Filler

Research samples are hard to obtain these days

I was a clinical research fellow coming to the end of my three year research programme on the aetiology of hepatobiliary cancers. One of my final studies was to analyse bile, collected via endoscopic retrograde cholangiopancreatography, with magnetic resonance spectroscopy to look for differences between patients with cancer and those without.

The initial spectroscopy readings were promising, with various bizarre, never previously seen peaks proudly announcing themselves. My initial excitement that I was on the verge of discovering the cause of biliary cancer was soon cut short, however, on realising that these peaks were probably due to the contrast agent used during cholangiopancreatography. Time was running outI had to submit my thesis within a few months and still had other lab work to complete. What I needed, and quickly, was a fresh, contrast-free bile sample. But from where?

I was pondering on how I could acquire such a sample on the train home. My heart was beginning to sink, thinking of the months it would take to get ethical committee approval for collecting surgical or postmortem bile specimens, when I started to develop a pain in my back. By the time I got home, the pain had moved to the front of the abdomen. I decided to ignore it, putting it down to a particularly hard game of indoor football the previous day, and thought I would cheer myself up with a large curry. This was not a good idea. An hour later, I was curled up on the floor with an intense, colicky right upper quadrant pain, and (having examined my own abdomen) a classic Murphy's sign. Despite my assurances that it was probably nothing, my wife sensibly arranged to have me taken to hospital. There, first the on-call medical registrar (also a gastroenterologist) and then the surgical registrar diagnosed cholecystitis, and I was admitted.

I found it hard to believe that I was an inpatient with cholecystitis, even when an ultrasound scan the next day confirmed an inflamed gall bladder full of stones. Fortunately, it was not septic or obstructed, and a week later I underwent a laparoscopic cholecystectomy. Before the operation, I had mentioned my research in passing to the team looking after me. They found the situation hilarious, but I was not amused. However, when I awoke after the operation, I was glad that I had mentioned it, for I found two specimen pots by my side. One contained my gallstones, and the other 30 ml of my own bile.

It was a surreal and painful experience but not without advantages. I have increased empathy with patients, particularly those in acute pain, and with their desire for quick analgesia and treatment. I also understand how tests that are relatively trivial to the treating doctors on a Friday night may seem of monumental importance to patientsin my case a fasting lipid profile. And, finally, I had obtained the fresh, unadulterated, contrast-free bile sample I needed so urgently.

Shahid A Khan, specialist registrar in gastroenterology. 

Divisions of Medicine and Imaging Sciences, Faculty of Medicine, Imperial College, London

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