#low lithotomy

''22 year old female, sudden onset of severe abdominal pain at 04.32 this morning. Located in the right lower pelvic area. Pale and diaphoretic. Vitals heart rate 125, blood pressure 93/58 after a liter of fluids, resps 23, sats 95 on 1 liter of o2, temp 101,4. Light vaginal bleeding, nauseous and clammy. She has a IVC in each arm, one running the fluids. ''

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The hospital staff help transfer you to the gurney, attaching ecg leads, blood pressure cuff, pulse ox. A nurse taking blood for tests, hooking up another bag of fluids, also administering more antiemetic and pain medicine. A doctor approaching in green scrubs. ''Im doctor Vagene and i'm a gynecologist. Im going to need to examine you to figure out why you are here with us today.'' He rests his hand on your shoulder as to comfort you. ''I hear you got a sudden onset of pain this morning, also some vaginal bleeding. I would need to examine you to figure out what this is and how best to treat it.''

The room is cleared of non essential personel and a screen is pulled out to shield some of your dignity. Stirrups are attached to the end of the gurney, they help you to get to the lower end and help you get into position. They lift your legs into the stirrups to reveal your intimate area. The nurse that stayed behind steps up next to you, the doctor rolls the chair to the end of the gurney and lays a hand on the inside of your thigh. ''I'll begin now'' he says and before you know it you feel a cold metal speculum entering your vagina, the unexpected intrusion paralyse you. The doctor crancs the speculum and you feel the pressure from inside, step by step to reach my cervix.

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''I can see some bleeding from your cervix, nothing too alarming'' He slowly release the speculum sliding it out. Not even seconds later he seperates your labias apart introducing two fingers into your vagina, again the intrusion leaves you paralyzed. His fingers reach far into you, feeling for your cervix and ovaries. You let out a loud cry from the pain. His hand freezes in position as you cry. ''Is this where your pain is?'' he asks. You try your best to say yes but it mostly sounds like gibberish. He continues with a quick final sweep before slowly removing his fingers.

The nurse rolls a ultrasound machine next to the bed. The doctor applies some ultrasound gel on a vaginal probe before placing a condom over it. Yet again you don't have time to register what is about to happen before he sticks the probe inside of you. He moves it around looking at the screen trying to identify any abnormalities. You grab hold of the sheet on the bed as he finishes his exam. ''I see some free fluid in your abdomen, probably blood. Because your blood pressure and other vital signs are out of order I dont see any other solution to this than surgery. We need to find the bleeding and I suspect its coming from a ruptured cyst on your right ovarie.''

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The words hit you like a brick. Surgery? Your heart start racing faster and you struggle to catch your breath. The nurse approach your gurney and lay a firm yet calming hand on your shoulder. ''We will take care of you, no need to worry!'' The team from the ER come back and start prepping you for surgery. New blood tests are taken, you get changed into a gown and they wash you with antibacterial wipes. They add a wristband on your left arm with your name and date of birth. A bouffant cap over your hair. ''We'll get going now, are you ready?'' a man says standing at the top of the bed. His eyes radiates a sense of calm somehow.

The ride to the OR is bumpy and cold. The man pushes the bed into a cold and white room. In the middle you see a slim OR table with armrests and stirrups on it. Your bed is placed next to it and someone says; ''Please transfer onto this bed for us.'' You scoot over to the OR table and they swiftley lay a blanket over you. ''I'm doctor Ketam and i will be the anaesthesiologist during your surgery. Lets get started by attaching our monitors.'' he says as he begins placing the blood pressure cuff on your left arm, the pulse ox on your right index finger. He slowly lifts the gown to place three ecg stickers on your chest connecting them to the monitor. He helps you lay your arms perfectly on the armrests.

Doctor Vagene enters the room in the same green scrubs, now with a mask and cap. '' Lets get going doctor Ketam'' he says and nods to the anaesthesiologist to begin. Doctor Ketam grabs the mask from the anaesthesia machine and slowly puts it over your face. You take some paniced breaths but slowly you smell the gas entering your lungs. Slowly by each breath you find it harder and harder to focus, the room starts to spin. You feel doctor Ketams hand on your cheek and hear him say ''We are gonna take good care of you, just let go and relax.'' Seconds later you drift of to sleep.

You feel doctor Ketam grab a hold of your face, lifting your chin to open your airway. One by one he pushed breath after breath into your lungs with the help of a resovar bag. Your chest rise and fall in a even rhythm. For another minute you are kept alive by his rhythmic technique as your lungs get filled with oxygen. The next second he lifts the mask of your face and lay the mask on your chest. On the anaesthesia machine he has prepped for a LMA intubation. He grabs the instrument and push your teeths to open your mouth. In one swift motion he pushes the LMA into your mouth. You later feel the ballon inflate and adjusting it's position in your throat. He places tape on your face, twisting it around the tube before placing the end on your other cheek. Connecting the LMA to the tubing. Your body settle in to the rhythm of the anaesthesia machine.

The OR staff begins their preparations. Lifting your legs into the low lithotomy position. Adjusting the OR-table, placing a catheter then washing and draping your body. Doctor Vagene enters the OR again, this time in a surgical robe, getting gloved by the assistant.