Wednesday, March 29, 2006

Worth the Weight? Part 1

Lights, Camera, CO2...Action!

The Setting: Abdominal Cavity
The Actors: First, we encounter the Gatekeeper of the Abdomen: the thick fluffy quilt of motherly omentum, bright yellow and protective, an endogenous apron covering all who lie inside. Well, everyone, that is, except the Liver, whose bullet-proof vest of ribs is the only protection it allows: the Liver is smooth and still, a flexible wedge of shiny mauve, cool as a steady surgeon controlling all with deceptively powerful silence. Next, the Small Bowel, a bow(e)l of tannish-pink snakes intertwined in a pile, still writhing in their slow, charmed, caterpillar dance along their many feet of length. Off to the extreme stage left, an ominous purplish black Spleen hides quietly in the shadows of the left colic gutter chomping up red blood cells without bothering anyone else, like a good Spleen. Nestled underneath the dueodenum, the enigmatic Pancreas peeks through a window of peritoneum, wanting in on the action but exiled to be forever retroperitoneal, despite being surrounded on all sides to the point of immobility. Up above in the next room, the heart bounces happily on its trampoline, as evidenced by the boingy bulging in and back of the diaphragmatic divider wall. It is a pleasant landscape, overall. But something must be wrong, if we are here. Oh yes, something is very wrong. We are here for the Stomach.

The Main Character: Let's see this hateful Stomach. At first glance, It is as any stomach would be, draped across the left upper quadrant like a hammock, swinging contentedly from diaphragm to liver, dressed in bed ruffles of omentum from above and below. At second glance...well, it is still entirely...unremarkable. Just the right size. Just the right color. Not scooped out by an angry ulcer or invaded by an aggressive cancer. Not bleeding from burst vessels or choking from getting its neck stuck through the hole of the diaphragm. It looks, as we might tell a nervous patient as we peer into her ears or vagina, "healthy, pink, and normal."

The Plot: And yet, perhaps unfairly, it is the Stomach that we have come for today. It has been singled out and convicted, scheduled for mutilation, public humiliation, and a lifetime of deformity as punishment for its role in the situation at hand. The situation is severe clinical obesity, and like it or not, the Stomach is going to pay. Is it really the responsible one? Or just a scapegoat chosen to bear the brunt of the guilt, and the pain, felt by everyone involved? Who really reaps the benefits of this procedure, and who suffers the consequences? Today, as I witnessed, and assisted in, my first gastric bypass surgery, I began to hear, louder and louder, until I could no longer ignore its plaintive growls and heartfelt gurglings, the Mourning Cry of the Modernday Stomach.

To Be Continued...


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