Confessions of a Surgeon: The Good, the Bad, and the Complicated...Life Behind the O.R. Doors by Ruggieri M.D., Paul A.

for gallstones, so it was obvious what needed to be done next. It all seemed too easy, especially because Dr. Stiller was a thin man with no risk factors for complications. Here was a case where classic symptoms of pain had led to predictable imaging studies diagnosing gallstones, which led to a simple solution: surgery. I love gallstones because the diagnosis is usually obvious and patients are very satisfied after surgery. Laparoscopic cholecystectomy is one of the most common operations performed in this country. It involves removing the gallbladder through very small incisions. It is a quick, boring operation with few surprises. Inside the operating room, Dr. Stiller’s operation was progressing routinely, like the hundreds I had performed before his. But before removing the gallbladder, I decided to inject x-ray dye into the common bile duct, which is attached to the gallbladder. The subsequent x-ray is called a cholangiogram. I do it to see if any stones have leaked into the common bile duct. If stones are present, they will need to be removed at a later date, by a different procedure. It was a last-minute decision, partly because it was easy to do and partly because I was paranoid about missing something. In surgery, Murphy’s Law seems to kick in when operating on fellow doctors, doctors’ wives, nurses, lawyers, lawyers’ wives, or any other high-profile patients. Be assured: If anything can go wrong, it will! Often, surgeons bypass the cholangiogram if there is no suspi