Page 17

"Just move the fucking lights," I hissed. I was getting impatient. The initial high had long since worn off. The case had turned out to be a pretty standard one. I knew what the problem was, and I knew how to fix it. Radezki stared at me above his mask, his blue eyes magnified by a pair of thick glasses. I knew he was a good guy and that he didn't get a moment's sleep the whole night, but who said surgical residents should sleep? Did I sleep being on call every other night? Did anyone feel pity for me? Just calm down and let him continue. "Yes, yes, yes. Shine it here. Not there. No, no, no. We work here," I pointed, my index finger drifting in a casual circle around the upper abdomen. "Up here under the diaphragm—not in the bloody pelvis. Damn it, Pav, can't you see?"

We still had a long way to go. Probably another two hours at least. Still, I was irritated. How many years do I have to tolerate night surgery with double left-handed resi­dents, semi-comatose nurses and clueless anesthetists? As the years passed, my inner exasperation grew. I could com­plete that operation in an hour or so. For God's sake! Let me only move to the right side of the table and we are out of here for breakfast. Having dealt with hundreds of bleeding stom­achs I could do this operation with my eyes closed. But this was a teaching program and Radezki had to learn. Next year he should be able to cut some poor bugger somewhere in a small American town—on his own. He is a good chap, old Radezki. I like him. So let him continue, just calm down and teach him how to do it. That's what I'm paid for.

"John, please open your eyes and pull on this retractor..." The junior resident appeared to have fallen asleep while lean­ing on the hooked metal instrument with which he should have pulled the rib cage upwards. That would have, ideally, enabled us to expose the liver and the duodenum hidden underneath. That is, if he was doing what he was supposed to.

"Yes sir," responded the somnolent resident.

Page 16

"I started to research the litera­ture you suggested. I've only just begun but I must say, it looks like a pretty touchy case..."

I decided to downplay the issue—to get him focused before we enter the OR.

"A touchy case in a long series of touchy cases, Pay. Nobody gives a shit. I doubt whether Mantzur will even be present and if he will, no one will dare to open his mouth. Anyway, I hope that Winestone will let you present the case; you know that he asked us not to disclose Mantzur's fuck-ups. But we have to. Don't you worry; I'll be there to support you. And anyway; first it's Moshesh's turn. Come next Tues­day and he'll have to present that other fatality of Mant­zur's—the carotid, remember?"

With raised hands Radezki turned around, pushing open the OR door with his shoulder. His eyes laughed above the mask. He got the point. Good!

"Entertaining piece of work, eh?"

I shrugged and raised my eyebrows. Entertaining? Radezki took refuge in sarcasm. Every surgeon does. It's a stupid defense mechanism, but it helps one to function prop­erly. I rinsed my arms and hands as well and followed him into the room. There we let the scrub nurse gown us up. Radezki was eager; I could sense it. I knew he wanted to give it his best. Not everybody in this hospital did. Some of my colleagues provided more "entertainment" than good surgery.

Five minutes later I watched Radezki make the first cut. His hand was steady as the scalpel slid across the belly. Framed by the dark-green cloth, the flesh separated, exposing a solid layer of yellow fat. That close to the surface it always takes a while for things to get messy after the smaller blood vessels realize they've been severed.

A note to the reader

The pages entered on this blog are available in pdf as well so you can read the book from page 1 and onward in natural order.

Page 15

With a non-emergency case the paralyzing jitteriness will subside only after the abdomen is gaping wide open. That's when the job really begins. Any error, misjudgment, wrong movement or false decision can lead to a long list of complications. If you lose him, everybody will tell you that you should have known better. Worst of all, you will keep reminding yourself that it was your fault. If he heals without incident, it's no big deal. You're a surgeon. It's your job.

On the other hand, in an emergency you operate on a dying patient—or to be more precise, on a patient who will die if you do not operate on him. He's got everything to lose, and you can win it all for him. You're the star kicker fielded in the final seconds of the game to take your team to victory, kicking from a distance never before achieved. You've been practicing your whole career to perform above expectations, but if you can't that's OK. If he dies, no one will blame you. They'll understand you did the best you could. Like a soldier on the losing side, perhaps you made a mistake, perhaps not.

If he survives, however, you are a hero. Scrutiny is blind to the celebrated.

"Dr. Zohar—" Radezki began as he rinsed the antiseptic solution from his arms. I heard alarm in the tone of his voice. Something was worrying him. This was definitely the wrong time to get sidetracked by negativity.

"What's the matter, Pav?" Forgetting that my face was covered by mask I hoped my smile was encouraging. He was hesitant nonetheless.

"Well, you know—in two weeks I'll have to present Dr. Mantzur's recent pickup at the M&M."

Thank heavens it has nothing to do with this operation! Instead, it was about the M&M, the "Morbidity and Mortality" meetings where we regularly discuss events and complications leading to a patient's death. Pavel was obviously worried about getting into trouble with Mantzur, that's all. It was not easy for a resident to present at these meetings when one of the big shots like Mantzur was involved.

Page 14

I was wide-awake by this time and my body was starting to feel the exhilaration that precedes going to the unknown. It is a tension at the center of the stomach that doesn't disappear until the first cut has been made. When the action begins, the focus is on the patient and the patient only. My feelings are irrelevant. There's no room for your stomach to turn anxious somersaults in the OR.

Has anyone ever tried to write about all those feelings that go on in the surgeon's mind while he is scrubbing for the operation? I wish I could, but like my dreams the presence of creative thought is erased. One minute a brilliant and creative monologue. The next minute it's sucked into the vacuum of surgical criticality.

I turned right off Fourth Avenue onto Ninth Street and then into the hospital doctors' parking lot. I inserted the electronic card, and the railing opened up. The lot for the attending physicians was empty now, but not for long. It would soon be filled with cars branded Mercedes Benz, BMW, Lexus, and of course the customary large jeeps and SUVs whose farthest off road trek would be crossing a grassy median. I cast another glance at my watch as I rushed towards the OR from the physicians' parkade. Forty-three minutes.

On time.

Steam rose from the sink as hot water rushed in. Our dedicated resident Pavel Radezki and I watched the patient being put to sleep behind the glass wall and discussed the planned procedure as we washed our hands. I was calm, my neck muscles relaxed and the movements of my hands smooth. It is always the same: once the action approaches, the resentment of being bothered in the middle of the night is forgotten. Then, I'm eager to get started, sensing none of the usual tension I'd feel when scrubbing during the day for a major elective case.

Delay

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page 13

My black 1991 Caddy-Deville reached the top of the Verrazano Bridge and rolled towards Brooklyn. It was misty as the sun rose from Coney Island's side. I relished the sight, for the upper deck of the Verrazano offered a magnificent vista. In front there was Brooklyn, looking so peaceful with the mellow blanket of red and yellow leaves welcoming this late September day.

On the right Coney Island; below, the calm blue water dotted with ships steaming in and out of New York Harbor. On the left I could make out the southern tip of Manhattan and the Statue of Liberty, lit by the first rays of sunlight. And behind me was Staten Island, where I was awakened from a sound slumber about a half hour earlier.

It was a pleasant drive, unlike the routine rush-hour bumper-to-bumper morning crawl to Brooklyn. I tuned in the public radio station. It was too early for the morning news, but the classical music suited me just fine.

Driving is the only time I can think properly. Sometimes my thoughts embrace me so tightly I end up in front of the hospital without a clue as to how I got there. As I drove on, unimpeded by traffic, my thoughts drifted further and further into my memories...

...The outskirts of Johannesburg in a milky winter dawn, the smoggy air fed by thousands of wood fires on which early rising Soweto blacks cook their maize-meal for breakfast. Lady Mercy hospital with its casualty ward bursting at the seams; half-dead patients on woolen blankets groaning on bloodstained floors; knives, axes, screwdrivers, bicycle spokes still sticking out of their bodies.

Or the mist rising above Haifa's bay. The steady drumming of Israeli helicopters carrying in wounded from the northern front. They'd emerge from the black of night to land on the helipad by the sea and discharge their bloody and often noisy cargo... the nineteen year old boy shrieking as he tried to push his bowels back into his abdomen as we raced him to the trauma unit...

Brooklyn. I snapped back to the present. I took the Thirty Eighth Street turnoff and immediately started bouncing over the potholes anchored like land mines in the roadway.