would not take no for an answer.

‘Please, Dr Ang, you are like his guardian angel and we need you in the operating room with him,’ the family pleaded.

‘All right. I’ll go in for 10 minutes and then I’ll leave the surgeons to do the work,’ I said.

The patient was Eddy, a 40-year-old Chinese who was first diagnosed with metastatic gastrointestinal stromal tumour (Gist) in 2008.

Initially, he responded marvellously to a medicine called Gleevec.

In the past, despite the most aggressive treatment programmes, patients with metastatic Gist fared poorly and most would die within a year of diagnosis.

In 2001, Gleevec was approved for treatment of Gist. By popping four tablets every day, the tumour would melt away within a few months.

Patients with metastatic Gist require long-term treatment.

Unfortunately for some patients, the tumour can acquire resistance to the drug.

Eddy was one of those patients and he came to see me when his tumour was growing despite Gleevec.

He was admitted to hospital with severe abdominal pain caused by a spontaneous rupture of his bowel.

By then, his abdomen was markedly distended, like that of a full-term pregnant woman.

To relieve his breathlessness, a small tube was inserted into his abdomen to drain the fluid. Each day, litres of bloody abdominal fluid would pour out from his abdomen.

He suffered from severe infection as the bowel contents emptied into the abdominal cavity. Despite antibiotics, the infection became worse and the bacteria started ‘eating’ holes in his abdominal wall.

We nursed him for almost a month in the intensive care ward.

Ventilated on a respirator and cleansed with continuous dialysis, he was brought back from the brink of death to good enough health to consider surgery.

‘We have a window of opportunity to go in and try to clean up the mess,’ I explained to his family.

The objectives of surgery were clearly defined – repair the perforated bowel, stop the bleeding and take out as much of the tumour as possible.

Dr Richard Chew, a senior general surgeon, was selected to lead the three-man team.

Half an hour into the operation, I peered out from behind the backs of the surgeons to see an exposed abdomen. There were masses of cancerous tissue packed in the upper half.

In the lower abdomen, his small intestines had ruptured and were turned inside out. There was blood everywhere. I watched and tried not to bite my nails as the surgeons calmly clamped off and tied up one bleeding vessel after another.

‘Gauze. Towel. Suction. Artery forceps. Stitch.’ The team of doctors and nurses worked with few words and much efficiency, like a well-rehearsed dance.

As the only member of the audience, I watched in awe as the surgeons operated.

At the patient’s side, the anaesthetist was hard at work trying to maintain the blood pressure.

He and his nurse were frantically drawing and injecting blood into the patient’s veins.

I put myself to good use by helping to call for blood. I can’t remember how many times I spoke to the medical officer on duty at the National Blood Centre, each time more frantic than the last. What I do know was that my 10minutes turned into 51/2 hours.

During this time, we poured 12 litres of blood into the patient. This did not include all the other fluids which were also infused to support the blood pressure.

In between my phone calls, the surgeons managed to remove part of the damaged bowels, repair the smaller perforations in Eddy’s intestines, staple off part of his stomach that had been invaded by the cancer, stop the bleeding and cut off more than 80 per cent of the tumour.

Both Eddy and I survived the operation.

As the attending physician, I am grateful for the tremendous effort of the entire care team – from the surgeons in the hospital to the duty medical officer at the blood bank, and from the intensive care nurses to the theatre attendants.

Much as I enjoyed being part of the action, I am convinced more than ever that my place is in my clinic, beside the examination couch, rather than on the operating floor.

This article first appeared in "Mind Your Body", a Straits Times Supplement.