A Thing of Beauty

Still so much a virgin (when it comes to medicine) I am currently discovering the most intimate parts of the human body--that of sinew, muscle and bone. I’ve met my match in the form of a cold steel blade held stealthily in a hand; in the quiet hallways during pre-rounds; while moving in the early dawn past walls holding signs that say: “Competence” and “calm” and “compassion.”

Aside from post op and pre op visits with patients, it is a quiet world in the operating room. Suction makes a soft whoosh in the background, machines monitor a patient’s vitals, a surgeon mutters as he or she contemplates the next move; the clicks of steel as one more instrument is picked up, put down. But, for each of us, this is a quiet space. Sure, we may talk about textbook anatomy, explore the abdomen a bit after a gall bladder removal, banter about cars, vacations, relationships, what we had for dinner, and make a comment or two when the bovie is working its way through a thyroid...but in each of us resides quiet anticipation, because what is happening before us is nothing short of surreal.

As early as 1850 surgeons were able to appreciate ether as a successfully inhaled anesthetic, and even before that, doctors would sometimes get patients good and drunk (among other things, cocaine was also used) to try and numb the effects and pain of surgery. Aside from sleep, surgery is our most vulnerable state. Once the last stitch is placed, there is a collective sigh in the room because what has happened has been years in the making—a disease, perhaps, dormant, for years. And we can fix it. Sometimes we can remove it. And yes, sometimes we can’t do nearly as much as we would like, but medicine heals. I think of the first doctors and assistants doing some of these procedures—open heart surgery, lobectomies, removing brain tumors—and how exhilarating and absolutely terrifying that must have been.

Leaving the OR yesterday, after a minor procedure (that looked pretty damn complicated to me) the scrub nurse clapped her hands when it was all said and done, all the equipment was accounted for, and the patient was being prepped for PACU (post-anesthetic care unit) and said, “TOB!” I asked her what it meant (thinking it was slang or a pneumonic for something I should know, or something I had learned but forgot, or, worse yet, something critical that would be on my board exam I’m hopefully taking this August) and she laughed at my curiously worried face and said, “That was an excellent procedure. A TOB. A Thing of Beauty!”

And through all four surgeries today, all of the TOBs, there was art and movement involving everyone in the OR, like a dance, regal with our hands to our chests or resting on the patient, we danced. And we had good surprises: An infection that cleaned up well, a tumor with excellent margins, and my last patient. After the last surgery, the circulating nurse (the one who makes sure everything is going well in the room) asked me to hold onto my patient’s arm to keep him from pulling at his tubing while he was coming out of anesthesia. I instinctively grabbed the man’s hand and held it instead. Like I would with a friend. Like a handshake. As he began to wake up, I was surprised to find him beginning to grip my hand--hard--then harder. When I told him he was doing okay, to take deep breaths and that he needed to let go of my hand so we could move him he said, “No! No. Don’t let go.” And I didn’t. And I won’t. Not even tomorrow when I’m walking the halls at 6am, an hour before everyone else because I want to not only impress the hell out of my preceptor and do a good job, but also because, even now, I wonder how he’s doing.

The beautiful thing about surgery that I never realized, never allowed myself to realize because I’ve always been so queasy with blood—is that it covers everything. As one of the surgeons told me today: “The great thing about surgery is you get a bit of internal medicine, infectious disease, cardiology, behavioral medicine, sometimes a bit of social work…and then, in the middle of all that you say, ‘Hey, today I think I’m going to do a little surgery and see if we can't help someone out.’”  

In the hustle and bustle of being in a hospital, with the machines and beeps and movement of patients and their families, I am learning to love the intensity of the OR, the focus and yes, even the quiet. As we work as a team. As I reach to hold all of the patient’s hands now as they begin to wake up. As another disease process is erupted and laid to rest, there is this reverie and this truth: This absolute and total thing of beauty.