A woman goes into a hospital with pain she has had around the region of her right ovary for almost two years with no other symptoms except for some sciatic pain. She has been sent to the hospital because the pain has really flared up over the past couple of days and her GP says it could be appendicitus. At the hospital, all blood results come back normal so she does not have appendicitus and this and the fact that she doesn't have a fever or vaginal discharge tends to rule out pelvic inflammatory disease. Next step is for her to have an ultrasound scan. This reveals that she has some fluid collected at the bottom of her pelvis that shouldn't be that but apart from that, all is normal - ovaries, uterus and endometrium all look healthy. The doctor next suggests a laparoscopy. This is an operation where a few small incisions will be made into the woman's abdomen (leaving small scars) and a camera will pan around and explore inside the abdomen area. Please note the woman reports that her bowel is virtually always in perfect working order. She has however been experiencing constipation for the past 3 days. The woman, nil by mouth from 3am, gives some thought to the operation she is due to have the next day. 'I don't want to be opened up and closed up for nothing. This could introduce infection, and could cause damage where there previously was none.' The woman also worries about the fact that she will feel sore for some weeks after the operation and this will mean she has to take time off her job. She's very sporty and hopes that the operation won't cause any lasting weakness. What if she never returns to full fitness? The doctor's do very little to reassure her that this is not the case. So what will this operation accomplish anyway? The patient has while thinking realised that she began a course of iron tablets about 3 days ago and these are responsible for her constipation. She thinks it likely that the constipation caused her ovary pain to flare up. She also recalls that a past internal scan showed up one small cyst on her ovary, that has since according to the ultrasound disappeared. Is it's absence due to a failing or limitation of the ultrasound or has it actually burst/disappeared. Could this fluid be the result of a cyst bursting? The woman suddenly wonders what this operation could accomplish. Ovarian cancer has almost totally been ruled out by the ultrasound and an absence of related symptoms. PID and appencitus have been ruled out by the bloodtests. Bowel problems can be ruled out by no history of bowel complaints. What else is there? It only really leaves endometriosis, which has not even been mentioned by the doctors. Do they suspect it? A laparoscopy is the only sure way of diagnosing endometriosis, but as there is no treatment or cure for this condition, what is the point in knowing for sure? The woman was not surprisingly left wondering 'Why am I having this done?'. She informs the nurse that she will need to speak to the doctors again before the surgery takes place.
The next morning the woman is preped for surgery and wheeled down to the operating theatre. The doctors have been informed that the woman has more questions to ask before going in for the operation. She reminds the doctors that she is healthy young woman who enjoys sport and has a busy career and doesn't want to be operating on for nothing. She outlines to the doctors the reasons why she thinks the operation will reveal nothing apart from possibly the presence of endometriosis. The doctors listen patiently. When she has said her piece, they compliment her on her thorough research. The young doctor says he respects her for what she has done and says he would be having the same thoughts if he was her. He concedes to her that it is very borderline as to whether the operation will acheive anything or not. He does nothing to encourage her to have the operation and corrects her on nothing and gives no additional arguments for having the surgery. On this grounds, she thinks it better for her to be wheeled back up to the ward and dischared where she will be free to run and jump and work because the pain has almost totally gone back done to it's normal mild and intermittent level.
She will explore other non-invasive tests that could be done to diagnose the problem with her GP. She feels she has made the right decision, but she saved herself. It was the doctor's job to make the right decision and save her.
VANESSA PARADIS - A french popstar, best known for hits such as 'Joe le Taxi', 'Sunday Mondays' and 'Be my Baby'
BRITT ECKLAND - best known for playing Willow in 'The Wicker Man'
MARY MARGARET O HARA - Singer best known for her eccentric arm movements whilst performing
JULIA ROBERTS
