circulating nurse, and an anesthetist. Allen, Durga, and the tech worked in direct contact with the patient and observed the sterile barrier. So they were gloved and gowned. The anesthetist, the circulating nurse, and the anesthesiologist-if she wandered in-were not sterile.
The first patient shuffled in, a middle-aged man wearing a hospital gown. Allen matched the face to the procedure on the surgery schedule: bilateral inguinal hernia repair.
They eased the patient onto the operating table. He looked up a little wary at the huge circular AMSCO quantum surgical lights hovering over him on jointed arms, like the wings of a robotic angel. Next, the patient eyed the anesthesia machine which sprouted pumps, dials, tubes, and digital screens.
“You’re going to be just fine,” Allen said.
Then the anesthetist ran his IV and hooked up his monitor leads and injected Versed in the IV, which he followed with a shot of Sublimaze. The patient was masked, pre-oxygenated, and then was put under with Pentothal.
All smooth, amid casual banter about
“Really, really overrated,” said Jeannie, the circulating nurse.
“Fakey, I thought, the wooden stuff hanging in the trees,” said Jerry, the anesthetist.
“Smart, though,” offered Allen. “Remember the way they hyped it on the web?”
After Pentothal, the muscle relaxant, succinylcholine, was administered. The patient shuddered. Behind his mask, Allen clicked his teeth. It was the same kind of muscular spasm that he had caused in Hank Sommer.
Allen took a deep breath and waited as the patient lost control of his muscles and went flaccid. Expertly, the anesthetist fitted a plastic shield over the patient’s teeth, then inserted an instrument like a stainless-steel, right- angled trowel-a laryngoscopic blade-into the sedated man’s throat. The patient’s head shifted as the blade was levered forward and upward to elevate the epiglottis and expose the glotal opening. Then the anesthetist inserted a plastic tracheal tube, hooked up the breathing circuit to the machine, and pumped nitrous oxide into the patient’s lungs.
Allen directed everything that occurred in the OR with verbal instructions. Nonverbal cues were conveyed through the eyes, the only feature that showed above the surgical masks. Surgical teams were close watchers, especially of their surgeon leader. Now all the eyes in the room keyed on him, to sense his mood, to see what kind of day he’d have.
He heard them whisper that he hadn’t shaved this morning and what did it mean?
The patient’s stomach was draped with sterile blue sheets. Another sterile blue sheet separated the patient’s head from the operating field. The human shape became abstract. Allen’s target was an anonymous shaved square of belly which had been designated with a rubber stamp: LEFT.
The tech unwrapped and positioned a sterile tray that contained the instruments for hernia repair, the square of exposed flesh was washed with orange Betadine disinfectant. One last point of etiquette remained: the choice of music on the CD player that sat on a table along one wall.
The eyes over the masks turned to Allen who always selected the music.
“Jeannie, pick us some sounds,” Allen said casually to the circulating nurse.
Allen could feel the slight lift in the room as Jeannie spun some Sheryl Crowe. Allen held up a gloved hand, the scrub tech firmly put a scalpel in it, and he made the first incision.
And so the day proceeded under the hot surgical lights. In between procedures, Allen moved between the pre op suites, where he interviewed his next patient, and the consult room, where he spoke briefly with the family of his last procedure.
A hemorrhoidectomy.
A left-breast biopsy.
Time out to consult on a patient in emergency, then back down to surgery to remove another suspect lump from an elderly woman’s breast and run it though Radiology.
Lunch was interrupted by a page to consult on a man admitted with a numb, discolored leg and a history of heart problems. Allen jogged up two flights of stairs, saw the patient, and agreed with the internist to give the man a clot-busting drug.
The hours floated by with soft intensity like a long, almost weightless parachute drop.
And soon it would end, after the last scheduled procedure, a laparoscopic cholecystectomy. The lap choly was a routine gallbladder removal using a laparoscopic wand that contained a miniature video camera and lights.
After the patient was intubated and breathing on the machine, his abdominal cavity was inflated with carbon dioxide gas. A ten-millimeter sheath was poked inside through a port incision above the navel. Then the camera was inserted in the sleeve.
Two television monitors were positioned on either side of the operating table, so Allen and his resident could both easily view the liver and gallbladder.
Three other ports were incised higher in the stomach wall on the patient’s right-hand side, just beneath the liver. And sleeves were inserted. Two for the resident to handle his forceps and one midbelly, for Allen to use the dissecting forceps, in this case an electric cautery.
Laparoscopy was essentially a spatial-orientation video game played on a living person. Allen held the rotating, pistol-grip forceps controls in his hands and coordinated the working end of the forceps to the image the camera projected on the television towers.
The glistening coral-colored formations of human inner space reminded Allen of spelunking, going into underwater caves with Aqua-Lung and handheld lights-something he hadn’t tried yet. Maybe Milt would go for it?
“Lights,” Allen said. The powerful overhead lights were turned off.
“Music,” Allen said. Again Jeannie chose. Bruce Springsteen belted out “Born to Run” as the resident gripped the gallbladder with a forceps and positioned it against the liver. With exquisitely fine muscle control and timing, Allen clipped the cystic artery and duct with titanium staples, then severed them. He then carved the gallbladder free from the liver bed with the cautery. Before removing it through the umbilical port, as he tidied up some minor bleeders with the cautery, he had an attack of sheer whimsy.
Or perhaps inspiration.
To underscore the new boost in his mood, or perhaps to honor the secret transgression that had launched him out of his rut-Allen acted on impulse in a fleeting moment when no one was watching the video towers. With a deft whirl of the cautery controls he seared two letters into the patient’s abdominal wall:
His own initials up on the screens.
No harm done, it would heal in a few days. It was just a tiny flourish. He would have preferred Vivaldi trumpets instead of Clarence Clemons’s saxophone, but, hey, what the hell. .
Allen stripped off his last sterile gown of the day and tossed it in a hamper. Then he dictated his notes and was on his way to the locker room when he met Merman in the hall.
“So how do you code an ostrich kick?” Merman asked.
“What’s this, another joke?” Allen was mildly intrigued.
“No way. ER just admitted a guy with a transverse fracture of the left humerus. Bam. One kick.”
“Where did it happen? At a zoo?”
“No idea. C’mon, take a look at his arm, the nurse in ER said the kick tore a hole in a heavy leather sleeve and you can see the scale pattern of the bird’s toe knuckle in the mangled skin.”
“That’d be worth seeing,” Allen said, genuinely curious. He kept pace with Merman as they left surgery, went around the pre op admitting desk, and headed down the corridor to Emergency. They turned a corner and, ahead of them, a group of nurses and the ER doc were gathered around a man on a gurney and-
Allen immediately stood absolutely still and let Merman continue on alone.
The patient was Earl Garf.
And Phil Broker was standing at the edge of the medical huddle.
And right next to Broker, holding on to his elbow real friendly-like, was the nurse-anesthetist from Ely, Minnesota: Amy Skoda.
