Naturally, then, I wasn't looking forward to this gastrectomy with Hercules, whom I could see inside working away as I scrubbed. I hoped he hadn't read any more current literature. A resident named O'Toole was there, too, but no intern was in evidence. As I backed in, surrendering, I could tell the atmosphere was anything but congenial.
"I want a decent clamp," yelled Hercules to the scrub nurse as he threw one over his shoulder against the white tile wall. "Peters, get the hell in here. How is a man supposed to do surgery without any help?" Some of these surgeons took a bit of getting used to. Much of the time they behaved like petulant children, especially when it came to the instruments, which they tended to throw around rather indiscriminately and to use in unexpected ways — such as cutting wire with dissecting scissors. Yet the next time they were handed one of these instruments that they might have damaged themselves, they'd stomp and rage, blaming all their recent bungles on a lack of proper equipment. No one ever said anything about these outbursts. You got used to them after a while.
As I moved in next to Hercules, he clamped my hands around a couple of retractors and said to lift up, not pull back. A familiar line. Actually, I was able to fake it, because there was nothing to retract at the moment. The stomach, which Hercules was working on, sat right on top of the incision in full view. He would need retraction later, while making the connection between the stomach pouch and the beginning of the intestine called the duodenum. I fervently hoped he had already cut the nerves to the stomach that are partially responsible for the secretion of acid. Those vagus nerves wind around the esophagus, and in order for the surgeon to cut them the intern has to hold up the rib cage; I hated that retraction.
Here I was again at my post in the OR watching a minute hand that appeared to be glued in place. As I fought to stay awake, my eyes blurred after each yawn, and my nose itched uncontrollably on the left side, a little below my eye, as if I were being attacked by a subtle, sadistic insect.
The position of my mask was another subtle torture. Each time I yawned it moved a little down my nose, perhaps half an inch. After five yawns it fell completely off my nose and was just covering my mouth. This called into play the circulating nurse. She hopped around to my side and lifted the mask up, touching it ever so carefully to avoid my skin, almost as if my whole face were infectious. Wishing to relieve the itch, I tried several times to push my nose against her hand as she adjusted the mask. But she was too quick for me, and pulled away each time before hand and nose could meet.
Hercules was even more nervous and erratic than usual. None of us around the table could anticipate what his next move might be. Fortunately I was immobilized by the retractors and not expected to contribute otherwise, but poor O’Toole was like a rat in an uncharted maze being called upon to perform impossible feats of anticipation.
"O’Toole, are you with me or against me? Hold that still!” While delivering this rhetorical question, Hercules gave O’Toole's left hand a sharp swat with the Mayo scissors. O’Toole gritted his teeth and adjusted his grip on the stomach.
“For Christ's sake, Peters, haven't you learned how to retract?" He grabbed my wrist for about the sixth time to readjust the retractors, even though retracting had nothing to do with what was going on at the moment. In fact, I wasn't needed; yet he wanted me there. He was like a lot of surgeons, who felt slighted if they weren't assisted by both a resident and an intern, regardless of need. I was a status symbol.
Hercules had rotated in front of me so that I was staring at his back as he began putting in the second layer of sutures on the stomach pouch. I could see neither the operative field nor my own hands.
The anesthesiologist spoke up rather suddenly. "Peters, please don't lean on the patient's chest. You're compromising his ventilation." He pushed my lower back through the ether screen to keep me from crowding the intravenous line. But I had no place to go, being already mashed up against Hercules.
Just then O’Toole stepped abruptly back with a startled expression on his face, holding up his right hand. I could see a few drops of blood dripping out of a neat slice through the rubber glove into the side of his index finger.
"If you had your finger where it was supposed to be it wouldn't have happened, O’Toole. Let’s wake up," boomed Hercules.
O’Toole said nothing as he turned to the scrub nurse, who slipped on another glove. I guess he was thankful to be still in possession of the finger.
Despite all, the surgeon somehow finished, and we began to close. One of my jobs was to irrigate with the bulb syringe after the strong, fibrous fascial layer of the abdominal wall had been closed with silk sutures about a quarter of an inch apart. O’Toole and I were feeling frisky by then, and as Hercules was rinsing his hand I raised the syringe up over the wound, over the patient, and shot a stream of warm saline across the table, hitting O'Toole in the gut. Our eyes met in understanding; we were partners in an unhappy situation.
Rejoining us at the table, Hercules turned suddenly jovial. Obviously, he thought he had accomplished the impossible once again. "If s too bad that my art gets covered up under the skin instead of being visible to the patient. All he has to show is this little incision." O'Toole's eyes rolled up into his head in mock dismay.
Since both O'Toole and Hercules were on hand to finish up, I marshaled my courage for the exit. "I have several other operations coming up, Doctor. Will you excuse me, please?" That irritated the old boy a little, but he waved me free with a gesture of noblesse oblige.
First I scratched my nose, long and hard, a sensual experience. Then I urinated, which was equally satisfying. It was eleven-twenty-five, and since the nephrectomy patient was just coming out of Room 10, I had a few minutes while it was being made ready for the first of my cholecystectomies. Nearby, at the door of the recovery room, I saw Karen, my angel of mercy and sex, pristine in her white uniform. She had come to take a patient down to the ward, and when she saw me she smiled broadly, asking with a trace of sarcasm if I had slept well last night. I told her to be pleasant or one of these nights I would roll her out of bed. Glancing around, she shushed me, adding that she had told her boyfriend she didn't want to go out that evening; she would be in, probably from eleven on, in case I was free. I filed the fact away, but I didn't think I'd be up to doing anything about it.
My aneurysm had been scheduled for his aortogram at eleven-fifteen, and I went down to see what was happening. Stepping into the fluoroscopy room, I saw that the chief resident was in the final preparations for the study. "You're ten minutes late, Peters. I could have used you to help get the catheter into the aortic bulb."
"And I would have been here, but I had to scrub for another case." I consciously withheld a "thanks to you."
"Well, here's the catheter position. Put on a lead-lined apron first. This fluoroscopy puts out a lot of radiation. Gotta protect the old gonads."
Following his advice, I took one of the heavy leaded aprons and put it on. By stepping behind him I could see the fluoro screen. As the lights went out, the fluoroscope came on automatically with a low resonant dick. Then image was extremely faint, as usual. In order to see a fluoroscopy well, you ought to adapt your eyes by wearing red goggles for thirty minutes or so beforehand. I couldn't tell very much about the aneurysm patient on the fluoro screen, because I hadn't had the chance to dark-adapt my eyes, but I could distinguish the heavy radiopaque stripe on the catheter.