I spent many hours in the operating room contemplating the white and black clock mounted on the wall behind the anesthesiologist. Every operating room had one. Like a high school student, I kept waiting for the ten minutes before the hour, hoping that the bell would ring, hoping for the end of the day. But the damn bell would never ring, especially during the late night cases.
"Mick, where are you?" asked Cutter over the telephone.
"In the intensive care unit, dicking around with Mr. Pisser's heart catheter," I replied.
"Meet me in operating room seven, NOW! We're going to have fun. It's exciting. I have no clue what we're going to do to this man. I called the boss. He's pissed that he has to come in again. He hates belly cases. Better watch out for flying knives tonight."
"Shit. I hate these late night cases. I'm always uncomfortable with these unplanned and chaotic operations," I commented.
"What is life without chaos, Mick? We surgeons love chaos. We thrive on it. We like to be comfortable with the uncomfortable. Hurry, Mick. I'm already sharpening my knife."
Dr. Ungaman loved to operate. In the operating room he always felt at home. And he needed to operate everyday. He secretly confided in me one day that operating was like shaving for him. He needed to do it everyday in order to look good!
It was eleven in the evening and it was the second case of the night. The body on the table was an unfortunate fifty-seven year old man with a bone marrow related cancer that had spread everywhere in his body. Mr. Jacobs was at the end of his life, sick as any one can be. He presented to the emergency room with an obstruction of his intestine because of a belly full of tumors. The chief resident saw him first and eagerly recommended to the family an emergency operation. Without it, he counseled them, their loved one would die. The only option was to go ahead with it. With it, I thought to myself, his only option was robbing him of a peaceful death. He had lost fifty pounds over the last two months. The cancer had already spread to his brain. His respiration was irregular. In my eyes his only option was vitamin M: a compassionate drip of vitamin morphine, injected into his veins and adjusted to his comfort. But a desperate family, feeling a lot of guilt about letting their loved one die that night, signed their names on the dotted line. They gave us permission to torture as we pleased their loved one.
So here we were in the operating room, six people standing around the body of this dying man. For the anesthesiologist, it was another opportunity to sit, kick back and relax while reading the latest issue of Reader's Digest. For the attending surgeon, Dr. Willie Harshberg, it was another difficult case he would brag about the following morning. For the chief resident, it was another opportunity to do a lot of cutting. His zealous hands couldn't wait for a second to enter the belly of this dying patient. For me, the intern, it was another player joining the team of five others sitting in the intensive care unit. My role was to coach those patients overnight and keep them alive until the early morning hour. For Inger and Ron, it was that extra overtime pay they would enjoy before the holidays.
Although I was disgusted by the whole situation, I stood at the operating room table, shoulder to shoulder with Dr. Harshberg. I was ready to follow his orders and help as instructed.
Perched over the body, like a vulture preying on a dead cadaver, the chief resident shouted "KNIFE." Inger handed him his shiny and sharpened knife. In medical school we called it 'scalpel.' But surgeons never called it 'scalpel.' I suppose 'scalpel' is too nice of a word and too unorthodox in the arena of surgeons.
"CUTTING AT ELEVEN O FIVE," shouted Dr. Harshberg.
"Thank you, gentlemen," responded the anesthesiologist, Dr. Gastein. He verified the time, wrote it down in his chart, and went back to reading his magazine.
With much enthusiasm, Dr. Ungaman took the knife and sliced Mr. Jacobs' belly half open.
"This incision is way too small. What type of operation are we doing here?" asked a sarcastic Dr. Harshberg.
"An exploratory laparotomy, sir," answered Dr. Ungaman.
"Well said, son. This is an exploratory procedure of the belly. We don't know how far nor how deep we're going to cut this man. So we need to have that abdomen wide open. Increase your surgical exposure. You can compromise on love son, but you can't compromise on exposure in my operating room. Is that understood?"
"Yes, sir," answered an enchanted Cutter.
Without any questioning he applied the knife to the skin and extended his cut from just below the chest all the way down to the navel.
"Cautery to me, Inger. Let's burn the little bleeders." With that said, he fired away the bovie catheter and toasted all encountered small blood vessels in the belly. Inger, Dr. Harshberg's favorite scrub nurse, watched with great passion. Within a few minutes, the belly of Mr. Jacobs was wide open and his muscles pulled to each side of the table. A stream of yellowish fluid gushed out and splashed our sterile aprons.
"SUCK, RASTUS," yelled Dr. Harshberg. "Suck that fluid or we're going to drown in this pig's urine!" He firmly grabbed my hand and redirected the sucker I was holding. Countless yards of small intestines, eager to see the lights of the operating room theater for the first time ever, kept creeping out. He tried to push them back into the belly.
"I HATE THE SHITLANDS!" he finally exploded in disgust while referring to the intestines.
"This is a nasty looking belly," exclaimed Dr. Ungaman. He seemed surprised. "Look at all these ugly tumors. This man is fucked."
"Yes, he is," echoed Dr. Harshberg. "But not the way he would have liked to be fucked tonight." Cutter laughed.
No shit, I thought to myself. It didn't take a genius to figure that one out. An elementary school student could have made that assessment in the emergency room. The question was, how were we going to let him die? Were we going to slice and dice his insides, or did we have any sense of humanity left in us to close him up and let fate takes its course. But the options weren't even discussed.
"How are you going to resect and reconstruct his bowel?" asked Dr. Harshberg.
The chief resident paused to think, as if his thought process was going to make any difference. Dr. Harshberg kept both of his hands on the intestines and kept pushing them down. I was praying hard that he would call it off. Or maybe that someone would stand up for this dying man at that moment, and call it off. But who was it going to be? Cutter was too eager to cut. I was too chicken to speak up. Dr. Gastein was busy reading his Reader's Digest. The nurses were too taken by their Christmas shopping conversation. And Dr. Harshberg was absolutely disgusted by the shitlands.
My silence was a passive contributor to his cruel management.
"Don't fag on me, Rastus. You need to concentrate on what you're doing. Keep retracting that belly," cried Dr. Harshberg as he grabbed my right hand and pulled back.
I looked down on his belly. It was a mess. The scene was unbearable. I'm a physician and I took my medical oath which they took too. Remember first, do no harm. I kept repeating it in my mind. I should speak up. I must intervene at any cost.
"I'm a physician and I took my medical oath..." I started saying.
"I sure hope you did. Stop babbling, Rastus, and answer the circulating nurse," shouted Dr. Harshberg as he kicked my left foot.
Wrapped up in my own thoughts, I hadn't heard the telephone ring in the operating room. Nor had I heard the circulating nurse talk to me.
"The nurse in the intensive care unit is calling regarding Mr. Sullstein. Apparently he has been quite lethargic and unable to move his whole left side. What do you want her to do?"
Before I could answer her, Dr. Harshberg did.
"You're dreaming too much tonight. You're of no use to us right now. Scrub out Rastus, and go fix Mr. Sullstein."
|Chapter Two||Chapter Four|
Copyright © 1996 Maher Abbas, M.D. All rights reserved