Indexing Title: DCHUA’s Medical Anecdotal Report [05-2]

 MAR Title: Guiding Strings

 Date of Medical Observation: March 11, 2005

 Narration:

             After assisting the newest Head and Neck specialist or the first time, who in turn was assisting the youngest of my teammates in his first thyroid operation, I felt an extra sense of confidence with my upcoming thyroidectomy, the second of three distributed among our team for that day.  Knowledge dawned from the consultant’s steady narration during the procedure differs as much from an atlas, as from the first time I operated on a goiter case assisted by a consultant.  It was like finding a well-paved road to a place you’ve often visited via the more obvious rutted path.

            The tortuous blood vessels on the gland of my patient seemed easily handled now.  Individually identifying, ligating and cutting each vessel, I flipped the right lobe forward, identifying the recurrent laryngeal nerve in the process.  As I reached the trachea and the groove beneath it, it occurred to me that what I had thought to be the most significant structure in thyroid surgery did not as expected continue along the tracheoesophageal groove.  Failing to find the nerve, I called for help.  One of my mentors answered, identifying what I had thought a vessel to be the already cut nerve!  A lump caught in my throat.  I tried to recall what I had done in the past few days to deserve such misfortune.  As we went about reconnecting the severed ends, I silently prayed that God grant me and my patient mercy, and that the neurotmesis would heal properly after a few months.  The rest of the operation went along uneventfully.

            I asked the anesthesiologist to take a peak at the voice box before the patient recovered from the anesthesia.  He mentioned that both the vocal cords seemed to be moving normally.  Indeed, as the patient fully recovered at the post-anesthesia care unit, she was speaking normally.  Hers was the most beautiful voice I had heard in a very long time!  She went on to recover uneventfully, without even irritation from the tube previously placed into her airway, nor nausea from the anesthetics.