Adapt and Overcome

Me and Dr. Mike Marohn before the lap chole became a 7 hour biliary case

Yesterday was a tremendous first day. We spent the first 2 hours in the ICU which had become a makeshift burn unit with the arrival of two serverely burned firefighters from an outlying district. With over 50% total body surface area burns the most frightening part of their condition was their significant facial and neck burns. After assessing their fluid status, Dr. Rust expertly intubated both patients, ensuring both safe airways for the helicopter flight to the burn unit in the capital. With our late start, we moved quickly into our first two lap choles and a lipoma resection. The cases went really well and I was impressed with the improvement in skills I saw in the surgeons we had trained previously.

Then came today….. The local team was itching for us to show them how to do a laparoscopic cholangiogram. I tried unsuccessfully to get Mike (my more senior co-surgeon) to take them through the case but somehow, I was the one scrubbed when we got the image that changed our day. No flow of contrast into the duodenum, and two big filling defects in a dilated common bile duct … for the non-medical folks – when you are in Choibalsan, that means a long day! Adapt we did. The operation was converted to an open common bile duct exploration and trans duodenal sphincteroplasty. Amazing anatomy but 7 hours scrubbed in the OR. Suffice it to say, the team bonded over the trials of that case and when the patient woke up bright eyed and slightly grumpy, we felt a sense of victory.

The next case ended up being an incredibly inflamed gallbladder that Mike and I took over from a frustrated Mongolian team. Their judgement was correct … they should have opened … but Mike and I were able to muscle through the concrete, overcome, and get the gallbladder out intact. We received over enthusiastic accolades for our skills and enjoyed our moment of feeling like the heros.

One final gallbladder left us in the OR until 930pm – too late for dinner, too late for basketball, and just in time for bed.

Mike likes to say he is a fan of “adapt and overcome” … perhaps his first day in Choibalsan was designed as a test of that mantra … adapt and overcome we did. Adapt and overcome …