Wednesday, November 14, 2007
Veins and Ducts
Inside a vein, it's always perfect. No matter the state of the rest of the body, when you open a vein and look inside it's smooth and shiny and slippery. The inner wall glistens and lavishes the eye with a creamy-khaki surface. Not that it's common to get into one on purpose: but for things as minor as a cut-down (directly opening a vein to insert a large IV), or as major as a portal-vein decompression (a finger-in-the-dike procedure to stave off the effects of cirrhosis), the lumen of a vein seems impervious to the ravages going on around it. It's like pushing through an old house stacked full of garbage, and finding a tiny closet, empty and clean, floor all waxed and sparkling. A private, preserved space, kept pristine for secret reasons. (Arteries, not so much.)
The bile duct is like that, too, if a little less certainly. When there's obstruction with infection, it can get red and thick, the inner surface knobbly and cobbled. Mostly, though, it's a similar wonder: clean and crisp and sparkling on the inside. There's something about these vessels and ducts that foster their own brand of amazement. Springy and soft, yet turgid and tough. Sewing a vein, unlike anything else, (as long as it's not during a mad rescue attempt) is almost meditative. It's quiet; maybe because the suture is finer, the instruments more delicate than with other kinds. And because it demands the perfection of needlepoint: even bites, close, careful and exact. There's rubbery resistance to the needle which gives way with a little recoil. There's no tissue quite like it. If creating, say, an arteriovenous fistula for dialysis, or if sewing a vein-patch onto an artery, you go through the vein first with the needle, and the textural difference is clear. Sometimes, you hold the slender suture between thumb and index finger of one hand, gently tugging upward to tent and approximate the edges, while suturing with the other. Very gently. The vein is more plastic, thinner, versatile. And, always, cleaner. When you release flow, the vein bulges, and holds.
Sometimes, it's the same with a bile duct: you might be closing a hole, sewing edge to edge. More often it's to make a connection between duct and bowel, and the two couldn't be more different. (Well, yes, they could. But if they were, you probably couldn't connect them at all.) Then, it's more of a puzzle: getting together two things of entirely different thickness and texture, one of gross and separating layers and another of imperceptible ones. It's a challenge and has its own rewards, but not the quiet kind that veins provide.
A vein, laid open but stilled of flow. A silky surface even when lying next to corporeal corruption. It's not a big thing, really; but seeing it time and again, is somehow reassuring. A signal that things might be made right. If one place in this person is still okay, maybe the rest can still get there.