Surgery: Baptism

"So you want to go into Surgery?" asked Dr. H, elbows deep in a patient's abdomen. We were standing in the OR at 7:30 on a Sunday morning, and I imagined the rest of the world still gently asleep in their beds, early sunlight filtering quietly in through the windowshades. I had already been awake for three hours, and was in the process of being awarded for my diligence with the first of three emergency operations of the day. I had visited my patients in their beds in the dark morning, listened to their concerns, and created their plans for the day's work of healing. I had stood in my place at the end of the queue as the ritual of morning rounds wound its way around the hospital. I had participated in the flurry of action as a trauma patient (alcohol, car collision, rollover) was rushed to the OR, STAT! Changed into my green scrubs, I stood, flummoxed and breathless, as the attending and senior resident performed the magic of swashbuckling into a man's abdomen in a matter of minutes, a process that they called "controlled chaos," to get to the secret inside: a lacerated spleen that was rapidly hemorrhaging his life away.

Within minutes, the comment "spleen out" was followed by a maroon object which emerged from the depths of the abdomen to attend its own open-casket viewing in a blue, kidney-shaped basin. What a sad remnant of man's body, separated from him forever! The spleen had been slashed liberally across the face by the patient's own traitorous 10th, 11th, and 12th ribs, set free by fractures to wreak their havoc inside his abdomen.

"Get up here." Flustered, I moved my hands to where Dr. H was investigating loops of small bowel for injury.

"No, take my place. Now follow Paul as he works the bowel. Get your hands in there! You're responsible if he misses something!" Dr. H stepped away as I touched the bowel gingerly, several inches behind Paul, who was nonchalantly proceeding along the intestinal tract, smoothing, feeling, inspecting for signs of trauma.

"You move along, checking every inch of the bowel for damage; that's a standard procedure for trauma. You see where the bowel changes caliber here?" Indeed, the bowel changed perceptibly but indescribably at the point Paul was indicating to me. No amount of description in an anatomy textbook had ever revealed that secret to me so openly as this patient's body. "That's where the jejunum becomes ileum." We continued in this fashion for a time, companionably.

"You're still missing something," said Dr. H from the corner. He moved closer to me. Thrusting his hand into the bloody abdomen, he soaked my left hand and arm with the ooze.

"So you want to go into Surgery? There. Now, you're baptized."