Dude, Where's My Stethoscope?

by Gray, Donovan

  I gently rest the blade of the scalpel on the surface of the skin. A moment later I apply firm downward pressure. As the blade bites into the tissue I begin carving an ellipse around the lesion. Sometimes bright red blood wells up through the incision, forcing me to stop and compress the area with a wad of gauze until it settles. Fresh blood has an unmistakable odour. I used to find it disturbing, but now some days I hardly even notice it. When the field is no longer obscured by blood I resume cutting a swath through epidermis, dermis and subcutaneous tissue. Once the ellipse is complete I fillet the chunk of flesh out and drop it into the specimen jar. Oftentimes I’ll put a couple of dissolvable stitches deep inside the wound before closing the more superficial layers with regular suture. I dry the skin with some fresh gauze, slap on an adhesive dressing and voila! Mission Accomplished, as Dubya would say.

  For most physicians, these basic procedures become automatic. Like driving a car, once the skill has been mastered we no longer need to devote every iota of our attention to the process every time we do it. For certain tasks it’s safe to temporarily activate cruise control and give the overseeing, self-aware part of our brains a chance to disconnect and take a breather. Don’t worry – it checks in regularly to monitor how things are going. It just doesn’t strain to analyze and micromanage every nanosecond of the procedure. It’s a useful little technique that helps stave off burnout.

  Another tactic we often use to help us cope better is disengagement. We separate ourselves from some of the inherently distasteful things we’re required to do every day by mentally stepping back and viewing our actions from a distance. I'm not sure whether the process is partially under conscious control or if it's completely subliminal, but either way it’s a nifty trick. It doesn’t work perfectly every time, though. Once in a while I’ll be poised to begin a procedure when it will suddenly occur to me that my mind hasn’t yet slid into its neutral “physician mode.” In other words, the non-medical part of my cerebral cortex hasn’t politely stepped aside to let the Vulcan take over. Worse yet, occasionally the veil lifts right when I’m smack dab in the middle of something. When this happens I become a doctor with John Q. Citizen’s viewpoint. This has the effect of transiently turning my perspective on what I’m doing inside out, which can lead to some jarring observations. For example, when the biopsy scalpel I’m wielding punctures my patient’s skin and rivulets of blood start to flow, every now and then I think Holy crap! I just cut this guy with a scalpel! What’s that all about?

  Sometimes this parallactic view makes me consider other procedures in my therapeutic repertoire in an entirely different light:

  Rapid sequence intubations – I give critically ill patients drugs that completely paralyze every voluntary muscle in their body. I then glide a plastic ET tube past their inert vocal cords in order to manually take over the process of breathing for them. If I can’t get the tube in, their risk of a bad outcome increases exponentially. Zoinks!

  Chest tube insertion – I dissect the chest wall of a conscious person down to the level of the lining of the lungs, then stuff a tube the size of a garden hose into their pleural space in order to drain air, blood or pus. Seriously?

  Neonatal resuscitation – I try to insufflate life into floppy, blue newborns. Did I really sign up for this?

  Lumbar punctures – I slide a four-inch needle between two of the lower lumbar vertebrae in order to obtain a sample of cerebrospinal fluid for laboratory analysis. Just think of it as the human equivalent of maple syrup tapping… .

  Central lines – I insert sasquatch-sized IVs into people’s necks for better venous access. Ack!

  Corneal foreign body removals – I use needles and spinning brushes to scrape fragments of metal and other embedded objects off the surface of patients’ eyes. Hold still now… .

  Assisting at laparotomies – I help the surgeon open someone up and exteriorize their guts for inspection and repair. Are you kidding me?

  Prostate exams – I…whaaat? Let’s not even go there!

  Fortunately, these unexpected episodes of viewing things through non-medical eyes are so short-lived, they’re almost stillborn. Their evanescent nature allows me to quickly return to the strange realm of Asclepius where things that would under normal circumstances be considered outrageous are, for now, perfectly acceptable. I believe this mental sleight of hand is one of the Jedi mind tricks that allow us to perform unpleasant procedures without becoming overwhelmed by them. I also suspect it may help prevent us from getting hopelessly mired in an endless loop of recursive thoughts.

  But then again, what the hell do I know?

  Sometimes the Voices Are Real… .

  Last Tuesday my morning office went into double overtime. When it finally wrapped up I went to the hospital to see some inpatients. My rounds there finished at 1:25. My afternoon office was scheduled to begin at 1:30, so I decided to skip lunch. Unfortunately, within a minute of making that decision I was feeling so wretched I could hardly stand myself. For those of you who don’t know me, just ask Jan - nobody does pathetic like I do. I hopped in my car and drove to Tim Hortons with visions of a chicken salad sandwich dancing in my head.

  As I pulled onto the far end of the lot I happily noted there were no cars in the drive-through lane. What fabulous luck! I was cruising towards the microphone when suddenly Methuselah’s older brother shuffled out from between two parked cars and directly into my path. I mashed on the brakes. He stopped and turned to peer at me through incredibly thick glasses. I waited for him to give some modest display of apology – a nod or wave or perhaps a sheepish half-smile. Instead he curled his lip harder than Billy Idol and continued on his way. By the time he finished creaking past, another car glided in from the opposite direction and stopped at the drive-through microphone. I pulled up behind it, gnashing my teeth and cursing Geritol under my breath. I briefly contemplated leaving, but I was too hungry. I decided to wait and see what they ordered. If it was something quick like coffee, I’d place an order. If not, I’d leave.

  I snuck a look at the person in the vehicle in front of me and recognized her to be Mrs. Hatter, a tenuously-controlled schizophrenic. As usual, she was busy taking enormous drags from one of her supersized homemade cigarettes.

  “Welcome to Tim Hortons! Can I take your order please?”

  Mrs. Hatter looked straight up at the sky for a few seconds. She then cocked her head to the side like a pigeon and scanned the horizon in all directions. When she was satisfied all sectors were clear she resumed puffing.

  “Uh, welcome to Tim Hortons… . Can I take your order please?”

  She did her sky inspection once again. This time she also checked the glove compartment, her purse and the back seat. She then stubbed out her cigarette and lit a new one.

  My stomach grumbled loudly. I debated whether or not I should walk over to her and explain that this particular voice happened to be coming from the drive-through microphone. I ended up deciding to wait one more minute and hope she figured it out on her own. Are you there, God? It’s me, Donny. Help her figure it out, okay? And while you’re at it, would you mind encouraging her to order just a coffee? Much obliged.

  “Hello? Anyone there? Would you like to place an order?”

  “Yeah, I’m gonna take der chili deal an’ a big coffee. An’ maybe a couple of dem donuts. Hey, youse guys got any sandwiches? What kinda soups you sell ’ere, anyways? Anyting on special today? How much you tink dis is gonna cost?”

  I burnt rubber out of the parking lot.

  Status Interrupticus

  Mr. Golding is a 50-year-old man with a strong family history of heart disease. His cholesterol is astronomical and dietary adjustments have failed miserably. I’ve called him in to get him started on a cholesterol-lowering medication.

  “Hey doc!”

  “Hi Mr. Golding.”

  “I guess my cholesterol’s still pretty high, eh?”

  “Yes, that’s right.”

  “How high was it?”

 
“It was – ”

  “I just can’t figure out why it won’t come down, doc! For breakfast every morning I eat a small bowl of Corn Flakes with skimmed milk. After that I have an apple or an orange, or sometimes I’ll take a glass of juice instead.”

  “That’s good – ”

  “Real juice, mind you, not fake junk like Tang. I can’t believe astronauts used to drink that stuff!”

  “Can’t say I’ve ever – ”

  “If I’m still hungry, I’ll have toast with margarine. Is that Becel stuff any good?”

  “What?”

  “According to the ads on TV, it’s really low in fat or something.”

  “Most dieticians say – ”

  “For lunch the wife fixes me a tuna sandwich. I must have told her a million times to go easy on the mayo, but she still slathers it on like crazy! Hey, doc, do you think she’s trying to kill me? Har-har!”

  “Let’s hope not. Anyway, your cholesterol’s still quite high, so – ”

  “Oh, and supper! What we eat depends on what day of the week it is. Usually Monday’s spaghetti night, but sometimes we have… doc? Where are you going? Doc?”

  The Call of the Wild (Sorry, Jack!)

  Last September I went on a canoe trip with four colleagues. I’m not much of a voyageur, but I figure if you live in northern Ontario you may as well get out and enjoy the great outdoors once in a while. Sometimes the wild north gets a little too wild, though… .

  It was close to 4:00 on a chilly Wednesday afternoon by the time we finished cramming our supplies into the back of the truck. The drive from our town to Missinaibi Provincial Park was upwards of 400 kilometres, the last one-fifth of which involved slaloming down an unbelievably bumpy logging road.

  When we were about 30 minutes from our destination a host of ominous-looking black clouds began boiling across the sky. By the time we arrived at the main entrance to the park it was raining torrentially. We’re talking biblical here. Noah. The floating zoo. A Farewell to Unicorns. You get the picture. We scoured the grounds for a vacant campsite. At last we found a cramped spot with a multitude of rocks and tree roots protruding through the grass. Welcome to Trump Towers! We pitched our tents in the pouring rain, ate a cold supper and crawled into our sleeping bags. As I prepared to enter the Dreaming I tried not to think about the warm bed I had left behind.

  The next morning was cool and overcast, but at least it wasn’t raining. We broke camp and trooped down to the dock. The lake was steel grey. The small cove the dock jutted into was calm, but the rest of the lake looked choppy. As we loaded our provisions into the two canoes, a gnarled old Grizzly Adams look-alike hobbled over.

  “Goin’ out on the lake?” he queried.

  “Yes, we have a four-day trip planned,” I replied. “Can’t wait to get started!”

  “Dern cold out.”

  “You’re right, it is a bit nippy.”

  “Ah’ve been out here more’n 25 years, an’ you wouldn’t catch me goin’ out on a mornin’ like this!”

  “Oh. Well, according to the Weather Network – ”

  He pointed at the kayak I had borrowed for the trip.

  “Which one of yehs planning on using that contraption?”

  “I am. As a matter of fact, this will be my first trip in a kayak!” I declared proudly.

  For a moment his rheumy eyes widened in disbelief. He then snorted derisively and stumped away. I could have sworn I heard him mutter something about “dern city fools” under his breath.

  While the canoes launched I zipped up my water-resistant windbreaker, secured my life jacket and pushed the kayak into the lake. Although it was light and handled easily, I found it hard to keep up with the canoes. After several minutes of paddling we got out of the cove and into the main body of the lake. Out there the winds were much stronger and the water was rough. Our progress slowed to a crawl. I conjured up a mental image of our trip map. We had to paddle approximately half the length of the lake before we got to the origin of the Missinaibi River. At our current pace, that was going to take four or five hours. If we hugged the shoreline there would be much less wind to contend with, but we’d be adding a lot of extra mileage to the trip. I had no idea how to do that clever barrel-roll manoeuvre that allows you to remain seated and flip a capsized kayak right-side up, so if I ended up in the drink I’d have to swim for dry land. I was therefore hoping the canoeists would stick close to shore. Instead, they chose the low-mileage option and headed straight for the centre of the lake.

  Kayak paddles have a nasty tendency to dribble water onto you with each stroke, so by the end of the first hour I was soaked. By the end of the second hour the canoes were two tiny dots bobbing on the horizon and I was starting to wonder what the hell I was doing out in the middle of a freezing-cold lake in a kayak. Right about then I mistimed one of my strokes and plunged the paddle deep into a trough instead of a crest. This brought my centre of gravity way outside the kayak, which caused it to tilt nearly 90 degrees sideways. I spent the next two or three eternities staring down into the churning water and wishing I owned a caul as my vessel teetered on the verge of rolling over. It then made a loud grinding noise and shuddered back to its normal axis. After that I quit daydreaming.

  An hour later we stopped at an island to rest. I was completely drenched. While I wrung out my clothes and poured lake water out of my ducky boots, my friend Will passed some mugs of soup around.

  “Th-th-th-thanks!” I stammered. My teeth were chattering so badly it’s a wonder I didn’t bite my tongue off. The soup was piping hot and it warmed us up quickly. Before long we were back in the water, full of enthusiasm and ready for anything.

  By the time we entered the Missinaibi River the wind had died down considerably. We put ashore for a planning conference. According to our trip map, Quittagene Rapids was just around the bend. Although it was listed as only a Class II rapid (Class VI being Niagara Falls), the notes warned it became trickier and more technical when water levels were intermediate. We scouted it out, took an informal vote and decided to try running it. Will and Larry volunteered to go first. They started off promisingly, but a short while later they spun out in an eddy and ended up facing backwards. Unless you’re Super Dave Osborne, going back asswards through rapids is highly discouraged. They wisely abandoned the attempt and returned to the riverbank. From there they used the canoe’s painter ropes to manually guide it safely through the foaming whitewater.

  I was considering doing the same thing with my kayak when Yves winked at me and said: “Chance of a lifetime, man! You can do it!” Of course I had to take the challenge. We men are kind of stupid that way. Fortunately for me, it wasn’t as terrifying as it looked – the kayak seemed to naturally seek out the less riotous channels, so all I had to do was provide a little muscle and take evasive action whenever it looked like I was about to have a close encounter with a pointy rock. Ducking to avoid the overhanging sweepers and blasting out between the final set of boulders at the bottom was a real rush! A few minutes later the second canoe made its way through. We paddled for another hour before calling it quits and setting up camp for the night.

  The next morning dawned cold. A beautiful ghost-like mist cloaked the river. Eventually the sun rose high enough to burn the haze away. We ate breakfast, packed up and slid our vessels into the water. The wind was at our backs and we had no major portages that day, so we made excellent time. By early evening we arrived at our new campsite. We pitched the tents, started a fire and ate a hearty supper. That night a thousand stars filled the heavens.

  Saturday was our designated rest day. Activities included reading, writing, swimming, hiking, bird-watching and fishing. After lunch Will and John decided to paddle 30 minutes downstream to recon Sun Rapids. It was listed as a Class II technical, so they figured they wouldn’t have any trouble running it in an empty canoe. Several hours later they were still missing in action and the rest of us were beginning to worry. We were just getting ready to go search for them when they p
addled into view. They were sodden and their canoe was sporting an impressive array of fresh dings and scrapes. It turned out they had run the rapids twice. The first time they selected a route that had them pass to the right of a huge boulder in the middle of the whitewater. The second time around they attempted to pass the boulder on the left, but the current caught them broadside and slammed them against it. At the moment of impact they were both catapulted into the turbulence and their paddles floated away. The incredible force of the rushing water pinned the canoe in place and bent it into a U-shape, inside-out, around the rock. Amazingly, it didn’t snap in two. While Will swam downstream through the rapids to retrieve the paddles, John stood in the pounding, chin-high water and struggled to pry the canoe loose. It had taken a unique combination of prayers, curses and Herculean effort, but eventually they were successful in both finding the paddles and freeing the canoe. Thanks to the Royalex material the canoe was made of, it sprang back into its normal shape as soon as it was off the rock. The journey back to our site depleted whatever little energy John and Will had left. They both slept like logs that night.