I put my arms under the warm water, looking around for my resident. Over the fingers, through the webbed part, and onto the back, I thought, as I repeated the scrubbing technique I learned yesterday. I realized that my arms were shaking, and I took baby steps to make sure that I wasn’t breaking sterility as I pushed open the door to the operating room with my back. What greeted me could only be described as organized chaos. Lifting the patient onto the operating table, the surgical technician, Juan, beckoned me over: “Take the gown and put it on!” he sternly quipped, his voice not missing a beat. I just got here, I thought, as I fumbled through putting my arms through the outstretched gown. I checked and rechecked my maneuvers—recollecting yesterday’s orientation seemed so difficult, as if the memories were encased in an unknown location in my brain. My hippocampus struggled as my amygdala took over, returning to my instinctual movements. I splayed my arms wide and Juan brought them back by pushing them in: “Don’t break sterility!” he warned “or else…” his voice trailed off.
He was gone. Onto another part of the surgery. I stood there, arms at my side, as the scrub nurse velcroed my gown from the back. Tying the knot in front of my gown gingerly, and taking care to not break what little space I had when I was sterile, I looked at my reflection in the door that I had walked out of when I scrubbed in. As my gaze shifted to the attending surgeon, the residents, and finally the reflection again, I noticed there was nothing separating us. We were all a team, all in uniform, ready to take our roles in the symphony of surgery.
I knew that I would be the triangle player who only crashes his instrument once during the entire play. And for good reason. The triangle player is clumsy, and likely has no skill with an instrument yet. The medical student is the same way. I’m pretty useless, I mused, but even the triangle player does something. I’m basically a prop. As I stood there thinking about the triangle, I must have had a quizzical look on my face because my day-dreaming was interrupted by someone clearing their throat behind me. I didn’t notice him in the moment, and I was ready to turn around, but he commanded, “Don’t move. You’ll ruin your sterile field.”
Looking at the chaos, I shuffled to the side and peered down. Standing five foot two, there was a man who reminded me of the Keebler Elf. He was dressed in the same attire as us, but he carried it differently, a set of bespoke scrubs. It was hard for him to stand out of the crowd, and yet he did. He brought me to the surgical operative theater, and introduced me to the gruff surgeon: “This is Shree. He’s going to be witnessing this surgery on the most important day of his clinical career—his first ever surgery on his first day of clinical rotations.” The surgeon grunted, almost as if the mere suggestion of someone interrupting his breakneck pace was a burden, and I recoiled. What did I do?, I thought, shifting my gaze to the ground.
I’m good, I thought as I chided myself for overthinking even the most simplest things. And we were off to the races. The lead surgeon and his accomplices, the residents, moved with a swift vigor, cutting organs and ligaments which I barely knew. The body cavity was like a subterranean cavern, and the laparoscopic images that the television screen presented seemed like a video game.
The elfish surgeon, whose name I gleaned through the constant commands of the lead surgeon, was James. He explained that his role in the surgery was making sure that the uterus was positioned in the right place while the surgeon directed the symphony. Perhaps he was playing the trumpet, I thought, as I noticed the curved shape of the tool. It was designed to make sure that the uterus was vacuum sealed and gases didn’t leak out while the surgeon suctioned off the smoke and the different parts of the uterus which contained cancerous compounds. James explained, “All of the people in a surgery have a role. Even you and I, who are just observers, play a vital role. Sight is everything in surgery. If you don’t see anything, then you can cut something that you don’t want to. It would be disastrous for the surgery.”
Just then, the lead surgeon, whose name I didn’t even get to catch before he began his breakneck pace into the surgery, cried out, as his resident cowered beside him on the controller of the robotic laparoscope. There was a brief moment when everything fell silent. The world moved in slow motion as I glanced at the screen, and saw that it was filled with red. Suddenly, James leapt into action, the serene look on his face replaced with a determined gaze. He jostled with the resident and commanded, “Control the uterus,” as he put his fingers onto the robot. Blood gushed onto the screen as they tried to wipe it off, and the knife was placed on the sterile field as they entered the abdominal cavity once again, this time with their hands. Sutures were flying, needles were exchanged, and I had a front row seat to two amazing surgeons working with their fingers to save their patient from the snatches of death by controlling the loss of blood from her abdomen.
Surgery is almost like a cult, it has its own language and procedures, its obsession over sterility and technique makes it have a certain religiosity. As I watched the two surgeons work together to save this patient, I remember a sense of awe, and I couldn’t believe that medicine had advanced to such a state where we could cut open a human being without them remembering or feeling it the next day. As they wrapped up the surgery with a satisfied sigh, they passed the covered needle to the resident physician, broke off their gowns with a satisfying snap and heaved themselves onto two chairs in the corner. Having barely sat for two minutes after an hour-long session, I looked longingly at them as my legs and back ached. As the resident weaved in and out of the musculature, I gingerly asked her whether I could hold it and try suturing. As my needle passed through the patient’s skin, I felt so alive, just knowing that just a few hours before, I was meeting this patient for the first time as I stepped foot in the hospital as a newly minted third-year medical student.
James took me aside after the surgery, and explained that what I saw was known as an adverse event during surgery. Ligating the artery was not the way which the surgery was supposed to go, he explained, as he showed me the different tools which they had used. He gestured for me to remove the air from the uterus, and I complied. “What’s going to happen to the patient?” I questioned as I moved the uterus into the bag which would be eventually sent to the pathology lab.
“Most patients, we let them know the day after, and we admit our mistake.”
James’s face was grave. I realized that this decision was going to weigh on him, and I noticed that each wrinkle was more pronounced because of it, almost as if each wrinkle was a reminder of the worry he had felt when a surgery could have gone better. James’s explanations were clear, succinct, almost algorithmic. If you don’t make a good decision, then admit your mistake clearly, and move on. It almost felt as robotic as the laparoscope I had handed to the resident to begin the surgery. As I too snapped off my gown, and headed out into the light, I wondered if it was fitting to start off my medical career with a surgery which acknowledges its limitations. Medicine is practiced by humans, and that means that mistakes will happen. James’s admission that we are not all-knowing, and all-seeing beings, was even more poignant in an arena where we play God, trying to bring people back from the brink of death.
Walking down the hallway of the operating room, I noticed each room had a similar orchestra of surgical musicians: each symphony different from the last. James walked beside me, talking about which room contained which surgery: “That’s a cholecystectomy, that’s a cardiac catheterization, and that’s a circumcision.” Matter-of-factly, he explained that every surgery is a new story to be told, and that mistakes don’t define a career. However, the most important thing to explain to a patient is the importance you will place on their safety, and their quality of life. Maybe it was fate that I met James. Maybe not. As I move throughout the hospital, and my cynicism grows, and sometimes it’s hard to remember the non-judgmental and experiential wisdom that James brought to the OR. But I will always keep his insistence on curiosity as I move throughout my rotations, a reminder of that little Keebler Elf surgeon.
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All characters in this story are fictional, and any resemblance to persons living or dead is purely coincidental. Thanks to Darshan Kalola and Varun Taruvai for their edits and suggestions for this work.