The surgeon

by Wilfred Charles Heinz

  "Will you pump the table up just a little, Doctor?" he said to Darrow.

  "Yes, sir. Is that enough?"

  "That's enough," he said, "but now we can see where this team didn't do its job."

  "Sir?" Bronson said.

  "The patient is too far down the table. You can see, that when I drop this head rest, her head won't fall back. What we're trying to do is essentially what the sword swallowers have done for years—line up the upper teeth, the throat, and the stomach. Let's slide her up about four inches."

  "Just a minute, Doctor," Jasperson said, walking around behind him to check the intravenous needle in Mrs. Brower's outstretched arm.

  She should remember how to position, he was thinking, while Bronson and Darrow moved Mrs. Brower up the table and toward him. She should never forget it since we had to move that fat woman about a month ago.

  "That's fine," he said. "Are you ready to oxygenate her?"

  'Yes, sir," Jasperson said.

  "Watch out for her teeth," he said, winking at Bronson. "Her husband is a lawyer."

  She fitted the black cone over Mrs. Brower's nose and mouth, and held it there with her left hand. With her right hand she started to squeeze the black pressure bag that would force the oxygen into Mrs. Brower's lungs.

  "About a month ago," he said, "we had a 375-pound woman who swallowed the screw top off a salt shaker, and don't ask me how. Anyway, they positioned her too low on the table and, once she was anesthetized, it almost took a block and tackle to move her. You remember that one, Miss Jasperson?"

  "I'll never forget her," she said, squeezing the pressure bag.

  She'll never forget her, he thought. She'll never forget her, but she still lets them position the patient too far down the table.

  When the nurse handed him the tubular bronchoscope he held it up to one eye and looked down through it. He could see no light at the lower end, so he turned it over and adjusted the voltage regulator at the top, and then saw that the bulb, the size of the head of a wooden kitchen match, was burned out and blackened.

  "This bulb is dead," he said, handing it back to the nurse.

  "It was working a second ago."

  "You may have had the current up too high. That's when they burn out."

  "It was working a second ago," the nurse said.

  "You've got some other light carriers there. Let's get one in."

  "Yes, sir."

  "Now that everybody on this team seems to be missing his cues," he said, "who knows what I'm doing wrong?"

  "You?" Branson said.

  "That's right."

  "I don't know."

  "Dr. Darrow?"

  "I don't know, sir."

  "I'm not wearing my bronchoscopy shield," he said, meaning the circular, clear plastic disc that protects the face. "The fact that, for twenty years, I have preferred to pick sputum out of my eye when the patient coughs back at me, and just because I haven't contracted tuberculosis doesn't make it right."

  "She's ready, Doctor," Jasperson said, meaning that there was now enough oxygen in Mrs. Brower's lungs to supply her blood during the fifty seconds or so it would take him to get the bronchoscope into the trachea, which is the windpipe.

  "Thank you," he said. "If I had accustomed myself to the screen at a young age, as I should have, I wouldn't find it a nuisance now when it fogs up, and I'd use it."

  He dropped the head rest and let the head down. The nurse handed him the bronchoscope, and he turned it over and saw the lighted bulb.

  He had the bronchoscope in his right hand, and with the fingers of his left hand he pulled the upper teeth toward him while holding the lower teeth away with his thumb. He placed the bottom end of the bronchoscope on the back of the tongue and, flattening the tongue on the floor of the mouth, he looked for the epiglottis, the hinged, erect cartilage at the root of the tongue that closes and protects the windpipe during swallowing. It looks like a shoe horn and hides the vocal cords, and now he lifted the edge of it with the end of the bronchoscope and slipped beneath it and, seeing the two vocal cords in the larynx, he went between them and was in the trachea.

  As he leaned back on the stool, straightening his back, Jasperson connected the oxygen tubing to the small right-angle connector arm on the side of the bronchoscope. Then she turned on the chest respirator, and it began its breathing, in and out evenly, for Mrs. Brower.

  "Good," he said.

  Looking down through the top end of the bronchoscope now he saw that the trachea, pink-lined and with its cartilage rings, was clear. He moved the scope down to the bifurcation, the point where the trachea divides into the two large bronchi, one of each lung. He advanced the instrument carefully, moving it always not only by sight and feel but also by sound. As Mrs. Brewer's breath brushed the end of the scope the sound was faint but like that made by blowing over the open neck of a bottle, and he had many times bronchoscoped just by feel and sound so that a student or intern could look through the upper end as he slowly maneuvered the bronchoscope downward.

  "Right upper lobe negative," he said, using the long optical telescope with the right angle lens to look backward and upward at the three subdivisions of the upper lobe bronchus. Then he removed the telescope and, using just the bronchoscope tube, he could see the two divisions of the middle lobe and the five in the lower lobe.

  "Nothing in the right lung," he said. He had withdrawn the bronchoscope back to the bottom of the trachea and was advancing into the left lung, to explore the three main subdivisions of its upper lobe.

  "Left upper lobe negative," he said. "We may draw a blank on this lady."

  He rotated the bronchoscope slightly as he altered the angle to enter the aperture of the lower lobe. As he did, he saw it lying there, in the circle of light.

  "I have an announcement to make," he said, still looking down the scope. "We've just struck gold."

  It's hamburger meat all right, he thought. It was about as big in circumference as a pencil eraser, but bleached and pale against the salmon-pink mucosa of the bronchial tube.

  "It's in the lower lobe orifice," he said, straightening up. "Who wants to see a piece of misdirected hamburger meat?"

  "I do," Bronson said, and he came around and sat down on the stool and put his right eye to the scope.

  "Dr. Darrow?"

  "Yes, sir," Darrow said. "I'd like to see it."

  "You can really see it, too," Bronson said, getting up to let Darrow look.

  "Let me have those soft biopsy forceps," he said to the nurse.

  "Sir?"

  "The flat, foreign-body forceps."

  "Yes, sir."

  "You see it?" he said to Darrow.

  "Yes, sir. Very clearly."

  The nurse handed him the long, slim-handled forceps with the almost flat spoons on the end and he sat down and slid them down into the bronchoscope. Then, looking down, he moved the ends carefully, maneuvering them until they extended beyond the bottom end of the scope and he had positioned them on either side of the piece of hamburger. Then he closed them on the meat, and withdrew the ends toward the mouth of the scope.

  "I've got it," he said, still looking down the scope, "and now I'll employ a little trick you might remember. I've withdrawn the hamburger almost into the scope but not quite. If you try to pull it in, you run the risk of it breaking into smaller pieces and of losing it, so you bring the scope, the forceps and the piece of meat all out together—like this."

  He brought the bronchoscope out then, the ends of the forceps still protruding from the bottom end. He handed it to the nurse and reached down and brought up the head rest and raised Mrs. Brower's head and snapped the rest into place. Then he stood up and straightened his back.

  "In the old days," he said, pulling off his gloves and tossing them on the table against the wall, "box suppers were in vogue, and we were always doing old women without teeth who could only gum their chicken. Now it's cook-outs and hamburger."

  He took off the gown and put it on the table, and then
the mask. He looked at the wall clock, and it was 10:21.

  "How's the patient?" he said.

  "Fine, Doctor," Jasperson said.

  "You look tired, Jim," he said to Bronson.

  "I am."

  "You're pale and your eyes are bloodshot and you can hardly keep them open and your voice is husky."

  "I've had about two and a half hours sleep in the last thirty-four."

  More than twenty years ago he had gone through it all himself, on for thirty-six hours and off twelve. At General they called it the House Officers' Quarters, and the phones were high on the wall so that you couldn't answer them from the bed and in your sleep. You'd have to get up, and when they'd wake you for an order, with not only the nurse but the night supervisor listening, they'd make you say it at least three times.

  "Give him a quarter of morphine," you'd say.

  "You said a quarter of morphine?" the nurse would say.

  "A quarter of morphine."

  "Then I'll write it down here," the nurse would say. "I'll write: 'Dr. Carter, a quarter of morphine.'"

  "That's correct."

  "You don't mean a sixth?"

  "I mean a quarter."

  "Thank you, Doctor."

  Hours later, getting up, you wouldn't know what day it was or, sometimes in the winter when it was dark, whether it was 6 o'clock in the morning or 6 o'clock at night. You would open the window and look out to check the number of people on the street, and when you went over and checked in again the order would be on the chart. It would be on the order sheet with your name, and it would be correct, and sometimes you would not remember the call or the order at all. At least, he was to realize when fatigued in years to come, you learn then that your actual sleep-need is surprisingly minimal, and just that assurance can be a psychological stimulant when you need it.

  "Why don't you knock off?" he said to Branson now.

  "I'd like to," Branson said, "but you've got Mr. Scheller to do now."

  "I think if you were to withdraw temporarily from this case," he said, smiling at Branson, "the patient would still have a good chance of survival."

  "I know," Branson said, smiling now. "I didn't mean that. I'm down to assist, and I want to assist every time I can, and besides, I'm fond of Mr. Scheller."

  "Look," he said. "Darrow here is off the medical service now and he was going to observe today anyway. I think he's scrubbed a few times, and would be happy to scrub in with me and the great Dr. Robert Robinson."

  "That's right," Darrow said. "I'd like to assist."

  "So hit the sack," he said to Bronson.

  "Well," Bronson said, "I will if you say so."

  "Good," he said. "How's our patient now?"

  "Excellent," Jasperson said.

  "Can you people get her back into bed if Dr. Darrow and I leave now?"

  "I'll give them a hand," Bronson said.

  "Thank you, everybody," he said, "and incidentally, save that piece of hamburger, I want it shown to this lady when she wakes up, but don't send it to Pathology. They might put it under the microscope and report a new disease."

  If Mr. Scheller works out the way I believe he will, he was thinking, walking out with Darrow following him, Bronson should see it. It's too bad he's knocked out, because Bronson is going to be one of the good ones and he should see it.

  10:24 A.M.

  XIII

  The elevator stopped at the second floor and the door opened. While two student nurses in their striped uniforms got on, and while the door was still open, he could hear a small child crying and, over it, the nasal, feminine voice on the page system.

  "Dr. Rand. Dr. Maurice Rand. Dr. Levitt. Dr. Julius. . ."

  When it stopped at the O.R. floor he got out, Darrow following him. Sarah Wheeler was standing halfway down the hall, talking with two maids. Her mask was hanging from her neck, and she was cleaning her glasses with it, and then she turned and walked toward him, putting her glasses on.

  "Hello, Bahamas," he said.

  "Hello, Bahamas yourself," she said.

  "Don't charm me any more," he said. "Just tell me when I can get in there."

  "In ten or fifteen minutes," she said. "Soon as we finish cleaning up."

  "Then Stan is finished?"

  "I'll say," she said.

  "Oh?" he said. "What's the matter?"

  "He lost his patient."

  "Damn," he said, feeling it suddenly, never having even seen the patient and knowing nothing about him except that he was a human being, but knowing Stan.

  "I know," she said.

  "What happened?"

  'Too much bleeding and then hypertension, I guess. A heart attack."

  "Where's Stan now?"

  "In the locker room, I think."

  "When you call for them to start my patient down, will you let me know?"

  "Sure. It'll be about fifteen minutes."

  "I'll tell you what you do," he said to Darrow. "Why don't you go in and see if there's anything you can do to help them set up the room. I'll see you in there."

  "Yes, sir."

  "Have you seen Rob lately?"

  "He's been up here a couple of times," she said. "I think he's down with your patient and his family."

  "I'll see you, Sal."

  "Sure."

  When he had first opened his own practice, they had given him one case a month to do at the Veterans' Hospital. It was on the first Tuesday of every month, and they paid him $25. Because it was the only $25 he could count on every month, he had promised himself that no matter how busy he might become he would always do that case. Now they held out their most difficult or most interesting case for him each month, and on the first Tuesday he still made the hour's drive out over the Memorial Bridge and did the case and drove back again and they still paid him $25.

  One first Tuesday he made the trip twice. He took out a right lung and left the comparatively simple, automatic, step-by-step closing to the staff surgeon named Halloran and the resident. He drove back over the bridge and when he got to Mercy there was a message to call Carrie McKeen.

  "What's up?" he said.

  "For John's sake, Matt," she said, "where have you been?"

  "I stopped off in New Orleans for the Mardi Gras."

  "Never mind that," she said. "Call Veterans'. They're in a panic over there."

  "What's their problem?"

  "Don't ask me. As near as I can make out, your patient has a hole in his pulmonary artery."

  He called Veterans' and got the O.R. supervisor. She told him to hold on and she put the circulating, or floating, nurse on the phone.

  "What's the trouble?" he said.

  "There's a hole in the right pulmonary artery," the float said.

  "What's Dr. Halloran doing?"

  "He's standing there with his finger in it."

  "Why doesn't he put a soft vascular clamp on it and tie it?"

  "He says he hasn't got room. He says it's receded, and every time he takes his finger out it hemorrhages again."

  "How's the patient doing?"

  "Fine."

  "Good," he said. "Tell Dr. Halloran to just stand there, and I'm starting back over right now. He knows as well as I do that as long as he keeps his finger in the dike the patient will do all right. I'll be over in forty-five minutes."

  "Yes, Doctor," the float said.

  It was February and it was sleeting and a trailer-truck had jackknifed, blocking two lanes of the bridge. Before he realized it, he was in the middle of the jam, cars and trucks ahead of him and on both sides and behind, the drivers swearing and blowing their horns and the police, red-faced from the cold and from anger, waving their arms and blowing their whistles and trying to clear the jam.

  "Look," he said to one cop. "I'm a doctor and there's an emergency over at Veterans' Hospital. I can't get out of here, so I'm leaving my car while I make a phone call. I'll be back in two minutes, but if this starts to move push my car aside, will you?"

  "Okay, Doc," the cop said, "
but it ain't gonna move."

  He found a phone in a cigar store with a Billiard table in the back. Two men, their shirt sleeves rolled up and one of them with long side-burns, were shooting Billiards, as if what was going on outside happened every day. While he waited, with the door of the phone booth open until the O.R. supervisor called the float to the phone again, he could hear the click of the Billiard balls.