Procedure: Cholecystostomy Placement
History: 45-year-old Asian Male post stroke, gallbladder inflammation.
Consent: Patient unresponsive, unable to give informed consent. Explained procedure to patient’s next of kin, Flora Chung, wife. Discussed risks, including bleeding, infection, and death. Upon hearing the word “death,” next of kin grabbed my hand and began to cry. She informed me her husband was at the dining table working through geometry proofs with their son when he suddenly slumped over. They’d celebrated their twentieth anniversary this past weekend in a B&B in Sausalito. She claimed all this doctor talk of death and disability made no sense. He’d been normal on Saturday, on the balcony pouring champagne, while she sat on his lap, wearing nothing but a blanket, while they watched the fog roll into the Bay. Attempted to redirect her, but she fell onto her knees and said she couldn’t carry on if he died, she didn’t even know where he kept the deeds to the house, didn’t understand geometry, and oh fuck how could she raise Benjamin by herself? Explained the risk of death from this procedure was minimal. Did not explain this was only my second time performing a cholecystostomy, the first being ten years ago while in medical school. Or that there were four more procedures after this one and the tech was giving me looks because we were already behind. Or that even if this procedure went well, Mr. Chung was already permanently disabled, would never again help Benjamin with homework, and would need high level assisted care because his stroke was catastrophic. I picked her up off the floor, and pointed to where she needed to sign. Informed consent obtained.
Technique: Patient sterilely prepped and draped. Endotracheal tube taped to patient’s face. His unwashed hair musty and clumped together. His putrid smell. The same as what my father smelled like when he was in cardiac intensive care after his heart attack twenty-five years ago. My father’s arm jerking with each breath of the ventilator. I was sixteen years old on November 13, 1996. The doctors scrambling, administering CPR. 11:07 p.m., the time of death. The machines turned off, the tubes pulled out. The purple tinged skin. My mother on her knees. I didn’t feel anything. I didn’t offer to help lift her up.
Her years of depression. Her phone calls, waking me up at night during finals week. The toilet is leaking again, what do I do? Stopcalling! I don’t know how to fix toilets.
The tech tapped my shoulder, gave me the scalpel. I couldn’t remember. Which needle do I use? Which catheter? I placed the drain into the patient’s gallbladder.
Patient tolerated the procedure without any apparent complication.
Disposition: Mr. Chung transferred back to the ICU in critical condition.
Addendum: In my office, slumped over, holding my phone, after searching through the contact list. They’re paging me to Room 6 to start the next case. I want to call my mother, but I can’t remember her number.
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