The surgeon

by Wilfred Charles Heinz

  "That's right," Jimmy Wilson said.

  "So he's become our best orderly," he said. He had scanned the line between the circles on the respiration chart and noted they were between 18 and 22 a minute and normal.

  "I admire that," Jimmy Wilson said.

  "He's also our best boxer," he said, thinking: The white blood count at 8000 and the hemoglobin at 12 grams are normal. "In fact, he's our only boxer. He boxes in the Golden Gloves."

  "Next year I win," Jimmy said.

  "You always say that," he said.

  Each year Jimmy Wilson would post on the bulletin board the same sign:

  Sponsor Needed

  Middleweight boxer requires sponsors

  to enter Golden Gloves Tournament.

  Signed Jimmy Wilson.

  "Last year I make the finals here," Jimmy Wilson said.

  Each year, because Jimmy Wilson was unable to stretch his pay check from Thursday to Thursday, he would sell his protective cup and ring shoes and robe, and so ten of them would chip in five dollars each to re-equip him.

  "You don't eat right," he said to Jimmy Wilson but still checking Mr. Scheller's charts and thinking: The urinalysis is good with no blood cells or sugar or albumen and the bowel movements are normal and the blood pressure is all right at 140 over 80.

  "I eat fine," Jimmy Wilson said.

  "Too many jelly doughnuts," he said. He had finished scanning Mr. Scheller's charts and he placed them back at the foot of the bed.

  "That's what I like," Jimmy Wilson said. "Jelly doughnuts."

  "I've been looking at the results of your tests," he said to Mr. Scheller, walking around to the side of the bed. "They're all excellent, so everything's going to be all right."

  "I just hope so," Mr. Scheller said, turning his head now and looking at him.

  "It will all go just fine," he said. "Jimmy, here, will move you inside in a minute and I'll see you in there."

  "Doctor?" Mr. Scheller said.

  "Yes?"

  "There's something I'd like to tell you."

  I'd rather not hear it, he was thinking, but I will. If, at this time, they want to, you have to let them speak because it's better spoken.

  "I've never been a very religious man," Mr. Scheller said.

  "Oh?"

  He heard this more often than those who spoke it knew. At first it flattered his ego, his hero image of himself, but after the first few times he came to realize that, as much as he wanted them to believe in him, it embarrassed him, this substitute faith in him that is forced by their fear of death.

  "I've never been much for going to church," Mr. Scheller said.

  "I understand."

  "But I trust in you."

  "I accept your trust," he said, taking Mr. Scheller's right hand in both of his and looking down at him. "Now please believe that you're going to be all right, because you are. When you're in there, they're just going to stick your arm with a needle, like they did the other day when we looked down inside your windpipe with a bronchoscope. That's all you're going to feel, and the next thing you know youll be back in your room waiting to kid the nurses."

  "I believe in you, Doctor," Mr. Scheller said.

  "Good," he said.

  He put Mr. Scheller's hand down on the sheet and heard the door open behind him. The floating nurse walked by him to the foot of the bed.

  "Here we go now," Jimmy Wilson said, pulling his mask up.

  "You're going to be all right," he said to Mr. Scheller. "Just remember that."

  He turned then, as they started to maneuver the bed, and pulled his own mask up, knotting the two strings above his cap, and he walked to the next door and went in and walked to the sink next to Bob Robinson.

  "You find Mrs. Scheller and her son?" Bob Robinson said, scrubbing.

  "Yes," he said. "They were waiting for me."

  He had taken a brush out of the holder and, with the foot pedal, he had squirted some of the Septisol onto the brush and into his left hand.

  "You see Benjamin Davies' daughter?"

  "Yes," he said. He had worked up a lather in the palm of his left hand and was brushing under the nails. "I explained it to her and her mother."

  "Thank God," Bob Robinson said. "She's been raising the roof."

  "I also told Mrs. Kirk's husband."

  "I see him on TV," Rob said. "What's he like?"

  "A fine man. He took it as well as anyone could."

  "It's a damn shame," Rob said.

  "He's decided he doesn't want her told, at least not now. They're buying a new house and he's going through with it so she won't suspect anything."

  "It's a damn shame," Rob said, scrubbing.

  "Bemie Waterman's doing fine," he said, squirting Septisol into his right hand and starting on the nails.

  "You think we cured him?"

  "I think so," he said. "I didn't have time for Anthony Trusco and Lynn Cummings."

  "We doing her tomorrow?"

  "That's right, and after we finish here I've got to get over to University for a mitral."

  "I'll look in on her," Roh said, rinsing his hands and forearms. "I'll also see Trusco."

  "I think he's curing himself. I looked at his new pictures last night and he's fifty per cent better."

  A week before, when they had looked at Anthony Trusco's original X-rays, his lungs had seemed pervaded by snowflakes. He had been running a temperature for two weeks and complaining of headaches and had a non-productive cough. When a skin test for tuberculosis came back negative the possibilities were that a cancer from an unidentified primary source had spread through his blood stream and filtered out through his lungs or that he had psittacosis, a virus spread by parrots, parakeets, and a number of other birds.

  "I know," Rob was saying. "I compared the new ones with the old pictures this morning and half that blizzard in there has cleared."

  "Ask him again if he hasn't been around a parrot or a parakeet," he said. "I once had an electrician who picked it up doing some rewiring in a pet store."

  He was scrubbing the back of his left hand now and starting up the forearm. He had been doing this, scrubbing two and three times a day, for so long that he no longer had to set the timer. He had become as accustomed to the passage of five minutes as, he read once in Red Smith's column, Tommy Loughran became accustomed to the passage of three minutes and so was able to finish every round he boxed in his own corner.

  "Trusco puts down flooring," Rob was saying, "linoleum and rubber tile and that kind of thing. I asked him about pet shops, but he says he hasn't worked in any."

  "Has he been to a zoo?" he said.

  Because he scrubbed so often, and for so long, and worked always in rubber gloves, his hands had become so soft that he was conscious of it when he shook hands with other men. In fact, it actually embarrassed him with men like Anthony Trusco.

  "I asked him that," Rob was saying, "but he says not."

  "Get him to think back again over any private homes or apartments he did where there might have been a bird."

  "I will," Rob said. "This thing interests me."

  "As long as he's winning, we won't change horses."

  "You see Mr. Scheller in the hall?" Rob said.

  "Yes."

  "You think we've got another Roberto Leon?"

  "We'll know in a half-hour," he said.

  "I'd better get in there," Rob said, "and see how they're doing with him."

  When he finished scrubbing he rinsed his forearms and hands, pushed the door of the operating room open with his right shoulder and, his hands up in front of him and palms toward himself, he walked across to the table with the sterile gowns and folded towels on it. He picked up a towel and dried his hands and arms and, as he did, the scrub nurse saw him and came over and shook out a gown. He slipped into it, and she pulled it around him and tied it in back. Then he opened one of the towels, ripped open the packet of powder, and powdered his hands. He picked up the left glove, carefully but automatically picking it up
by the inside, where the gauntlet was folded down, and he slipped it on. He snapped on the right one, the soft smell of the small cloud of powder coming even through the mask, and then he pulled the gauntlet of the left glove up over the knitted wristlet of the gown and adjusted the right one.

  Once he did not even know how to put on a pair of gloves. It was that first day when he assisted at that thyroid at General and he couldn't get the hemostats to open and he was shaking all over. It was that short, stout German surgeon with the silver-rimmed eyeglasses and the fat hands and he was shouting: "Off, off, off!" And then: "No, Doctor. No, no, no! It's not difficult! Hold them like this!" And all the time he, who wanted now to be a surgeon more than anything else in the world, was shaking like a leaf.

  As he turned back now to the room he saw Mr. Scheller, the upper half of his body uncovered, thin and pale-skinned on his back on the table under the lights. He was already under the Pentothal Sodium, with the intra-tracheal tube down his windpipe and the anesthetist named Anne Morris taping it to the right cheek.

  "Well, Orphan Annie," he said, "how are you doing?"

  "Fine, Doctor," she said, looking over at him with those big blue eyes over the mask. "We're doing just fine."

  "Good enough," he said.

  Standing there, his gloved hands folded in front of him priestlike, he watched Darrow and Jimmy Wilson while they turned Mr. Scheller onto his left side, the left arm, the intravenous tube rising from it, out along the arm board. Darrow was sliding the flat metal grounding plate for the Bovie, the electric cautery machine, under Mr. Scheller's left hip.

  "Now let's get that left leg bent," he said to Jimmy Wilson, "so he'll be nice and steady."

  He had learned it in the war, early in Normandy, that if they bent the under leg up they wouldn't roll as much on the litters. He had learned it as soon as they hit Normandy and when the thirty litter bearers had all they could do to handle them because they had five hundred casualties the first night when they were hoping for no more than fifty, or just enough to keep everyone busy. Then they had lost one truck, coming in at Utah, but fortunately they had dispersed their instruments over three trucks, and whenever he thought of this he remembered that one German. He had always felt a special urge to take care of the prisoners, to show them that Americans are decent people, but that night, walking down the line of litters and coming to that one German, he had done no more than reach down and push his intestines in and walk on because he knew it was hopeless and he couldn't waste the time. As it was, he and the two others had operated for twenty-four hours straight, surprisingly not aware that they were tiring until, at the end, the hoarseness of their voices gave away their fatigue.

  Now he watched the anesthetist put the pillow under Mr. Scheller's head and Jimmy Wilson fit the pillow up between the legs. Then the floating nurse and Jimmy Wilson were anchoring the body, pulling the wide adhesive tapes across the hip, crossing them at the hip, and sticking them to the sides of the table. When Darrow started to soap the right chest and back he walked over and looked again at the new set of X-rays, at the shadow lying up there high in the right lung and immediately adjacent to the heart.

  "Those are much sharper pictures than the ones he came in with," Bob Robinson was saying, walking up.

  "That's right," he said. "These are good."

  Two days before, when he had bronchoscoped Mr. Scheller, he had seen the growth coming out of the right upper lobe orifice, or opening, where the bronchus, or branch of the windpipe, enters that lobe of the lung. He had seen only the top of the growth sticking out because, viewed through a bronchoscope, a bronchial tumor is like an iceberg with most of it hidden from sight.

  "You know something?" Rob was saying, looking more closely now at the lateral view. "The way it's not exactly in the mid-line but a little bit anterior to it, makes me think that if it hasn't invaded his superior vena cava already it's close to it."

  "That's the way it looks," he said.

  The tumor, in the light of the scope, had looked like cauliflower, although red instead of white, and when he took a small specimen of it with the biopsy forceps he knew that the odds were twenty to one that it was cancer. Twenty-four hours later he had seen the pathology report: "Bronchogenic carcinoma, squamous-cell type."

  "Doctor," he said to Darrow now, "you're not trying to scrub my patient away are you? You wouldn't want me to have to go out and find a new one."

  "No, sir," Darrow said, stopping and looking at him, the swab in the holder arrested in midair.

  "That's fine. I think you can paint him now."

  "I'll paint him," Bob Robinson said to Darrow. "You'll have to go out and do a fast second scrub on yourself."

  "Thank you," Darrow said.

  "Mary?" he said to the scrub nurse. "You've got that polyethylene tubing soaking?"

  "Yes, Doctor."

  "In three sizes?"

  "Yes, sir."

  "You're all right," he said. "You're a champion."

  He watched, conscious of his growing impatience to begin, while Bob Robinson painted. He watched him dip into the pan of disinfectant and swab the whole area, the orange-pink merthiolate running down ahead of the swab and Rob spreading it evenly as he went.

  "You know you're very good at painting?" he said. "I don't think I've ever seen you do it before and you're a regular Rembrandt."

  "Thank you," Rob said, "but do you think I'll ever be a surgeon?"

  "I wonder the same thing about myself," he said, and then to the anesthetist: "How's he doing?"

  "Fine, Doctor."

  "Excuse me, Doctor," the scrub nurse said, "but what size blades do you want?"

  "I'll take medium," he said. "He doesn't seem like he's going to be too tough."

  He saw Darrow come in from the scrub room and walk to the table against the wall and pick up a towel. He saw that Bob Robinson had finished the painting and that the floating nurse was moving the pan of disinfectant away.

  "Good," he said. He walked up to the table and, realizing that it was a little low, he looked down and found the foot pedal and raised the table to just the right height so that, at the end, he would not feel it in his shoulders, in the deltoids.

  Darrow, in his gown and gloves now, was moving in at his left and Bob Robinson was walking around to the other side of the table. To the right the scrub nurse had moved the instrument table up and had swung the instrument tray across on its stand, and when he reached across his chest with his left hand she pressed the scalpel into it.

  "Now we always make our scratch," he said to Darrow, "the width of a hand below the scapula and halfway between the scapula and the spine. If you go too close to the scapula you interfere with the nerve supply, and this man's a painter. He needs all his muscles, particularly on this side."

  "Yes, sir," Darrow said.

  He had turned the scalpel over in his left hand and now with the back of it he made the scratch, just marking the skin, bringing it down in the Big C and shifting it to his right hand and finishing under the right breast. Then he made two small cross marks, intersecting the scratch line about twelve inches apart.

  "So when we put him back together again," he said to Darrow, "we'll know where it goes."

  "Yes, sir," Darrow said.

  He placed the first towel and then the three others, as a frame, around the scratch. Where two of them intersected at the right breast he snapped on a towel clamp.

  "We put this clamp here," he said to Darrow, "so that when we put in our decompression tube later we don't have to look all around for the right spot under the drapes."

  "Yes, sir," Darrow said.

  No, he was thinking, I wouldn't really want to be young like he is and starting out all over again. To me this body, now that the thinning, aging ugliness of it is about to be draped away, will become beautiful. He won't see it yet, but I will find beauty here in the miraculous, clean, functional, always-in-the-same-place orderliness of everything.

  Over the whole body now he and Bob Robinson and
Darrow were spreading the green thoracotomy sheet with the white-trimmed opening. At his left he clamped his comer of it at shoulder height to the empty intravenous stand and, when Bob Robinson had clamped his corner to the stand with the bottles of saline and reserve blood hanging from it, Mr. Scheller's head and the anesthetist bending over him were hidden from view. Then, to his right, he clamped a towel to the sheet and to the near corner of the instrument tray, and Bob Robinson did the same on his side.