The morning of the surgery began early. Hanna woke up at 5 AM, her mind a whirl of anticipation and nerves. Her heart throbbing wildly. Her pent up desires bubbling through the maze of her reluctance and confused mind. Ramesh was already up, offering her a comforting smile as she prepared for the day. Hanna took a shower, the warm water calming her nerves slightly, and then waited for the next steps.

Nurse Sudha, with her serious demeanor, grunt face and professional efficiency, arrived to assist Hanna. "Good morning, Hanna. It's time to get you ready for the operation," she said not-so-gently.

Show me your hand, I need to insert the cannula for IV. Sudha carefully placed an IV in Hanna's forearm, ensuring it was secure. "This will help us administer any necessary medications during the surgery," she explained. Hanna was provided a surgical green gown into which she was ordered to change after complete undress. Hanna did as required , as Ramesh waited on other side of the temporary screen. Hanna’s feet and calf upto her knees was visible from the other side as she dropped her pants and underpants , removed top and bra and kept it on the screen.. And proceeded to wear the front opening gown. Hanna came back and was sitting on the bed, Ramesh collected her cloths and put it in the bag he was carrying.

Once Hanna was back on her bed, nurse Sudha started filling a couple of syringes with some medication. The syringes appeared to have thicker needles, which was noticed by Hanna. Sudha asked Hanna to lie down. She wanted to inject the medicines in an intramuscular manner in Hanna’s buttocks. They were some anti anxiety and antiseptic medications she mentioned.

Hanna, having seen the needles and feeling a bit scared if it was actually for her, asked if Sudha could inject it through cannula in her arm. Sudha sounded irritated, and just remarked .. “Do as I say.. You are not a medical person to advise me how to give this medication” This is 14 Gauge needles and since the medicine is made on an oil base, it can get stuck in the cannula. I will inject it in the upper quadrants of your buttocks… that, apart from bringing down your anxiety, will keep you reminded that “Surgery is not a painless affair. Now please lie down on you bed”

Having been reprimanded rudely, Hanna did not dare to open her mouth again, though she anticipated this was not a normal injection. Ramesh was mute spectator as Hanna turned around and clinched the pillow. Sudha moved Hanna;s gown from below to fully expose Hanna’s buttocks. She did not bother much about Hanna’s dignity or that there were other patients and their attendants around. Most people nearby could see everything about the patient . Sudha applied alcohol and inserted the needle. Hanna expressed the pain of the sting with a sound.. Then Sudha started injecting the medication. Hanna was having a continuous sting of higher intensity and let out a cry “Ummmmmmm”... Other patients and their attendants looked towards Hanna’s bed. Finally it was done. Sudha laughed loudly as she massaged that injected bum. She, in a sadistic tone, asked Hanna.. Hope you are okay and you liked the taste of the injection in your left bum.. Now let's also give it to your right bum, so that we are impartial.. Onlookers laughed loudly and before Hanna could recover and react, Sudha inserted the second injection.. Again a lot of pain , crowd around laughing, Ramesh confused how to react but in a way mildly satisfied to see the pain Hanna was going through, by her own will. “Ok Hanna, please get on the wheelchair soon, we will get going “ remarked Sudha. Ramesh helped Hanna as she tried to sit up and then moved into wheelchair.

Sudha then wheeled an agonizing Hanna towards the Operating Theatre (OT), with Ramesh walking alongside them. As they approached the OT, Sudha turned to Ramesh and said, "You can join Hanna in the OT if you'd like., but first change into the hospital sterile gown”

Hanna was pleasantly surprised and relieved to know that Ramesh would be with her during the surgery. "Thank you for being here with me," she said softly, though she also realized that like her, Ramesh was a deep medfet too and he was enjoying her ordeal.

The OT in the Government Hospital was functional but not overly sophisticated. The room was large and well-lit, with walls painted a sterile white and floors made of polished linoleum. The equipment was basic yet reliable, reflecting the hospital's focus on clinical expertise rather than cutting-edge technology.

All the drapes in the OT were green, creating a cohesive and calming environment. The surgical instruments were neatly arranged on sterile trays, ready for use. A large overhead light illuminated the operating table, ensuring the surgical team had a clear view of the procedure.

Dr. Pradnya Hanamshet and the rest of the clinical team were already present, preparing for the surgery. Hanna was wheeled to the center of the room and helped onto the operating table. Nurse Sudha adjusted the drapes around her, ensuring everything was in place.

Dr. Pradnya approached Hanna with a reassuring smile. "Hanna, based on your physical examination yesterday, we've decided to go with a spinal and epidural anesthesia. This means you'll be numb from the waist down, but you'll remain conscious during the surgery."

Hanna nodded, her trust in the medical team giving her some measure of comfort. "Okay, doctor. I'm ready." She was scared but thrilled at what was going to come now.

Dr Pradyna asked Hanna to turn to her other side. Dr. Pradnya began by cleaning Hanna's lower back with an antiseptic solution. She then carefully inserted the needle for the spinal anesthesia, ensuring it was placed correctly. "You might feel a slight pinch and pressure, but it will be over quickly," she explained.

As the spinal anesthesia took effect, Hanna felt her lower body becoming numb. Dr. Pradnya tested the area to ensure the anesthesia was working correctly. "Can you feel this?" she asked, gently touching Hanna's legs.

"No, I can't feel anything," Hanna replied, feeling a strange mix of relief and anticipation.

Next, Dr. Pradnya prepared for the epidural anesthesia. She inserted a flexible cannula into Hanna's upper back, ensuring it was securely in place. "This cannula will allow us to administer epidural anesthesia throughout the surgery, ensuring you remain comfortable," she explained. The region was secured with the duct tape and the tube was pasted on Hanna’s back. Ramesh enjoyed seeing the anesthesia process.

With the anesthesia successfully administered, the surgical team began their preparations. Nurse Sudha and Jessy, helped by Dr Pradyna, turned Hanna to supine position. Nurse Sudha removed the drapes and gown. Hanna was in the most embarrassing position now. She was fully naked from head to toe with nothing on her at the moment. She could see Ramesh standing behind on her right side and his probing eyes .. She thought to herself, he was the one who had the best time in this episode, but she also had sympathy for him because he was the reason for her to live her dream. He would also take care of her after this surgery and she had no one else here.

By now Hanna was numb from below the chest area and could not feel anything below her breasts. Her breasts were still sensitive, exposed, laying like buns on her chest. Her nipples were taut again and were about to start throbbing because of her excitement. She was embarrassed that so many in OT with different values and backgrounds would see this. She tried to distract herself to allow her nipples to settle down but her mind was engaged and not letting her move away.

Sudha and Jessy then scrubbed Hanna's chest below her breasts, entire abdomen, thighs, and genital area with saline water, followed by betadine solution to ensure a sterile field. The antiseptic scrub left Hanna's skin clean.

Sudha asked Jessy loudly to get the urinary catheter. Next, Nurse Sudha inserted a catheter into Hanna's urinary bladder to help her pass urine during the surgery. She attached it to a urinary back and it was hung by the side of the OT-table. "This will help us monitor your fluid balance and ensure your comfort," she explained gently.

Dr. Kalaivani and Dr. Santosh Kaur, both dressed in their surgical scrubs, approached the table. Dr. Kalaivani gave Hanna a reassuring nod, while Dr. Kaur's confident presence was a source of strength.

"Remember, Hanna, we're here to take care of you," Dr. Kalaivani said gently. "This is a complex procedure, but you're in good hands."

Hanna took a deep breath, feeling a sense of many things all at once – fear, embarrassment, fulfillment, joy, lightness , deja-vu of going to the point of no-return – amidst the flurry of activity around her. As the surgery began, she knew that the dedicated team of doctors was ready to do everything in their power to ensure a successful outcome., but she also knew that this was her deeper want, rather than any real reason to lose the organs,

Hanna's heart raced as she lay on the operating table, her hands gently strapped to the armrests to keep her still. The IV drip was started, delivering a steady flow of fluids and medication. The room was filled with a mixture of apprehension, determination, and professionalism as the surgical team made their final preparations.

Dr. Santosh Kaur, towering and imposing in her scrubs, commanded the room with her presence. She was a figure of strength and confidence, a true leader in the operating theatre. Her body language and confidence were representative of her extensive experience and expertise.

"We're ready to begin," Dr. Kaur announced, her voice steady and authoritative. She positioned herself at the head of the table, her eyes focused on the task ahead.

“Dr Kaur”. Interrupted Dr Leela Pundit. Dr Kaur looked at Dr Pundit who was just near Dr Hanamshet at the head of the table. As I discussed with you, I want to monitor Hanna for her anxiety through the surgery. This is for my research on Concious Patients through complex surgeries. ..

“Ah.. “ said, Dr Kaur… Please do the needful, I was about to give her the first incision of her life. Please go ahead Dr Pundit and prepare the patient for your experiment , said Dr Kaur in Matter-of-fact manner.

Sure Dr Kaur , “Thank you “, said Dr Pundit. Only deviation from protocol Dr Kaur would let the patient be without drapes including on the chest throughout the surgery. That may make her feel a bit vulnerable.

Dr Kaur opined, I know .. but I think Hanna should be okay with it. We are all doctors in the room and the only other person is her friend Ramesh. You are not going to get many opportunities where surgery has this level of complexity and the patient is not on General Anesthesia and fully conscious. Hanna, Do you want to say anything ?

Hanna , being half body numbed, did not know how to react. Neither was Dr Kaur interested in her answer. Dr Kaur had made up her mind to let Dr Pundit continue with her experiment and signalled to Dr Pundit to get the setup ready.

Dr Leela Pundit, turned to Dr Pradnya and asked , “Dr , are we giving any sedative to the patient?”..

Dr Pradnya Hanamshet , “ Dr , I was thinking or partially sedating Hanna to reduce her awareness of the procedure, but … “

Dr Kaur Intervened , “Dr Hanamshet, I think lets not sedate her, unless she has some kind of anxiety attack. I am also very interested in data that Dr Pundit is collecting.. What do you think of Dr Gunashekaran ?”

Dr Kalaivani just smiled, indicating that she is not bothered about patient comfort but the research is important.

+++++

As Dr. Leela prepared her patient, she moved with a practiced precision that came from years of experience. Hanna, lay on the operating table with a mixture of apprehension and vulnerability in her eyes. Dr. Leela offered a reassuring smile as she gently placed the blood pressure cuff on her left upper arm. The cuff inflated with a soft hiss, and the monitor displayed the readings, providing a snapshot of the patient's cardiovascular state.

Next, she attached the pulse oximeter to the patient's left earlobe. The small clip gently pinched the skin, and the device began to measure the oxygen saturation levels in his blood, a crucial indicator of his respiratory status.

Dr. Leela then carefully positioned the 12-lead ECG electrodes on Hanna's bare chest. Each electrode was meticulously placed to ensure accurate readings, mapping out the electrical activity of the heart. The adhesive pads felt cool against Hanna's skin as they were secured in place, as chest was not numbed. The monitor displayed the rhythmic waves of his heartbeat, a visual representation of the life pulsing within him.

On the patient's right side, the regular blood pressure monitor was set up, with its inflatable cuff wrapped snugly around his right upper arm. Dr. Leela manually measured the blood pressure in the right arm periodically, cross-referencing the readings with those on the monitor to ensure accuracy.

To add to the monitoring setup, Dr. Leela attached an additional cuff around the patient's left thigh. This cuff provided a secondary measurement of blood pressure in the limb, offering a comprehensive view of the patient's circulatory status.

Throughout the procedure, Dr. Leela meticulously auscultated the Hanna’s chest at periodic intervals. She placed her stethoscope on various points, listening intently to the sounds of his heart and lungs. The cold diaphragm of the stethoscope pressed gently against his chest, amplifying the rhythmic beats of his heart and the steady flow of air through his lungs. Dr. Leela moved the stethoscope from the apex of the heart to the base, then to each lung field, ensuring she captured every nuance of his physiological state. Dr Leela was very through in her chest auscultation every single time she repeated it every 30 minutes through the course of this 6 hours surgery. More so, Dr Leela encouraged Hanna to make eye contact with her, show her tongue often times during auscultation to gauge is Hanna was fully alert to what was going on. This must have run riot in Hanna’s mind and increased her thrill and excitement many fold.

+++++

Ramesh was having time of his life seeing Hanna like this on the examination table. He came out multiple times during the surgery without being able to control himself.

Hanna was fully naked throughout the surgery. Her arms were extended on hand rests and fully secured with the belts. Her legs were slightly moved apart and also secured to the OT table by belts on thighs and ankles. A catheter was coming out at the top of her vagina through the ureters and attached to a urine bag. Both upper arms had BP cuffs wrapped, her left thigh had a BP cluff wrapped, which would periodically inflate. There were electrodes placed on various parts of her chest under left breast and in the axilla and on her back. A pulse oximeter pitched her left pinna.. The monitors were beeping through the procedure. There was otherwise an uneasy calm, sometimes broken by giggles and discussion between the doctors. Thinking about it, Hanna must have felt like an experimental frog in a biology lab. But she still has not been opened up.

With Dr Leela Pundit having setup her research specimen, the OT was organised as follows around the patient.

Dr Kaur leading the surgery was on the right side of patient, at about her abdominal area where the main surgery was to take place. If Dr Kaur was to give the first incision it would be from bottom of chest to the pubic hair. Dr Kalaivani was on left side of the patient. If she were to give the first incision, it would go from pubic hair to the bottom of chest.

Besides Dr Kaur on her left side , but also on right side of patient was Dr Leela Pundit. She was also in scrubs but had her Cardiology Stainless Steel Dual Head , heavy Stethoscope hanging off her neck . She was correctly positioned to monitor Hanna’s breathing and heart conditions periodically.

On the head side of the table, was anesthesiologist Dr Pradyna Hanamshet. It was the place where she usually stood. In this case there was no screen separating the patient's view from the operating field but usually her view is blocked by the screen. Today she was excited to see the live surgery throughout . She had a heavy triple head allen welch like Stethoscope resting on her shoulders. She also would auscultate Hanna’s chest from top side multiple times during the surgery as a responsible anesthesiologist.

On the right side of Kalaivani was young Dr Sameera Reddy. She was all curious about the procedure, the research, the experiment . Her role was mainly observation but she helped with retractor. When she was not holding the retractor, she was encouraged to listen to Hanna’s chest once in a while and co-relate with the monitor readings. She too, therefore, had her Cardiology Stethoscope with her.

Nurses were positioned , one on either side behind doctors to provide the surgical instruments when asked.

Dr Kaur : “So we are ready to begin.” There was a Chorus of yes Dr in the room.

Dr Kaur: Dr Kalaivani , Do you want to do the high honours today or you want me to start.

Dr Kalaivani : Let me do the honours Dr today.. You have lot of work ahead.

Dr Kaur : Thanks Dr , Please start. But as you know we are also doing Omentectomy , please give our lovely patient a good long incision so that I can completely view her internals and remove all of Omentum.

Dr Kalaivani : Sure Dr. I understand.

With a deep breath, Dr. Kalaivani made the first incision. She first marked the two ends with the blunt side of the scalpel, one just above the pubic b

When this was heard, that incision was long, Hanna skipped a beat, the monitor lost a beep and came back to a faster heart rate. Dr Pradnya and Dr Leela were alarmed but then it settled quickly to little higher than normal rate. All Doctors in the room were relieved. As a part of reflux at this point in time ,Hanna also urinated .. The first discharge of pale yellow urine was collected in the bag.

Dr Kaur noticed it and said .. “Dr Kalaivani.. Don’t delay anymore, our patient is started peeing already”.. There were giggles and laughter in the room leaving Hanna more red-faced with embarrassment .

The scalpel moved with precision, creating a long cut from Hanna's pubic bone up to sternum, circumventing the thicker tissue of the umbilicus in a semi-circular arc. The layers of skin and tissue parted beneath the blade, revealing the intricate structures within. Dr Kalaivani carefully cuts through the skin, subcutaneous tissue (fatty tissue beneath the skin), and the fascia (a tough layer of connective tissue).

The rectus abdominis muscles are separated along the midline (linea alba) to provide access to the abdominal cavity. Once the fascia is opened, the peritoneum (a thin membrane lining the abdominal cavity) is carefully incised to enter the abdominal cavity. Dr Kalaivani asked for retractors, which was provided by Jessy. The retractor was inserted to hold the edges of the incision apart from the left side and she asked Dr Sameera to hold it in place at one end and Jessy at the other. On the other side, Dr Kaur positioned the retractors and she was helped by Dr Leela to hold them in place.

This gave a very clear view of the abdominal organs

Kaur asked Sudha to raise the supports attached to the Operation table to hold the retractors in place. Sudha did so on side of Kaur, and after hinging the retractors on left stood on their own without intruding into Dr Kaur;s access. This was done on the left side relieving Dr Sameera and Jessy from holding the retractors manually.

Good Job , Dr Gunashekaran, remarked Dr Kaur, though she was about 8 years junior to Dr Kalaivani. Dr Kalaivani , smiled in satisfaction and it was only reflecting in her eyes. There were small drops of sweat on Kalaivani’s forehead. She turned around and Dr Sameera wiped it with a piece of cotton using tongs.

“Over to you , Dr Kaur", said Dr Kalaivani.

As the incision was made, the atmosphere in the room shifted. The team of doctors leaned in, their faces a mix of concentration and resolve. Each Dr was taking a look at the Hanna’s opened abdomen. Hanna herself was very calm now with a sense of happiness on her face. She was fully aware of her internals being exposed to the doctors. She was not feeling anything but would smell her own blood and burnt smell of the cautery on the arteries where it was used to very delicately seal the openings by Dr Kalaivani.

Dr. Pradnya Hanamshet, the anesthesiologist, monitored Hanna's vital signs closely. She occasionally glanced at Hanna's face, offering a reassuring smile. Hanna felt the numbness from the anesthesia, but her mind remained alert and aware of her surroundings.

Dr. Leela Pundit, the general physician, stood nearby, observing the surgery with keen interest. She listened to Hanna's heart and lungs periodically, gauging her anxiety and ensuring her stability. Dr. Pundit's research on conscious patients during complex surgeries added an extra layer of depth to her observations.

Dr. Sameera Reddy, the fresh-faced resident, watched in awe. Her eyes followed every movement, her hands eager to assist. The gravity of the situation was not lost on her, and she felt a profound sense of responsibility.

Dr Kaur now proceeded to systematically examine the abdominal organs, including the stomach, intestines, liver, gallbladder, spleen, pancreas, kidneys, and other structures.

"We're proceeding with the omentectomy," Dr. Kaur announced. She carefully lifted the omentum, a fatty layer of tissue that covers the intestines. Using precise, deliberate movements, she began to remove the omentum, ensuring no affected tissue was left behind. But at the same time, she is very careful to avoid damaging any nearby blood vessels, lymph nodes, or other structures. Once the omentum is fully separated, the Dr Kaur ligated (ties off) the blood vessels supplying the omentum to prevent bleeding. The omentum was then divided, and the entire omentum was excised in small portions.

Hanna's eyes flickered with a mixture of fear and determination. She could hear the gentle hum of conversation, the clinking of surgical instruments, and the rhythmic beeping of the monitors. The sensation of numbness in her lower body was surreal, but the presence of Ramesh nearby gave her strength. She was also in the middle of fulfilling her wildest dream. That was making her feel light and happy.

Ramesh's heart ached as he watched his girlfriend undergo the procedure. His eyes moved between Hanna’s abdomen and her face, offering silent support and unwavering love along with fulfilling his intense love to see the surgery. He felt a surge of admiration for Hanna's courage and the dedication of the medical team.

Dr. Kaur's movements were swift and confident. She meticulously removed the omentum, ensuring all malignant tissue was excised. The layers of organs and tissue were exposed in their raw, vulnerable state. The sight was both awe-inspiring and humbling.

Dr Kalaivani and Dr Kaur now moved to uterus and ovaries. The uterus, along with its surrounding structures (fallopian tubes, ovaries, and ligaments), was identified. Dr Kalaivani and Dr Kaur now looked at each other, an expression of concern and confusion was in their eyes.

Dr Kalaivani : Dr Kaur, I don’t see much of a malignancy as this girl claimed in the consulting room.

Dr Kaur, That’s true and we have removed her omentum. Was it a false positive in her earlier report then.

Dr Kaur: Hanna, I dont see your uterus or ovaries having any pathology. Do you want me to stop now and close your abdomen ?

Hanna, now with an expression of gratitude in her eyes, nodded in negative. When Dr Kalaivani pressed to know if the surgery should continue, Hanna nodded with a “Yes” ..

Doctors were relived that it was a patient choice whether pathology indicated it or not.

Dr Sameera: Dr Kalaivani Ma’am and Dr Santosh Kaur Ma;am.. If there is no pathology and our patient wants to get the uterus and ovaries removed, is it possible that we may harvest them and use as transplant in our other transgeneder patients who may want to have children.

Dr Kalaivani and Dr Kaur were livid. That’s a very interesting idea. But we have never done uterus transplant in this hospital said Dr Kaur.

It has been successfully done in Europe remarked Dr Kalaivani.

I see , said Dr Kaur. Do we want to harvest her organs than. Do we have transplant facility to store them.

Dr Leela.. My sister Dr Anjali is a transplant surgeon and works with the medical college. I can ask her if she can help, which she will most likely.

Dr Kaur .. Is that so ? Thats nice . In that case lets consider harvesting her uterus , ovaries and fallopian tubes. But that will extend this surgery by another 3 hours. Are your folks in for this ?

Kalaivani , nodded “Sure “ . Dr Leela was already in by her proposal. Dr Hanamshet also nodded her consent.

Dr Kaur to Dr Hanamshet : “Dr Hanamshet, whats your opinion?”

Dr Pradnya Hanamshet - “Sure , patient is so far doing good. All vitals look okay.. And for whatever reason we started epidural, that will come handy now. She is now bit exhausted but I think I can give her necessary dips to build some stamina”.. I am all excited and increasing her epidural to last for another 3.5 hours. Saying this she injected something in the IV that was running epidural and adjusted its flow. She went by and auscultated Hanna;s chest again at multiple points to check for heart stability.

Dr Kaur, spoke to Dr Leela.. … “Dr Leela , you been examining her chest - heart and lungs all along” Do you think she will endure this ?

Dr Leela,. “Of Course… Hanna has been good patient. Though I do see patterns of tachy cardia sometimes , she has been steady.. Very rate to have a patient like this .. We can proceed to transplant”.

Dr Pradnya , “Do we want to Sedate her now ?”

Dr Leela - “No , Not for now. Lets see if she gets too exhausted “

Dr Hanamshet : “Okay , Sure Doctor”

Dr Kalaivani - Since this is going on for another 3 to 4 hours, do you want something to drink .. I am already feeling hungry and tired.

Dr Kaur, Sure, We will disinfect her abdomen and then take a short 5 minute break before we come back and harvest her uterus , ovaries and fallopian tubes. Saying this Dr Kaur asked for Suction, which was provided to Dr Sameera by Jessy. Dr Kaur poured antiseptic liquid in the abdominal cavity and Dr Sameera sucked it out.

Okay Hanna and Ramesh, We will be back in 5 minutes, remarked Dr Kaur.

Girls, “What do you want to have in the break”.. Jessy , What do we have in stock ?“ asked Dr Kalaivani.

Ma’am , we have tetra packs of Lassi in the fridge and we also have fresh milk. A bit away from the OT , but at a viewable distance, nurses arranged 4 rotating stools for Doctors to sit down and relax. I will have Lassi , remarked Dr Kaur. Me too, said Dr Kalaivani. Maybe get Lassi for every one who remarked “Dr Leela”.. Dr Sameera said, “ I will have warm fresh milk instead” Jessy went out and brought 6 glasses of Lassi and 1 glass of warm milk. Dr Leela, Dr Pradnya picked up their own glass, lowered their face mask and sipped lassi. Sameera had her warm milk leaning by the wall since she had no chair. Jessy helped Dr Kaur with her lassi since she could not be touching anything for sterile field reasons. Similarly Dr Kalivani was helped by Sudha. After this nurses had their Lassi on their own.

Ramesh who was viewing the surgery from the feet side of Hanna , went to the head side. Hanna was lying brave with a glitter in her eyes for having fulfilled her dream. She was strapped to an exam table with all monitors hooked up and her abdominal cavity was fully open and exposed by the retractors. Her omentum had already been removed and she was lying there with one less organ than 5 hours before when it all began. Ramesh felt a surge of emotions which he could not nail down for what they were. He avoided going too close to Hanna for a feat or contaminating something. Hanna had come to terms and even if she was in these conditions the IV fluids were keeping her hydrated and warm. The anesthesia was keeping her numb and feeling no pain. Ramesh went to the head end of the table and kissed Hanna affectionately on her forehead and cheek . Tears flowed from his eyes, admiring Hanna’s bravery . He had a side thought if all this was worth it, but Hanna was probably more convinced. Deepest regions of her mind had been touched.

Dr Kaur, Dr Kalaivani reached the OT first and took up their positions. They were moved to see Ramesh kissing Hanna on the forehead and shedding tears. It was an emotionally charged atmosphere.

Ramesh, We are about to begin again now. Please get back to your position. Ramesh patted Hanna on the cheek and left to stand at the base of the OT table. Tears had flowed from Hanna’e eyes too.

Dr Leela returned. She took a cotton swap and wiped the tears off Hanna’s face. She kissed Hanna on her forehead and called her “Brave Girl”

Dr Pradnya also returned, the nurses Jesse and Sudha also returned to their respective places.

Where is our milk Girl Dr Sameera ? asked Dr Leela..

By the time Dr Sameera came and took her position..

Our milk girl has come , Lets begin, remarked Dr Kaur.

The surgery began again .

Hanna, conscious but numb from the waist down, could hear the sounds of the surgical instruments and the soft conversations between the doctors. Her heart raced, but the presence of Ramesh by her side and the professionalism of the medical team provided a sense of reassurance.

Dr. Pradnya Hanamshet, the anesthesiologist, closely monitored Hanna's vital signs. She adjusted the flow of epidural anesthesia through the flexible cannula, ensuring Hanna remained comfortable and pain-free. Dr. Pradnya's calm demeanor and reassuring presence were a steady anchor for Hanna throughout the procedure.

Dr. Leela Pundit, the general physician, observed the complex surgery with keen interest. She occasionally listened to Hanna's heart and lungs, her stethoscope moving with practiced precision. Dr. Pundit's ongoing research on conscious patients during complex surgeries added an extra layer of depth to her observations. She noted Hanna's anxiety levels, offering words of encouragement and support.

Dr. Sameera Reddy, the young resident, watched in awe as the surgery progressed. Her eyes followed every movement of Dr. Kaur and Dr. Kalaivani, her hands ready to assist when needed. The gravity of the situation was not lost on her, and she felt a profound sense of responsibility and dedication.

Ramesh stood nearby, his heart heavy with concern and admiration. He watched as the skilled hands of the doctors worked on his friend. His eyes sometimes touched Hanna's face, offering silent support and unwavering love.

Now Dr Kalaivani took the lead. She exchanged the position with Dr Kaur , who was now assisting Dr Kalaivani. Dr Kalaivani started by examining all the structures by feeling them with her fingers inside the abdominal cavity. Having identified the uterus, fallopian tubes and ovaries, she proceeded with separating and ligating the connecting uterine arteries and veins. She clamped them with surgical clips and then tied them in place with sutures. She then carefully detached the attached round ligaments, broad ligaments, and uterosacral ligaments by cutting them and tying them to prevent bleeding.

Dr Kalaivani then proceeded to carefully dissect the bladder from the lower part of uterus (Cervix) and upper part of Vagina to separate it from the uterus. After this Dr Kalaivani proceeded to detach the uterus by making an incision on the upper part of Vagina and taking out the uterus.

By this time a cold box was arranged by Jessy to hold the organs for transplant. The uterus was cleaned with disinfectant and carefully placed in the box.

Dr Kalaivani and Dr Kaur checked for any bleeding and ensured that all blood vessels are properly ligated.They thoroughly inspected the pelvic area to ensure there is no bleeding and that all tissues are healthy and intact. Hemostasis (stopping of bleeding) is achieved using cautery, sutures, or surgical clips as needed.

After this Dr Kaur and Dr Kalaivani again exchanged their positions, with Dr Kaur taking the lead to harvest the ovaries and fallopian tubes. These were harvested from Hanna together.

The fallopian tubes are attached to the uterus at the cornua (upper corners). Dr Kalivani had already systematically detached each fallopian tube from the uterus by cutting and tying them off to ensure they did not bleed. Dr Kaur proceeded to detach The fallopian tubes from the mesosalpinx (the part of the broad ligament that supports the tubes).

The ovaries are attached to the uterus by the ovarian ligaments and to the pelvic sidewall by the suspensory ligaments (infundibulopelvic ligaments). Dr Kaur carefully detached each ovary from the ovarian ligaments and suspensory ligaments by cutting and tying them off. This step requires precision to avoid damaging nearby structures, such as the ureters (tubes that carry urine from the kidneys to the bladder).

Once the ovaries and fallopian tubes were fully detached, Dr Kaur proceeded to carefully remove them from the abdominal cavity and save them in the cold box prepared by Jessy.

After harvesting both Ovaries and fallopian tubes, Dr Kaur thoroughly inspected the pelvic area to ensure there is no bleeding and that all tissues are healthy and intact and proceeded to achieve Hemostasis

The hours passed with a blend of intense concentration and coordinated teamwork. Each member of the surgical team played their part with precision and dedication. The room was filled with a sense of purpose, a shared mission to save a life, which in fact in the middle turned into a work that provided impetus to transplant research.

As the surgery neared its conclusion, the tension in the room began to ease. The omentum had been successfully removed, and the affected organs were carefully inspected. Uterus, Fallopian tubes and Ovaries were harvested for transplant carefully. Dr. Kaur and Dr. Kalaivani worked in harmony, their expertise shining through every action.

Hanna felt a sense of relief and exhaustion. She had been conscious throughout the eight -hour surgery, her mind a whirlwind of emotions. The support and help from Ramesh and the agreement with the medical team had carried her through and fulfilled one of her wildest fantasies. She was still unaware of the pain she will need to endure in the coming time as anesthesia wears off.

"We're ready to close," Dr. Kaur announced, her voice filled with quiet determination.

The long cut, extending from the base of Hanna's sternum to pubic bone, required careful and precise suturing. The team worked methodically, layer by layer, ensuring the wound was closed securely.

The final steps of the surgery were completed with the same meticulous care. The incision was closed, and the layers of tissue were carefully stitched back together. The peritoneum, the thin membrane lining the abdominal cavity, was closed with a continuous running suture to ensure it is securely sealed. Dr Kalaivani did this suturing.

The fascia, a tough layer of connective tissue that supports the abdominal muscles, was closed with strong, absorbable sutures. The sutures were placed in an continuous fashion to securely approximate the edges of the fascia.Ensuring a tight closure of the fascia is crucial for providing strength to the abdominal wall and preventing hernias. This was sutured by Dr Kaur. Dr Kaur continued to suture the rectus abdominis muscle. The rectus abdominis muscles may be approximated if they were separated during the surgery.This step was done with absorbable sutures to bring the muscle layers back together. The subcutaneous tissue, or fatty layer beneath the skin, is closed with absorbable sutures in a continuous fashion by Dr Kalaivani. This step helps to eliminate any dead space and reduce the risk of fluid accumulation (seroma). Dr Kalaivani then closed the skin non-absorbable sutures, which were to be removed after the wound has healed. The area was again cleaned with betadine and saline, revealing the clean, closed sutured wound.

Dr Kaur, herself, proceeded to apply a sterile dressing, to the closed incision to protect it from infection and provide a clean environment for healing. This included gauze pads, adhesive bandages, or other sterile coverings.

Dr. Kaur stepped back, her face a mixture of satisfaction and exhaustion. "We've done it," she said, her voice filled with quiet pride.

The room was filled with a sense of accomplishment. The medical team had worked together seamlessly, their collective efforts fulfilling what Hanna asked for.

Ramesh leaned in, his eyes filled with love and gratitude. "You're amazing, Hanna. I'm so proud of you."

Hanna managed a weak smile, her heart swelling with emotion. She knew that the journey was far from over, but with the support of her loved ones and the dedication of the medical team, she felt ready to face whatever lay ahead.