The Don once told me an interesting concept about surgery. I was on call with him during a Thursday night when I witnessed it first hand.
The call commenced in disaster and ofcourse we got stuck with a tricky case off the bat. A young boy of 12 came to casualty with loss of appetite and mild abdominal cramps for a week. After being probed by the casualty officer and some investigations done, he turfed the patient off to us because ofcourse, he ran out of options.
Naturally i thought this is a cold case and doesn’t warrant admission. non specific abdominal pain after hours? What’s new. I guess I was grateful it wasn’t backpain or indigestion.
Let me tell you something about Surgeons. They are apex predators. They love blood, guts and gore. And boy do Surgeons love abdomens. It’s their glorified area of expertise. An abdomen could flinch a mile away and they would flip out a scalpel like an inborn reflex. The first thing a surgeon always does is, put his hand on the abdomen and look at the face of the patient… The surgeon is Waiting, stalking his prey quietly. a small grimace or flinch can send you flying to the OR before you can say bobs-your-uncle. A classical method of eliciting abdominal rebound tenderness which means there’s something abnormal in there and they will find it..
As i placed my hand on the child’s abdomen , I saw no flinching. No jumping. No screaming. I pressed harder. Nothing. I made notes and went on my way. The don came to hand me over patients to book for emergency theatre as usual. I could see the scalpel-hungry look in his eye. He asked me what was lying around casualty and I pointed over to the 12 year old boy and asked him to examine him.
He stopped. “Moosa come here. Feel this abdomen. I didn’t look up. “don I did. There’s nothing. Soft non tender. ”
“No! Moosa go and feel that abdomen now” …As i rolled my eyes deep into my occipital lobe, I put my hand on the abdomen and reflexly scoffed at the don, ITS SOFT AND NON TENDER.
He shuffled me aside and took his position beside the boy. As he palpated the abdomen I observed his technique. He skillfully leaned down and Sat beside Mandla. Boy show me where’s the pain. At this point I was annoyed at his ability to create work for us where it didn’t exist. Mandla pointed to the left lower quadrant. The don waved his magic hand over the area and gently placed his hand over it. Mandla hummed a gentle soothing sound which sounded much like a groan. The Don listened, felt and watched him carefully. He cradled the abdomen in his hands and was quiet for a while.”Moosa listen carefully. That’s the sound of worms whipping in bowel content”.
Heh!? Naturally I now thought the don had finally lost his marbles, something I eventually anticipated. “Okay don.are you done speaking to the worms? Can I go. I have work to do”
“Moosa get Mandla’s mother . he needs emergency OT” . I was snorting anger now and my feet were stuck to the casualty floor. “GO NOW!”
I stormed off to get Mandlas mother but didn’t say a word.
“Mommy. Mandela has ekelemu ( worms) in his tummy. He needs to have an operation.
“Doctor how do you know?”
“Mommy my boss has heard and felt them in his tummy”. I almost gagged with laughter.
As absurd as this sounded to me, mandlas mother looked convinced. apparently that explanation did the trick for her. Next thing we were rolling him to OT. I was excited to see how the Don behaved when he was wrong, something I’d never seen before.
I was expecting a negative finding so i could tell the don about the 1 time he was wrong.
The anaethetist was skeptical as well. She probed me for the reason of the surgery. And i handed her over to the don for a scientific explanation in which ‘he heard the worms’. She snorted. I was amused. But the Don had earned his stripes and no one would refuse him an operating room.
After Mandla being gassed, I scrubbed up. I Looked at the virgin unscarred abdomen of a child. Not deserving of a scalpel. I always hated the feel of a first cut seering through the skin muscle and sheath. Even the smell of cautery of a virgin abdomen’s blood vessels was particularly different. It didnt smell like the usual burnt tissue. It smelled cleaner. Fresher. I cringed.
“Don. We could always send him for an ultrasound tomorrow. And place him on the elective list” i tried one last time to save this boys abdomen.
“Sure moosa. He will be dead by then”
I was silenced.
He cut. I dabbed. I was saddened by the scar this would leave. He would be forever reminded about this impulsive man’s need to cut , by this ugly scar. An unnatural atrocity. An abomination to the beautiful abdomen.
We reached the sheath of the abdomen. I dabbed the blood away. A piece of white sheath was stuck to the gauze. I attempted to pull. Don stopped me.
He made a single neat incision. And Lo and behold, a swarm of a brilliant white array of spaghetti strings. Swimming violently. A thousand worms. Swimming to the shore of the bowels. I looked up with shock. My hands were frozen in the abdomen. I couldn’t move. I felt their tails whip against my gloves hands, a feeling i will never forget.
“Moosa. I heard the f#*&ing bastards swim. Are you deaf” . he was calm and cool. He collected each one. Counting as he placed it.
He was closed and cleaned. I was filled with pride. The don was really a don. He trusted his clinical judgement enough to slice through a childs abdomen, sure as hell there was something in there. That’s bravery or insanity, maybe a bit of both.
Somehow Mandlas scar looked less abnormal and more heroic now. I cleaned him up beaming with pride. I wondered how things would have been if I had sent him home, after all he had no signs of an acute abdomen. I was so glad I didn’t.
After being recovered i showed Mandla what we found.
His eyes proptosed out of his orbit. He was amazed and overjoyed. He asked for a jar of worms to show his soccer coach.
I could hear Mandlas Mom thanking God. I smiled and thanked The Don.
Note: the above picture was what we found in mandlas abdomen. No consent was obtained from the worms (lol)