unexpected finding

Overweight, heavy smoker, abdominal and pelvic adhesions, persistent complex but small ovarian cyst, unsuitable for open surgery, not yet had children, planning to remove cyst by laparoscopy but if too difficult then for removal of the whole ovary. She will still have one ovary left, fertility conserved.
 First on the list. Late start. Difficult access but safe entry. Uterus and both ovaries fixed deep in the pelvis by adhesions. Anaesthetist won't allow steep head down position due to poor oxygenation so bowel and abundant fat obscure access.
Eventually mobilise the uterus and affected ovary only to find, unforeseen, that the other ovary is much more enlarged. This was not detected by scans before the surgery. This means that at least one ovary must have successful removal of its enclosed cyst. I set out to remove the larger cyst, planning to remove the whole of the smaller ovary if successful in preserving the first one.
The ovary is laid open, draining an unpleasant milky fatty fluid and then a clump of hair, but the cyst capsule will not come free. It is thick, tough and densely adherent to the ovarian shell. Since the smaller ovary almost certainly contains the same type of cyst then at least one of them must be removed without also removing or irreversibly damaging the surrounding ovary. Slow progress is made while the anaesthetist repeatedly warns that the patient's  life is in jeopardy if the surgery continues much longer. If the procedure is abandoned incomplete then firstly there will be a large raw surface which will attract adhesions to the bowel but worse, the exposed inside of the cyst will continue to release its irritating contents into the pelvis and abdomen. I work feverishly under constant threat of  termination of the procedure. I cannot just stop and try again another day as the anaesthetist is unlikely to agree to further surgery and a half-completed operation will cause adhesions which will make any further procedure even more difficult and dangerous.
The instruments find the thick irregular cyst hard to grasp, repeatedly slipping off, constantly being replaced, but slowly the cyst is removed with the poor battered ovary saved. All I need to do is remove the other ovary with its cyst inside but the anaesthetist's patience has expired.I am forced to withdraw with the original cyst untouched after two and a half hours of frustrating surgery. Half of the remaining theatre list is cancelled and by the time it is finished (including removal of an ectopic pregnancy) it is time to start my afternoon clinic.
As I arrive for the clinic my secretary asks me if I can see a sick elderly lady who has come a great distance to see me on the wrong day by mistake.I can't say no so the clinic is an hour late before it has started. But surprisingly the day improves.
Despite the stressful beginning, all the afternoon patients are delightful. My feelings of persecution gradually fade.
 I remember that it is Friday. After the last consultation I pick up fish and chips on the way home.

 I have the weekend off.