Judith, a 53-year-old married woman had been referred by her GP to the hospital's surgical outpatient department in December 1991, where she gave a 15-year history of right upper quadrant pain. This pain had been fairly intermittent and she had felt able to cope with it, not least because she was caring for her two elderly parents who lived with her and her husband. She had been investigated in 1978 when a laparotomy had been performed; a left ovarian cyst was discovered and treated. However, the pain continued but, according to Judith, she was able to cope with it until 6 months ago, when it became constant in nature and was made worse on eating fatty food. Her GP had arranged an abdominal ultrasound scan in November 1991; this demonstrated a normal liver, pancreas and right kidney, but a shrunken gall bladder with echogenic calculi present. Judith was seen in the outpatient department by the consultant in February 1992, who explained her problem and offered her a laparoscopic cholecystectomy. Judith accepted and was listed to be admitted to the surgical unit in early March 1992.