The bile lady

Of the two of us, my wife Medy was, before 2008, far and away the healthier. She would hit the treadmill an hour every morning, go on low carbohydrate and other types of diets, use brown rice and brown sugar, and avoid desserts. In contrast, I had (and still have) a sweet tooth and, despite all my resolutions to stay healthy and slim, would devour ice cream, candy, and cakes practically daily.

Before 2008, Medy had never been hospitalized, except for childbirth and a minor polyp operation. In contrast, because of hypertension, I had been brought several times to the emergency rooms of various hospitals, in Manila, Cebu, even Poland while attending a conference. In the middle of my speech in Baguio while I was in DepEd, I became dizzy, had to stop, and was revived by doctors in the audience. I took a term off undergraduate studies for medical treatment, was operated on much later in Iran, had to be nursed back to health in China, and in general, even allowing for hypochondria, was the more likely to get into serious medical trouble.

Instead, in 2008, Medy stayed 47 days in Makati Medical Center, 12 of those days in ICU, another 4 days afterwards in the same hospital, and 11 days at St. Luke’s Medical Center. In the process, she lost almost 30 pounds, had two near-death experiences, and is alive today only because of a miracle wrought by prayers.

How could someone so healthy end up staying that long in hospitals? The long and short answer is bile.

Sometime in the first few weeks of 2008, Medy was diagnosed with cholecystolithiasis, a medical term for gallstones, or more precisely, cholesterol stones in her gall bladder. The condition is fairly common, occurring in up to 55 percent of all adult women in the world. That means that one out of every two women you know probably has gallstones.

Often, gallstones are not serious enough to require surgery. In fact, there are a number of non-medical cures for gallstones (perhaps merely urban legend), involving massive doses of virgin coconut oil, probiotics, or even just plain water.

Scientifically speaking, there are some non-surgical ways to remove gallstones, such as endoscopic retrograde cholangiography, endosonography or magnetic resonance cholangiopancreatography, percutaneous transhepatic cholecystoscopy lithotripsy, and endoscopic sphincterotomy. I have no idea what those are, since I am not a medical doctor; all I know is that they are mentioned in recent medical journal articles. (Did I hear someone mention that a little learning is a dangerous thing? With the Web, we have all become amateur physicians!)

In her case, Medy was medically advised to undergo surgery to have her entire gall bladder removed in order to avoid the possibility that one or more of her numerous tiny gallstones would move out of her gall bladder and into her pancreas, where they could do major damage.

Let us pause for a moment to review what we learned in school about human anatomy. What is bile? Here is a description from MedicineNet: “Bile is a yellow-green fluid that is made by the liver, stored in the gallbladder and passes through the common bile duct into the duodenum where it helps digest fat. The principal components of bile are cholesterol, bile salts, and the pigment bilirubin.”

Inside the liver, bile begins its long journey by flowing through numerous small ducts, like branches on a tree, that come together to form a large common hepatic duct, like the trunk of that tree. This common hepatic duct connects with the cystic duct that comes from the gall bladder to form the common bile duct.

As long as nothing obstructs the flow of bile, the digestive system works very well (after all, we all know Who designed this system). The intestine signals the gall bladder that it needs bile to digest fat, the gall bladder releases the bile it has stored from the liver, and the liver continues to produce bile to be stored in the gall bladder. Even if humans tamper with the divine design and the gall bladder is removed, there is minimal disruption, because bile can go directly from the liver into the duodenum as long as the common hepatic duct is not cut.

What is the duodenum? The duodenum is the first 12 fingerbreadths of the small intestine (duodeni in Latin means twelve) or about ten inches at the front or top end of the intestine or small bowel (botulus in Latin means sausage).

Since many of our friends already had gall bladder operations with no serious complications, Medy decided to have her gall bladder removed. She turned to a close friend since childhood, one of the country’s leading cancer surgeons. Since the surgeon could routinely remove microscopic cancer cells, there was no reason to think that he could not remove a huge thing like a gall bladder.

Unfortunately, there is Murphy’s Law that states that, if anything can go wrong, it will, and in Medy’s case, something went very wrong. (To be continued)