I smiled reassuringly and went over to check her incision. I carefully lifted the edge of her hospital gown, and pulled back the dressing. The incision was healing nicely.
Mrs. Allenbaum slapped my hand. “What do you think you’re doing? Why you little—”
“Sorry, Mrs. Allenbaum. I just needed to check your incision.”
“Pervert! Pervert!” She was swinging her left hand at me, making the IV pole totter precariously.
“Mrs. Allenbaum, please. I’m one of your doctors.”
“You’re a filthy pervert. That’s what you are!”
I backed away, waving my hands at her. She was shouting so loud that everyone on the floor must have heard that Mrs. Allenbaum’s doctor was a filthy pervert. “Shhh, Mrs. Allenbaum. Shhh! You don’t have to—” I backed right into a nurse who had come to investigate the commotion.
“Well, you got old Livy riled up now,” the nurse said.
I held up my hands. “All I did was check her incision.” I prayed the nurse hadn’t already called the Vice Squad and the SWAT team to arrest the sicko who was molesting the old lady in 7203. Even now, 250-pound guys with huge biceps and black stockings pulled over their faces might be rappelling down the walls of the hospital, waiting to point machine guns at me and shout, “Freeze, turkey!” I would end my second day at the Mayo Clinic in the Sex Offenders Unit of the Olmsted County Jail.
“Relax,” the nurse said. “Livy’s a little confused this morning. An hour ago she pulled out her IV and then tried to bite me when I restarted it.”
Mrs. Allenbaum, clutching her gown to her chest, continued to glare at me as I backed out of the room. There were only two more patients left to see. Was I imagining things or were they looking at me funny?
By 7:30 I was back in the doctors’ lounge checking Dr. Harding’s new list. Thankfully, no French diplomats or Arabian sheiks had been admitted during the night. John Stevenson, looking a little worse for wear, was tearing out his patient list from the printer. I thanked him for the party the night before and told him I had a good time.
“Are you making rounds today?” he asked.
“Just finished.”
“Just finished? When did you start, six A.M.?”
“No, five.”
“Are you nuts? Nobody makes rounds at five o’clock on Sunday.”
When I told John why I had rounded so early, he nodded in understanding.
“Listen,” he said, “you’re gonna do fine. Stop worrying. First of all, orthopods aren’t like fleas. Everyone isn’t out to pimp you every minute of every day.”
“Flea” is a pejorative term for an internist. Surgeons claim internists travel around in annoyingly large groups, like fleas, buzzing much and accomplishing little. They are notorious for one-upmanship.
“Nobody expects much from the junior residents anyway,” John went on. “Just do what you’re told, be prepared for every surgery, and read about every case on your service.”
I thanked him and went home, feeling even worse. “Be prepared for every surgery.” What did that mean? Did I have to learn how to do a total knee replacement before I had even seen one?
I peeled the cellophane from my brand-new copy of Campbell’s Operative Orthopedics and began poring over the sections on total hip and knee replacements—but it was a losing battle. I would read a sentence that contained an unfamiliar word. I would look up that word only to find the definition included another word I had never heard of. I would look up that word and pretty soon I couldn’t remember where I had started in the first place.
“So, how’d everything go?” Art asked me on Monday morning.
“Oh, fine,” I said, handing him his beeper. “No problems. A couple wounds are draining a little, but everyone’s okay.”
Everyone, that is, except me. I had just spent forty-eight hours in hell.
Is this, I wondered, what I have to look forward to for the next four years?
Chapter Three
July
Having survived that first weekend, I felt a little more confident. As the days passed, Art and I began to form a routine. We met for breakfast every morning in the hospital cafeteria. Technically, only residents who had been on call the night before, or who had started work before 6:00 A.M., were entitled to free breakfast, but when Art saw me reach for my wallet at the checkout line the first day he said, “Pay no attention to that bullshit. When you work as hard as we do, breakfast is free.”
The ortho residents always sat together, often taking up two or three long tables in the cafeteria. Although we would occasionally let medical students sit with us, we never allowed fleas.
I was sitting at breakfast one morning listening to the senior residents argue whether a staple from an old upper tibial osteotomy had to be removed before doing a total knee replacement. I never took part in these conversations. I was barely able to understand what they were talking about.
Down the table someone was reading the morning paper. Jack Manning, on call from the night before, was resting his head on his hand, staring bleary-eyed into space, a cold cup of coffee in front of him. Beepers were going off. Guys were hurrying away, leaving their breakfasts half-eaten. Other guys were arriving and taking their place. Several conversations were taking place at the same time.
“I’m not kidding; she kept waving her cigarette holder at Dr. Hale, telling him there was a battalion of tiny Iranian devils with poisoned pitchforks that waited ’til she fell asleep so they could start stabbing her in the groin.”
“I tried to fix the lateral side first but I just couldn’t reduce it. So I had to open the medial side, repair the ligament, and then go back and plate the lateral side. The damn thing took almost two hours.”
Art, who wasn’t interested in shoptalk, made a remark about a skirt he saw on a woman at the Depot House, Rochester’s only singles bar. “Two more inches and I think I could have seen the dark side of the moon,” he said.
Breakfast was Art’s time to regale us with stories of his latest conquests. Handsome, witty, an excellent athlete, and an incredibly charming ladies’ man, Art was a legend at Mayo. He always had some beautiful woman at his side. Although reasonably skilled as a surgeon, his work tended at times to be careless. He made no secret that his main interests were anatomic not orthopedic.
“I’m only human,” he said with a sigh of helplessness. “I couldn’t fight her off one more minute. Against my better judgment I finally had to give myself to her.”
“Against your better judgment, huh?”
“Even the just man falls seven times a day.”
“You wish.”
Art and I helped Mrs. Schmidt onto the operating table. After the anesthesiologists had put her to sleep, we wrapped a tourniquet around her upper thigh, prepped and draped her, and then sent for Dr. Harding. I was excited. This would be the first total knee replacement I had ever seen.
Big John came down from the staff lounge, scrubbed in, slapped his hands together, and approached the table. He took the patient’s knee in his huge hands and bent it up and down several times. He palpated both sides of the knee, then held out his hand.
“Scalpel,” he said.
The scrub nurse slapped the scalpel in his hand. Before I realized what was happening, Big John had run his hand down the front of the knee, and had sliced it wide open. Layers of fat spread to either side, and despite the tourniquet, blood began to ooze from several spots.
Within sixty seconds he had opened the capsule, everted the kneecap, and exposed the joint. I could see the worn and frayed cartilage, the spurs, and the bare bone where the cartilage had eroded. Periodically Dr. Harding would cut away a glob of fat and drop it in the kick bucket next to the table.
I had pictured surgery as a series of delicate maneuvers performed with a scalpel held gently between thumb and forefinger. This procedure seemed like bloody, rapid-fire chaos. “Slash and bash,” Art had called it.
When he finished exposing the joint, Dr. Harding picked up a
power saw from the nurse’s table and began to saw off the end of the femur. The piercing whine of the saw was unsettling, especially in light of my preconceived notions of the delicate nature of surgery.
“She’s got a lot of medial compartmental erosion,” John said after he finished the femoral cut. “That means we’re going to have to angle our tibial cut this way.” He grunted as he rammed a retractor into the other side of the knee.
“Here. Hold this damn thing,” he said, turning to me.
I grabbed the retractor.
“Don’t be afraid of it. It won’t bite you,” John said. “Pull hard on it. I have to be able to see the entire plateau before I make the cut.”
He took the saw from the nurse, leaned to his right for better leverage, and sawed off the top of the tibia. Then he flipped over the patella and sawed off the underside of it, too.
As Art irrigated the wound with antibiotic solution, Big John turned to the scrub nurse, instructing her on what prostheses he would use. I, meanwhile, stared in fascination at the sight in front of me. Our patient’s knee was filleted open. Sawed-off chunks of bone lay scattered about the field. I tried to act nonchalant, as though I were used to being surrounded by mutilated body parts.
(Yeah, ho-hum. Just another routine dismemberment. A femur here, a kneecap there. No big deal. It’s all in a day’s work.)
Art was irrigating the wound, and fluid was spilling over the side of the knee. “Hey, numb nuts,” he whispered. “Suck, will you?”
I grabbed the suction and a lap sponge and began cleaning up.
John finished selecting the prosthetic components he would use. The circulating nurse opened them and dropped them on the sterile back table. John then turned to us.
“Now,” he said, “the fun part.”
(So, what was the dismemberment—the boring part?)
First he held the components against the femur and tibia, assessing the fit. He took the saw and shaved a little more off one side of the tibia.
“All right,” he said, turning to the scrub nurse, “you can mix.”
The nurse shook some white powder from a plastic pouch into a dish in front of her. Then she broke open a brown vial of a strong-smelling liquid and began mixing it with the powder.
Powder? Liquid? What the hell was this? Was Big John going to start sprinkling this stuff over the patient like some shaman? I half expected him to start chanting incantations. Unga gagunga. Was he going to promise her total consciousness on her deathbed, too? Well, at least she’d have that going for her.
Three minutes later the nurse told John she was ready. He took the white, creamy mixture (that I later learned was bone cement) and began applying it to the end of the bone and the undersurface of each prosthesis. He then fit the prosthesis to the bone, took a large mallet, and began banging away on it, impacting it into place.
What a strange world: blood, bone, body parts, saws, hammers. How totally different from what I had expected. We seemed more like carpenters on a construction site than surgeons in an operating room. And yet I found it incredibly exciting, and was disappointed that to everyone else it seemed so routine. I wanted them to feel as I did, that this was something extraordinary, something reverential. We had opened a human body, cut away parts of it, discarded them, put in new ones, and then closed everything up again. And in a day or two this person would be walking, her pain gone. It was incredible. I wanted to keep this awe and fascination forever. I didn’t want it to ever become routine.
At 5:00 P.M., we finished our last case. I had been on call the night before, and although I had slept a few hours, the long day in the OR had worn me out. I sagged against the wall in the residents’ locker room and called my wife for a ride home.
Fifteen minutes later Patti pulled up to the back entrance of Methodist Hospital. Eileen, in her car seat, was chewing on a fistful of animal crackers. She waved her free hand and garbled her hello.
I leaned in the back window, picked out a clean spot on her forehead, and kissed her. Then Patti slid over and I got behind the wheel. As I swung out of the lot, Patti laid her left hand on my forearm.
“Miss me?” she said.
I turned to her and nodded, a sleepy smile on my face. “I always miss you.”
Patti was excited for me. She was a nurse, and she spoke the language. For the first few months of my residency, Patti probably knew more orthopedics than I did. She loved hearing about my work. Most young couples talk about movies or books or sports. We talked orthopedics. Constantly. In the car, over dinner, feeding the baby, doing dishes, in bed at night.
“It’s amazing how much that guy bled,” I said one night as I turned out the lights and reached for her.
That’s where Patti drew the line. “Are we going to talk about bleeding,” she said, pushing my hand away, “or are we going to—”
“Bleeding? Who cares about bleeding? Why would you want to talk about bleeding at a moment like this?”
On Friday nights those of us who weren’t on call would meet, with our wives, at Tinkler’s on Second Street. There would be beers, laughter—and more shoptalk.
“I’m not kidding you,” Frank Wales was saying one night. “This feller was so liquored up he didn’t even know his finger was missing. By the time the hand guys got him to the OR it was five A.M. I was just getting into bed when some nurse up on Seven called me to see one of Satterfield’s patients, who claimed Russian spies were hiding under her bed.”
“She may be on to something,” Bill Chapin said as he filled our glasses from the pitcher. “I’ve been up on Seven, and the place is crawling with Commies.”
“You’re a big help. I should have had the nurses call you.”
“No thanks. I was busy communicating with Martians through the fillings in my teeth. So what did you do?”
“I checked under her gol-dang bed and told her no one was there. Then she told me I was a Russian spy. That’s when I got a psych consult.”
“For you or her?”
“At that point I reckon I needed one as bad as she did.”
Patti, Alice Chapin, and Linda Wales were on one side of the table chatting away, casting an occasional disapproving glance at Frank, Bill, and me if our stories got too graphic or our jokes too crude.
“Where in the hell is Manning tonight?” Frank asked. “On call?”
Bill shook his head. “No, he and Sue are at a fondue party.”
“A fon—what in the Sam Hill is a fondoo party?”
“It’s a party where everyone fondles everyone else,” I said.
“It is not,” Patti said. Like most women she could carry on three conversations and still know what is going on at all the tables around her. “A fondue party is where people gather to taste fondue. Fondue is a sort of melted cheese.”
Frank looked perplexed. “Why in the hell would they want to do that?”
“It’s a party, Frank,” she said. “It’s just a way to get together with your friends.”
“So’s this, and I don’t need no neighbors pouring melted cheese over me neither.”
“Depends on the neighbor,” Bill said. “Now there are a couple of fine ladies in our neighborhood I wish would pour melted cheese over me.”
“Who?” Alice said. “Leslie Wilson? As if she’d have you.”
“Oh, yeah? Well, she already called and invited me to a Mazola party.”
The wives laughed uproariously. “Can you see it?” Alice said, holding her sides. “Bill at a Mazola party!”
“Beats melted cheese is all I can say,” Frank said.
Dr. Jonathan J. Wilhelm took a bite of his pancake, delicately wiped the corner of his mouth with his napkin, and then jerked his thumb at me. “Jesus Christ, who is this guy?”
Wilhelm was a senior resident who liked the sound of his own voice. He tended to dominate all conversations, constantly interjecting his opinion on everything. It was well known that he expected to be asked to stay on staff at Mayo when he finished his residency.
/> The topic at breakfast that morning was shoulder dislocations and, as usual, I just sat there and listened. They had been talking about an operation called a “Bristow.” I asked Art what a Bristow was. Wilhelm couldn’t believe it.
“Don’t tell me this guy is an ortho resident,” he said to everyone at the table. He turned to me. “Are you a medical student or a flea?”
“I’m the junior resident on Harding’s service.”
“You are an ortho resident?” He threw up his hands in disgust.
I was too intimidated, too shamefully aware of my own ignorance to defend myself. To his credit, Art stood up for me.
“Back off, Wilhelm. He’s all right.”
“All right? An ortho resident who never heard of a Bristow? Jesus Christ.” He shook his head and went back to his pancakes. I was just starting to sink back into a relieved anonymity when he turned to me and said, “Did you know the hip bone is connected to the thigh bone?” He was greatly amused by this witticism and looked around the table, encouraging everyone else to join his laughter. One or two did before Art once again told Wilhelm to knock it off.
“Whatever you say, Art,” Wilhelm said as the laughter subsided. “After all, you’re the one who’s stuck with him.”
There is only so much shit one can eat. Art saw the look in my eyes and grabbed me by the elbow. “Come on, Cassius,” he said. “We gotta make rounds.”
Wilhelm by then had forgotten me. He was lecturing the rest of the table on the histology of ligament healing.
“Forget it,” Art said, steering me away from the table. “The guy is a jerk. If the Clinic asks him to stay on staff they’re out of their minds.”
The Mayo work week was divided into surgery days and clinic days. We either operated all day, or we saw patients in the clinic all day. On surgery days I was the second assistant on all cases. Art would get to operate once in a while, but I did nothing more than hold retractors and write post-op orders. On clinic days I tagged along behind Art and Dr. Harding as they saw patients.
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