Monday, February 25, 2008

You Are So Beautiful

Do you have any idea how beautiful you are? Well, okay; maybe for some it's were. Before you got a little thick in the middle, smoked, or even just breathed city air for enough years, or drank a little, or did a few drugs, there was a time -- and maybe it's still true -- when you were knock-down, take-your-breath-away gorgeous. Many times while operating inside a belly I've stopped working and just looked, and then said to the others in the room, "C'mere everyone, look at this. Look how beautiful it is." Because it's true. Really, you should see yourself.

Operating, as is our aim, on sick people, more often than not things aren't so pretty inside. Diabetic, or old, or overweight, or with concomitant diseases affecting various organs, typical surgical patients rarely retain the born-in beauty and peach-fuzz perfection with which they came into the world. But sometimes bad things happen to the well-kept or the young, and, in another of those paradoxical disconnects of the surgical mind, we are given a moment to find pleasure despite another's pain. Sometimes it's just all look-at-me laid out, not hidden in adipose, undistorted; the logic, the development, the relationships, the purity so bright as to be stupefying. Who gets to witness it, who's allowed at the window? Not many. Me, amazingly enough. Let me try to show you what I mean.

More often than not, when inside a belly what you see is this:

The grayish stuff is intestine. The yellow, of course, is fat, covering blood vessels and other structures you'd like to be able to identify. Here's another view:

If you know what you're looking at, you'd be able to tell what's underneath:

So you dissect, and scrape, and burrow through fat, and you find what you need, and deal with it. But sometimes, wonderfully, amazingly, it looks like this (the picture might not be of a human. The fact that I couldn't find a picture only underscores the rarity. But the point remains):

Imagine the joy! Not only is the operation immeasurably easier, it allows a look at the exquisite elegance of our bodies as they were meant to be. A basic principle of surgical technique is traction and counter-traction: elevating or spreading tissues and applying pressure in opposite directions to stretch things out, making dissection possible. When you pick up a loop of bowel to get that tension, most often there's much more work to do until you find the target vessels. But sometimes, like that picture above, it's all there. You can see right through it. If you like doing surgery, it's impossible not to be ecstatic. Like rounding a bend after a long climb and being able to see forever, you must stop and savor it. You can be precise and gentle; the tissues require no more, and deserve no less. There's something like sadness when the operation is over.

Down the backside of the abdominal cavity runs all the plumbing: the aorta, bigger around than your thumb, carrying blood from the heart; the vena cava, bulging and blue, bringing it back; the ureters, carrying urine from the kidneys to the bladder. More often than not, they're hidden by fat. When you can see them -- the aorta, at least, and its branches -- they're often pocked and corroded, rusted and irregular. But just often enough to be a thrilling surprise, you can see them in all their orderly complexity; shiny and pristine, they ought to sizzle like high-tension wires.

Those big blue veins are both turgid and tender, scarily so. Their thinness speaks loudly of danger. Like a powerful waterfall, they call you closer, even as your knees feel weak. And the aorta, in the young and healthy, is a wonder. Its walls are strong and thick, but they bulge with each heartbeat. Retaining their natural elasticity (before inevitably giving it up to cholesterol) they throb and push against your fingers; simultaneously static and brimming with life. Knowing the power enclosed within (poke a hole and see what happens!), it's like standing at Kilauea and feeling tremors. Smaller branches, curlicued in the mesentery, lift and uncoil, stretching out and falling back, to the music of the heart monitor. It can be mesmerizing.

Much more than simple tubes, the ureters produce sensuous muscular waves, more subtle than gut peristalsis and less frequent, and therefore more pleasing. When unsure what you're looking at, rather than wait you can pinch with a forceps or give a flick with your finger: it'll respond with a lazy roll. Sometimes, just for the pleasure, I've done it more than once.


egomosperficio said...

an interesting portrait of our insides, sid. it makes me want to forgo the bacon and get back to jogging. although i am fairly lean, i can't help but wonder if my organs are coated in a yellow icing of fat.

it is amusing and fascinating to think that our personal and professional interests have the power to make us ecstatic about things that others might find quite dull [and, in your case, gross!].

another great post.

rlbates said...

It is beautiful! I agree. (didn't know what to say yesterday, as I have many of the same questions for God. Not ready to give up on Him though. Enjoyed the post and the comments)

Sid Schwab said...

ramona: I gave you an excused absence.

Anonymous said...

Wow....Here in Australia we see many "Quit smoking Commercials" designed to Shock us by showing what a smokers lung looks like...maybe we should think about showing internal images of obese peoples organs....Seeing the disgusting yellow stuff that coats our organs might be enough to stop some of us from shoveling fatty foods down our throats.

Nice post.


Anonymous said...

Breath-taking! It is inspiring and comforting to know how much awe and respect you find in the human body, despite wear, tear, neglect and abuse. You have such a genuine excited, compelling and pied piper way of bringing your readers along for the adventure! (Have you ever considered pitching a show about your surgical exploration guides to a venue such as PBS or The Discovery Channel?)

Sid Schwab said...

Annie: I love that you think that highly of it, but I'm quite sure I'm not up to the standards of those venues!

Anonymous said...

I beg to differ! You have such a wonderful conversational style, you're accurate, detailed, non-threatening, and your writing style is inviting! (No, I am not being paid for this endorsement =^} ). Here's a story pitch link, just in case I can pursuade you to consider the idea. I hope you'll pitch one becasue it will go directly over home plate! (How many metaphors did I mix - d@^% dyslexia!)

SeaSpray said...

I feel as though I have been romanced into falling in love with some stranger's abdominal cavity and their inner workings in all their glory. Your words are as doubt wooing us in through your love and admiration for those special moments.

I remain in awe of your appreciation for what you do as a surgeon. I guess you could say that I am in awe that you are in awe...even after so many years of practice. I wish I was in that OR to see what you saw and understand it through your eyes.

Your patients are blessed to have a surgeon who cares so much.

I am linking this. This post is right up there with Taking Trust!

Thank you! :)

P.S. I would love to see a character like YOU on Grey's Anatomy. :)

JP said...

This was a lovely post. And it blows the fear of "being seen in a bikini" right out of the water. I doubt this was your intention, but thx nonetheless (I'm going to work out right now)!

SeaSpray said...

P.S. Those beautiful innards sound like God's handiwork to me. ;)You see what he intended and you see what free will exercised can do...yellow, mushy corn pops of fat.

You know...I really DO believe that. Just got done reading the previous post and comments. Well written post, can appreciate your frustration and what you and some others don't understand. Wrestling with whether or not to jump in. I don't want to alienate anyone. :)

SeaSpray said...

So...did you break out into that song, complete with OR staff's perfectly choreographed dancing around the stretcher when you witnessed such beauty and perfection in your patient's abd cavity?? ;)

Øystein said...

Nice post!

I think the peritoneum is one of the most beautiful structures of our insides. As in this picture of mine.

Got your book the other day, btw. Enoying it immensely!

Sid Schwab said...

seaspray: I sang a lot in the OR, but usually when closing. And when I did, it was either from my Russian songbook, or Rogers and Hammerstein... sometimes, if the music playing was irresistable, I'd sing with that. In the former case, the nurse might well turn the ambient music up. In the latter, it might be turned off.

sterileeye: nice picture. It is indeed a wondrous structure -- shiny and slippery and able to do many things.

SeaSpray said...

Dang...wish I was in that OR! :)

Russian? I have always been intrigued by Russian history. I don't know why. Also anything French and again don't know why.

Singing in the OR...You DO LOVE your work! :)

Lisa said...

Sid, your work of art is beautiful too; your words.

Once again you captivate me. :)

Anonymous said...

A very nice thing about regularly enjoying the medical blogs is a growing wonder at the human body, and your blog is one of the best, Sid. Since starting to read these blogs almost two years ago, every day I come across words that I have to go to the online medical dictionaries (now have several available) to get a small understanding, and that has lead me often to do further research, even to understand basic cells, enzymes, etc, and how they interact to produce other things, etc, etc, etc. And online there are animated videos and drawings and photos of the incredible things going on continually in our bodies. I'm retired now and can spend lots of time online discovering what actually is an incredible universe which seems to me far more complex than the stars, etc. I've always been in excellent health because as a young teenager and later a wife and mother I knew to pay attention to that, and I luckily did a lot of the right things, such as limiting sugar and refined flour in our diets, daily exercise, basic vitamins, moderation in most things, though, and it all paid off. Every one of my parents and grandparents and siblings had extreme high blood pressure and died young of heart disease, and some had diabetes, allergies, obesity and high lipids as well as other diseases, but I and my family never have had those problems. Today, reading your post, was so inspiring, not because I think I will escape the ravages of time and eventual death, but because it once again made me so appreciative of the formidable strengths of the human body, a strong physical foundation for living life to the fullest to the end. Even when injured it compensates! Well, would you think me a little nutty if I say I have come to believe that my "mind" is all of brain and every other thing in my body, working together?

Øystein said...

I was filming what must be the exact opposite of abdominal beauty today - an operation on a patient with pseudomyxoma peritonei

Anonymous said...

Start> Programs> Windows Media player

File> Open file..> 8 min abs workout.avi the first thing I want to do after reading your article, and hmm I wonder how often you do see a 'beautiful intact' internal system.

Phil Needes said...

It does seem like you Sid to be using a Ligasure Atlas instrument to divide the ileo-colic vessels, were you assisting?

Anonymous said...

I came upon your blog accidentally this morning, looking for the lyrics to "you are so beautiful to me," and I feel lucky. (this kind of surprise the best part of internet research, right?)
What a marvelous, evocative post. And somehow reassuring, too. So many of us fear surgeons -- at least feel intimidated by their abilities and their seeming power over life and death. To know that a surgeon can see the unexpected beauty of a patient's insides, and can stand in awe of the human body in all of it's strength and frailty, is just great.
Thanks so much for giving us the chance to experience what you experience -- to share a perspective that, as you say, most of us will never get to have first-hand.
Your new fan,


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