"Do you like to surf?" I asked, as we arrived at the door to the men's ward.
"I don't know how," she said softly.
"Do you live close to the hospital?"
"No, I live in Manoa Valley with my parents." That was unfortunate. I wanted to hear her talk, but we were nearing Roso's room.
"Has Roso been vomiting?"
"No, not at all, just hiccuping. I never thought hiccuping could be so bad. He's miserable."
Glancing at my watch before stepping into the ward, I saw it was going on midnight. Even so, I didn't mind seeing Roso. In many ways he was my favorite patient. Small night lights near the floor gave off a suffused glow that seemed to mix with the even sounds of breathing and snoring. Suddenly a sharp hiccup pierced the tranquility, and the snoring went out of phase. I could have found Roso in inky blackness by those hiccups. We had operated on him my second morning as an intern. Actually, "we" is not quite accurate: the chief resident and a second-year resident had done the operating while I stood and held the retractors for three hours. I was the first to admit my ineptitude in the operating room; and the way things were going, my ignorance was secure. Unlike a lot of medical students, who as a rule are eager for surgery, I was short on operating-room experience, mostly because I hadn't wanted it, but also because I had been more interested in the electrolytes and the fluid problems after the operation. This had suited everybody. The other med students didn't dig the chemistry, while I had trouble bringing myself to stand for six hours in the OR watching other people cut and sew. Especially after the scene that took place the second time I had "scrubbed" back in New York.
It was to be a cancer operation, a complete breast removal, or radical mastectomy, as it is called, by the Big Cheese, the World-famous Surgeon himself. Being only a second-year medical student at the time, I had had a lot of misgivings about it, and the fact that everybody seemed a little tense, even the residents, had added to my anxiety. Suddenly the Big Cheese had come striding into the operating room, regally splendid and late as usual. He had fingered a few instruments in the big sterilizer tray, picked the whole thing up, and crashed it to the floor, swearing that they were scratched and bent and totally unacceptable. The noise had scared the anesthesiologist so much that he jumped and knocked the mask right off the patient. I had disappeared, hoping I wouldn't be missed, which was indeed the case.
Eventually, of course, I began to stay through some operations, start to finish, but I have not to this day figured surgeons out. Another of them back there was such a quiet, pleasant fellow until he was in the operating room, where I once saw him hurl a clamp at the resident anesthesiologist because the patient moved. On another occasion, the same man ordered one of the surgical residents out of the OR, claiming he was breathing too heavily. At any rate, so far there hadn't been much incentive for me to spend time in the operating room, and I was pretty green at surgery when my internship started.
Despite my inexperience, I knew the scrub routine, how to wash my hands, holding them just so, how to dry them, and how to put on the gown and gloves; I could even tie a few surgical knots. This had been learned pretty much by trial and error. My first scrub, in third-year med school, had been for a suture job in the emergency-room OR. I had spent the usual ten minutes scrubbing my hands and forearms, and had cleaned my nails with an orange stick before awkwardly donning the gown. I had on the baggy pants, the hat, the mask, the whole works, and the nurse had finally helped me with the rubber gloves. After twenty-five minutes of concentrated effort, at last I was ready to go; my hands were as sterile as a moon rock. Then I had casually picked up a stool and walked over to the patient, thereby contaminating my hands, my gown, everything. The nurse and the resident had laughed hysterically; even the bewildered patient had joined in as I started over from the beginning.
In Roso's case, even from my limited vantage point behind the retractors, I had known that nothing about his ulcer operation was going smoothly. The chief resident kept cursing the poor protoplasm, and I had to agree that Roso's tissue bled easily. Some heavy bleeding started near the pancreas at the bottom of the hole, but the two of them managed to complete the Billroth I, which meant hooking up the stomach and intestine just about the same as they had been before the operation, although minus the ulcer. Then I was supposed to put in Roso's skin sutures. It was no big deal to anyone except me; for me it was everything. I thought about asking one of the residents to put his finger on my first throw of the knot, like tying a Christmas present. It seemed a funny thought for about a second.
Actually, for a procedure so simple, tying that knot had been aggravating as hell. Sutures are often very narrow and difficult to feel through rubber gloves, especially at the tips, where the rubber is thickest and where you need the most sensitivity. I knew I had to tie the knot so that the edges of the wound came together, just kissing, without tension and without causing the skin to roll under. I also felt everyone watching me, judging. Although I knew a lot of things, nothing mattered then except that knot, because the knot is the thing without which an operation falls apart quite literally.
The end of the black silk in my right hand disappeared in the skin on one side of the wound and emerged on the other. I brought it together with the other end of the silk strand, in my left hand, and laid the first throw, tightening it until the edges touched lightly. Now for the next throw. But as soon as I let up on the tension, the wound popped open. I pulled it together again and put down the other throw as fast as I could, hoping somehow to beat the dehiscence — that gapping. The pitiful result left the edges of the wound dangerously far apart. Then, to my dismay, a hand reached out with scissors and cut the knot while partially suppressed giggles bubbled in the background.
Another hand began the suture again, dipping the curved needle easily under the skin to span the incision and come out the other side. I looked up in supplication to heaven; what good was I here when I couldn't even tie a knot?
I had gotten another chance on Roso's second row of stitches, which went in the opposite direction. By the time the second throw went down, the suture was so tight that the skin was bunched up in little ripples and the edges were rolled under from the tension. Out came the scissors again, courtesy of the second-year resident who had snipped through my first knot, and the wound separated with relief. It looked so easy and rhythmical when someone else did it. I had detected a trick here and there, though, a twist after the first throw, for instance. Instead of leaving the suture flat on the first throw, you pulled it back, both strings toward you. But that was only half of it. I tried again, with a little better result, although it was still too tight. At least Roso had been finished, for the time being.
The first suggestion of trouble was the hiccups, which had started about three days after the operation. Coming regularly every eighteen seconds, they were amusing at first. In fact, Roso became a hospital curiosity with his funny, clockwork hiccups. He was only fifty-five, but years in the pineapple fields made him look much older, all stooped and skinny; his pants kept falling off as he plodded through the ward pushing his IV stand. He, too, had run out of arm veins for his IV's and, like Marsha, had a catheter in his right groin. This caused even more trouble. If he tightened the drawstring enough to keep his pants on, his IV stopped. So he had to walk with one hand on the IV pole, the other holding up his pants.
Roso was Filipino, and his English vocabulary was limited to fifty or sixty trenchant words, which he used to convey emotional concepts. "Body no more strong," he would say, and it sufficed, like haiku poetry. I understood him and liked him very much. There was something tremendously noble and courageous about the man. Moreover, I think he liked me, which I realized later was an important part of my effort to keep him alive. When he saw me on morning rounds, Roso would smile broadly despite his hiccups, which made his whole body jump. Anyone could see that he was exhausted. I had tried every remedy I could find in surgical, medical, and pharmacological books, even folk medicine — breathing into a paper bag did not help him. In a more scientific vein, I had had him inhale a jug of 5-per-cent carbon dioxide, with no effect. Amyl nitrite and small doses of Thorazine hadn't worked, either, nor had calcium, which I tried in an attempt to correlate the hiccups with his general hypernervous state; his reflexes were so brisk that when I hit below his knee with my rubber hammer he'd flip his slipper off. My big mistake all along was in not considering the hiccups as symptoms of something deeper. I kept seeing them as an isolated problem, when in sad fact they were just a side effect of the smoldering catastrophe inside.