Friday, July 20, 2007
"Do you want a foley?" nurses frequently ask before the beginning of abdominal operations -- referring, of course, to the patient. "No," is my invariable reply. "I peed before I got here." "Hah hah." I'm guessing at least a few people wonder: do surgeons ever need to, you know.... The answer is a resounding "occasionally." Many of us, after all, are physical beings.
I've had to take a bathroom break only once or twice in a pretty long career. And it was for the other, er, number. Certain intestinal disorder, don't you know. And yes, it's embarrassing. The leave-taking, the walking past the front desk ("Done already, Dr. Schwab?" "No, uh, taking a little personal time. Be right back. Gotta go..."), the looks on faces at my return. Eyes and foreheads are pretty expressive, above surgical masks. Nurses, being decent human beings, are likely to worry, "Are you OK?" Anesthesia folk, ever witty, can be counted on to say something pithy. Nigel or Lynn, especially. "This should be refreshing. Finally you're less full of it." I can take it.
More common is flagging during an especially long, physically and emotionally taxing case; particularly late in the day, or during or after a long night on call. More than a few times I've asked for a shot of orange juice. It never tastes better, nor has more power of rejuvenation. Some poor nurse has to hie to the fridge in the lounge, scout up a straw (the bendy kind), and wiggle it behind my mask (first making an opening with a finger), while I lean toward her or him to keep from contaminating my gown, and use prehensile lips to try to arrest the tip and insert it into my mouth. Glug, glug. When it's cold, it's sesqui-orgasmic. I've also had candies digitally inserted behind my mask and guided to my lips. I always assumed the nurses didn't find it particularly appealing to do; but I've never been more grateful.
Angels of understanding, there's a couple of nurses -- ones with whom the relationship goes way back -- who've ascended a step-stool and given me a neck rub after I've stopped for the second or third time, leaned back from the table, and stretched. Oh man!! I flap my foot like a belly-scratched dog, and swear devotion till death.
Eschewing cold medicine, I've put a layer of gauze in my mask, under my nose. Drips. And, slightly off topic but nose related, I've gratefully accepted a swipe of benzoin (for its aroma) onto my mask when encountering a particularly putrid pus-pocket, or a well-rotted intestinal infarction. (Actually, I've used it pretty rarely: I've always thought draining pus was among the more noble things a surgeon does: and when it stinks up a room to the point of turning green those who must stay, and driving away those who can find an excuse to exit, there's no need to wonder if you're doing good for the patient. So, in a way, I like it. Dead bowel? Not so much.)
In the operating room, I've been poked, stabbed, cut, and cauterized. My left index finger bears the scar of a scalpeled flap, a centimeter at its base, equally tall: the result of an episode in training that sent me to the ER with a spurting digital artery, and after the sewing-up of which I returned to find my attacker/assistant (it was one of those rush-jobs: as I was ten seconds into opening the belly in the midst of a flood of blood, he reached to pinch off the aorta, banging my elbow...) happily repairing the patient's iliac artery as the attending looked up with amused eyes skrinkling above his mask.
Somewhere along the line, I converted my hepatitis antigens: probably from a needle-stick at San Francisco General Hospital, only a few years before HIV ravaged the place. Digging my way behind the rectum in a deep and narrow male pelvis, I've shaken cramps out of the palm of my hand. The backs of my knees have ached and the fronts wobbled as I leaned for hours into a tough dissection. I started wearing support hose in the OR way before middle age. Stasis dermatitis (mild) made itself known while I was Chief Resident.
If there's a point here, it's this: much as I like to emphasize on this blog that surgery is a thinking person's sport, there are times when it's all about the body.