On the Lighting of Farts and the Reduction of Bile

(NOTE: If you are part of my surgical team, feel free to skim until you get to the part that says THIS IS THE PART I FOR SURE WANT MY SURGICAL TEAM TO READ.)

Maybe having someone take out my gallbladder will also remove some of my perverseness.

For example, I am not in the least bit comforted by everyone’s intended-to-be-comforting stories about how smoothly their gallbladder surgery went. Percentage-wise, nationally anyway, there are complications in a certain number of gallbladder operations, so every time someone tells me how theirs was “a piece of cake,” I think that ratchets up my odds of having complications. (At least two people have actually used that phrase, “piece of cake,” which I find telling somehow, since cake tends to be high fat, which is what puffs up my gallbladder’s sense of itself and causes me the pain and discomfort I described so precisely to my surgeon that he said he felt confident my problems were caused by my low-functioning sac of bile.)

This concern about everyone’s happy endings meaning that I’ll have problems may not be particularly sound statistical or scientific reasoning, but it feels true, so I was comforted when one of my coworkers obliged me this morning by describing how her father had all kinds of complications, including an open, oozing wound.

For the record, I trust the overwhelming scientific evidence on things like evolution and climate change and even vaccinations. But I understand people who are skeptical. Magical thinking is so much fun and so much easier.

You know how you can light a fart on fire? I’ve never tried it, but a friend says she had to take her then-husband to the E.R. when he did it, without pants on, and caught his ass-hair on fire.

Pair that knowledge with the occasional situation in my own home when someone has farted. Happens very rarely, of course, and it’s almost never me. What do we do, on those rare, rare occasions? We light a match.

I thought, for years I thought this, that you lit a match to get rid of the fart smell because the trace amounts of methane then obliterated themselves.

My husband and my friend Joy, who has a Master’s degree in agricultural science, have finally almost pretty much convinced me that no, there’s no tiny methane explosion (so tiny you can’t see it); it’s just a matter of the sulfur covering up the smell.

I can’t tell you how little sense this makes to me. There are so many things that smell better than sulfur, and spritzing a little lavender would never catch your flannel pajamas on fire. (WHOOM! The flame was racing up my leg. I got those pjs off faster than you can say CH4.)

THIS IS THE PART I FOR SURE WANT MY SURGICAL TEAM TO READ:

I’m glad I’m not in charge of removing my own gallbladder. I’m glad it’s a surgeon who seems to have a good reputation (he’s removed the gallbladder of people I know, two of whom have said things like “piece of cake,” if not using that exact phrase). I also had my shit-detector highly tuned when I met with him last week, and it didn’t go off, not even once.

He was explaining to me what the percentages were, in terms of the likelihood that this operation would solve the problems I’m having. My precise description seemed to give him confidence that it was, in fact, my gallbladder, and I also had a scan two years ago during which a technician and I watched radioactive dye go through my digestive system, and also during which my gallbladder was kind of lackadaisical about pumping out the bile it had stored, which gave me the official diagnosis of, get this:

an equivocal gallbladder.

which seems like exactly the kind of gallbladder I’d have.

A friend’s preschooler learned all the words to the Clash’s “Should I Stay or Should I Go?” this week AT PRESCHOOL, and I can sort of picture my gallbladder rocking out to that song. But not quite on the beat, so—the answer to the question is now GO.

I liked how my surgeon talked about the percentages and then clarified that these were national averages, and his own numbers were much better.

This reminded me of Atul Gawande, who, in his article “Personal Best,” describes the frustration he felt when his own numbers kind of stalled out, after years of improving:

“As I went along, I compared my results against national data, and I began beating the averages. My rates of complications moved steadily lower and lower. And then, a couple of years ago, they didn’t. It started to seem that the only direction things could go from here was the wrong one.”

This particular article was recommended to me by my friend Kim Barnes, whose new novel, In the Kingdom of Men, is high on my post-surgery reading list. Kim prescribed the Gawande article after a conversation in which I described frustration at not meeting with the kind of success I wanted. “Maybe you need a coach,” she said, in a moment of absolute diagnostic aplomb. I haven’t decided yet if I need a coach, but I desperately needed to read this article.

What I love about Gawande, in addition to having Googled him to find out he’s pretty cute (if you like geeky-handsome, which I do), is his relentlessness: “Élite performers, researchers say, must engage in “deliberate practice”—sustained, mindful efforts to develop the full range of abilities that success requires. You have to work at what you’re not good at. In theory, people can do this themselves. But most people do not know where to start or how to proceed. Expertise, as the formula goes, requires going from unconscious incompetence to conscious incompetence to conscious competence and finally to unconscious competence.”

Everything he said I was applying to myself as a writer and a teacher, and only later realized that I wanted all my healthcare professionals to read him.

Particularly, I would want them to read his book The Checklist Manifesto, or at least have read the checklist itself, (also available as a pdf on the same webpage) which includes things the surgical team should check “before the induction of anaesthesia,” “before the skin incision,” and “before patient leaves operating room.” My favorite item on the checklist is “confirm all team members have introduced themselves by name and role,” because Gawande explains in the book how this ramps up the odds of them actually working well as a team.

I asked my surgeon if he would read my blog before he cut me open, and he said he would. I’m emailing the link, but I’ll bring a hard copy on Tuesday, just in case. I would be so happy, upon waking in recovery, to see on my hand or some other obvious place I’ll be able to see in recovery, a big checkmark in permanent marker, or better, the exact words from the last item on the checklist. I’ll know then, not only did my surgical team read my blog, they read Gawande, and I was, as I was trusting, in good hands.

Because in the end–although my magical thinking cap would prefer a surgeon who recently had a gallbladder operation go badly (thus ensuring my odds of mine going well)–my rational mind would prefer a surgeon who saw my cholecystectomy as one more chance to improve his percentage.

4 responses to “On the Lighting of Farts and the Reduction of Bile

  1. Gawande is a regular contributor to the New Yorker. I always enjoy his essays.

    I hope your surgery goes well, and that you can enjoy a piece of cake later.

  2. Praying that everything goes well and you feel better than new after your surgery. I am so glad that you have built a rapport with your surgical team. It always helps to know who is going to be hiding behind those scrubs and masks.

  3. I hope all goes well with your surgery. In addition, I have to add that your post made me laugh several times.

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