27 NOV 2007 Twizzlers and jerky
It’s 0300 again, my usual time to write. Here I am, typing away, fueled on midnight snacks of Twizzlers and beef jerky. When my call night finished, one of the ICU crew wanted to observe surgery. It is always encouraging to see someone from one part of the hospital interested in what happens in the other parts. She takes care of severely injured postoperative patients every day and wanted to see what happens to her patients before they arrived in the ICU. We were operating again on the Iraqi policeman who had been injured in the IED attack. His first operation had been fast, designed to identify the organs hurt by the fragments, remove the injured portion of the colon without reconnecting it, then quickly got him to the ICU to be resuscitated. Today Surgical oncologist J. and I were closing his belly and giving him a colostomy so his colon could work.
The nurses taught our visitor how to scrub and got her gowned for surgery. As tired as I was from the call night, it was worth staying to see someone who was observing surgery for the first time. In her eyes, the internal organs were something mysterious and new. She remarked that the man’s insides looked so healthy and new. They didn’t seem to be affected very much by the shrapnel that had passed through his belly. The policeman was only 19-years-old. She was fascinated by the way everything seemed so orderly and calm within the sterile square cordoned off by the blue surgical drapes.
I couldn’t help but think of the first time I had been in surgery. I watched J. Alex Haller, a pediatric surgeon in Baltimore. It was my second day of medical school. When I told my advisor that I wanted to be a pediatric surgeon, he brought me right to Dr. Haller’s office. Dr. Haller happened to be heading to the operating room and asked me to come along. He was fixing a teenage boy’s chest. The boy had a condition where his chest was caved in from the front like a funnel. I watched in wonder as Dr. Haller broke down the deformed supports of his breastplate bit by bit and reconstructed it into a naturally rounded shape. I remember how warm the boy’s moving heart felt. Even though the shape of his ribs was deformed, it was amazing to see the way the muscle and fat was so perfectly and smoothly joined to the cartilage and bone. It was a wonder that in a world of such disorder, such an incredible machine could be formed. The boy did well. He was sore and bruised after surgery and stayed in the hospital about a week. He and his parents were so pleased with the new shape of his chest. As sore as he was, the boy smiled broadly and thanked Dr. Haller.
We surgeons do some violent things to the body. We push it to the limits of what it can take. No recess or corner is sacred. After injuries, we work frantically to stop bleeding and salvage destroyed tissue and form. Under our knives, the secret cavities of the chest and belly are laid open to the light, their mysteries exposed. We must work carefully, cutting this part, and sparing that one. We use scalpels, scissors and heat to divide and eliminate tissue, then use sutures, pins, and glue to reconstruct them. But in the end, all our meddling is worthless if the healing powers of the body are not there to continue the work after surgery. With tiny machines beyond our finest skill, the body works secretly to repair the insults of trauma and the surgeon. We merely start the process and then step back in the hopes that the extraordinary processes of the body can take over.
It doesn’t take witnessing this miracle through the wide eyes of a neophyte to remind me that I am privileged to walk in this temple. I am amazed every time I see a person’s eyes flutter open after surgery. It’s amazing what a body can do with air, water, Twizzlers, and jerky.