THE WINDOWLESS OPERATING room of the Delhi Memorial Hospital was freezing cold. Under the surgical lights a patient lay on the operating table, his eyes closed, an anesthesia mask over his face.
Doesn’t the patient wonder why a routine gallbladder operation is taking place so late at night? thought the senior nurse. She threw a look at Dr. Pankaj Arora: the slicked-back hair, the gap in his teeth. If only the world knew what a butcher he is. She should never have allowed herself to get sucked into his scheme, but the money was good—enough to pay off the staggering debts her husband had accumulated.
The anesthesia machine stood at the head of the table, and a tube ran from it to the mask that had been placed over the patient’s mouth and nose.
Wearing protective caps, surgical masks, vinyl gloves, and long green surgical gowns, the team was led by Dr. Pankaj Arora. It wasn’t an urgent surgery; it could have waited until morning. But Arora had insisted and no one ever argued with him. His temper was notorious.
Arora applied antiseptic solution to the areas he’d marked on the body. He then made a small incision above the belly button and inserted a hollow needle through the abdominal wall. This would pump carbon dioxide into the abdomen, inflating the cavity.
“Do we need intraoperative cholangiography?” asked the senior nurse. It was standard procedure to check if there were any stones outside the gallbladder.
Arora gave the woman a terrifying look. No one asked unnecessary questions while he was operating. “If you had bothered to check,” said Arora, “you would know that he has no stones outside the gallbladder.”
In fact, he has none inside the gallbladder either.
The senior nurse cursed herself for asking a stupid question. It was never a good idea to get on the wrong side of Arora.
He efficiently attached the umbilical port and then made three more incisions, no more than an inch each, in the patient’s belly. Next he inserted a wand-like laparoscope that was equipped with cameras and surgical tools into the umbilical port. Immediately, the monitor in front of him came to life with a view from inside the patient.
“How’s the blood pressure?” he asked the anesthesiologist.
“Steady—one hundred and ten over seventy,” replied the anesthesiologist, looking at the iridescent numbers and squiggles that mapped the patient’s vital signs.
Arora used the laparoscope to pull back both the liver and gallbladder and removed the connecting tissue to expose the cystic duct and artery. The senior nurse quickly used clips to clamp off the duct and artery. Arora cut the duct, the artery, and the connecting tissue between the gallbladder and liver, and used the laparoscope to suck out the pear-shaped gallbladder.
At this stage all the instruments should have been withdrawn, the carbon dioxide allowed to escape, and the patient stitched up. Instead, Arora increased the size of one of the incisions—to almost four inches.
“More suction,” he said to the senior nurse. She immediately grabbed a long plastic tube, and began using it to vacuum the puddles of blood. Arora was like a drill sergeant inside the operating room.
He used his instruments to separate the colon from the right kidney. He cut the splenorenal ligament to free the kidney entirely. He then cut the ureter, placed an endoscopic specimen retrieval bag around the patient’s kidney, and pulled it out through the larger cut.
From the corner of his eye he saw the senior nurse place the kidney in the Surgiquip LifePort unit, a transport device that would continuously pump the kidney with a cold liquid solution. It would double the organ storage time until it could be transplanted.
Arora began to stitch up the patient.
Surgery completed, he walked over to the scrubbing area, removed his gloves, mask, and cap, and washed his hands. He then walked through the doctors’ lounge and into the corridor. The patient’s wife was seated in one of the visitors’ chairs. She had been looking at the clock anxiously for the past four hours.
She got up instantly. “Is everything all right, Dr. Arora?” she asked.
He smiled at her, his expression softening only momentarily. “Don’t worry,” he said, placing his hand on her shoulder. “He’s perfectly fine. He’ll be discharged in two days.”
A look of relief was evident on the wife’s face. “I was worried when it took so long. I was under the impression that the gallbladder could be removed in two hours.”
“Laparoscopy takes a little longer but most patients seem to recover faster and feel less pain after the surgery,” he explained, taking off his glasses and using his kerchief to clean them. “We also needed to carry out intraoperative cholangiography to check for stones outside the gallbladder. That’s why it took some more time.”
Oh, and we also removed a healthy kidney along the way.