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With my best poker face, I walked up to Amir, who was leaning on the doorframe, watching me.
“Here’s the toe you requested,” I said coyly. Amir attempted a painful grin. Maybe he wasn’t an android after all.
Next came a brief stop in the residents’ team room. Amir’s mood had turned dark. Jesus, had someone pissed in his Cheerios?I took a seat on the team-room cot and watched him rifle through his papers. I realized there was a tiny spot of light coming from a small window three quarters of the way up the wall, like the windows built into jail cells.
I stood and looked out at the sun setting on the world that I was leaving behind each day. Is that why the window was designed to be so miniscule? So we could only see a tiny slice of what we were missing?
Forty-five minutes had flown by. We were now preparing for the abdominal aortic aneurysm (AAA) repair scheduled in the main operating room. Amir had to fix the abnormal ballooning of an aging man’s crucial heart vessel so that it didn’t rupture.
Suddenly, Amir addressed me, softly, almost poetically. “The heart is like a beautiful woman, strong yet pliant. Its blood supply must be handled delicately; an improper interruption of circulation can be largely fatal. Remember this, medical student. Nature knows what it’s doing and we have to be very careful when we tamper with it.”
I must have dozed off, transfixed by his dulcet tone.
“Medical student!” I awoke, startled by his signature toe tap. “If you suffer from narcolepsy, surgery may not be the career for you...”
This was the cruel voice of the handsome prince.
“No, I—I’m just fine,” I recovered. “Let’s go watch you do an aortic graft.”
Amir sprang into action and we headed to the OR suites downstairs. He was performing the granddaddy of almost every miracle surgery. The triple A, or the abdominal aortic aneurysm, is a high-wire act where the heart’s major artery has to be partially shut down and fixed while normal blood flow is preserved.
Imagine a major city highway being barricaded during rush hour.
Only in this case, chaos can mean death. Very quickly.
The patient was an elderly man who required special handling due to his age and accompanying medical issues. The tricky part would be maintaining blood flow to all of his extremities and vital organs, from his fading brain cells to his anemic toes, while excising and replacing the diseased portion of the aorta.
So easy to snuff out life, I thought. Every one of us in the room was aware of the high mortality associated with the procedure. From the foot of the bed, I could see Amir wore magnification loupes; he looked like a large insect as he cross-clamped the aorta. Then he made a vertical incision through the ballooned-out, diseased tissue and inserted the synthetic graft that would comprise the patient’sreconstituted aorta. He threaded suture after suture, circumferentially, like a spider building a web, until the graft was perfectly sealed.
Amir and his attending finished the critical portions of the operation. They tested the blood flow through the new graft and Amir looked down at me.
“Medical student,” he said. “You close the skin.”
“What? Me?”
“Um, yeah, you,” he said. “Don’t make me change my mind.” He gave me a magnified insect-like wink.
A nurse held out a tray of necessary tools as I moved to the head of the bed. Desiring a cosmetic closure, Amir indicated he wanted sutures in place of staples. My experience practicing knots had paid off. I laid down the sutures, gracefully burying the knots. For the first time, I felt like an artist in a studio, performing with delicacy and precision. I could feel my overseer, Amir, next to me, nodding in microscopic bursts of approval.
I gently arranged butterfly closures, affixing adhesive bandage strips along the wound line to bolster it, and covered it all with impermeable tape. The case was completed successfully, and the patient was transferred to the recovery room.
I floated out of the OR, stood outside in the hall, and closed my eyes for a second, to take it all in. I heard gurneys squeak by, and nurses and doctors moving past me in audible clusters.
I’d done it. I’d caught that fierce wave and ridden it, blood pumping, adrenaline surging, dopamine and serotonin flooding into the pleasure centers of the brain.
“Good job, doctor,” Amir said proudly, promoting me for a fantasy moment from the faceless ranks of med students.
A new woman had been born—I had signed a surgeon’s covenant of blood. Move over, big cats. There was no stopping me now.
16. Tequila and Tumors
As we approached the second half of our fourth-year rotation, our supreme commander Dr. Shay offered to take the team out for drinks and hors d’oeuvres. I felt ambivalent about socializing with my colleagues. None of them had seen me out of scrubs, and my inclination was to keep it that way.
However, refusing to join the party would make a selfish statement, a less desirable option.
After a twelve-hour workday, I returned to my apartment, which I noticed was starting to smell like stale salt-and-vinegar potato chips (a med-school staple). But my mood picked up. Here was a chance for an evening of fresh air and adult interaction away from the sweat shop.
As a first step toward liberation, I quickly yanked off my odious scrubs and carried them upstairs. Waking up for work at three thirty every morning, I’d perfected the art of the “rapid sponge bath”: quick splash, pits and pubes. The prospect now of a long, luxurious shower felt heavenly.
