Monday, February 23, 2009

OR Dictations (Apologies to the estates of E. Hemingway and S. Beckett)

Laparoscopic Cholecystectomy:
The patient was wheeled in the room. The room was cold. My God it was cold. I shivered. I noticed others shivering. I shook my head. The lights were bright. It was a clean, well-lighted room and I could see everything clearly. There was no talking. I grunted at a nurse. I beckoned. I pointed. The patient was shifted from the cart to the OR table. I was pleased. It was good and I nodded at the old man. I washed my hands. I used powerful solvents. I washed them thoroughly. I scrubbed until the palms were raw and pink. I scrubbed until they were just on the verge of spontaneous hemorrhage. I dried off. I ruminated about my orchids. There was a late frost that morning. I left them out overnight. Damn the weather. The damned frost. I gowned and then draped everything sterilely. It was a clean and sterile working area. It smelled of the early morning. I was pleased. I asked for the knife. Some useless woman pressed a scalpel into my meaty palm. I will have my way with her later. I began to cut. It was an old but true blade, and these are the blades I use. It was sharp. I sliced. I made the flesh bleed. I pushed in my ports. I moved smoothly and efficiently. I was good. There was perfection. I made everyone recognize it. I dissected with smooth and precise movements. The organs were all brown and pink and glistened in the fiberoptic light. The gallbladder gave itself up. I pulled it out. I yelled at the nurses. I yelled loudly and firmly. I made myself heard. It was out. The gallbladder lay brown, broken, and defeated on the blue towel. I looked at it. I went to lunch. I drank grappa. End of dictation.


Right Colectomy
I entered the room. Who is the this I? Am I the surgeon? How shall I label myself. Who is this patient asleep on the OR table with a breathing tube hanging out his slacked jaw? Why is everyone looking at me? Am I here? Where am I? Someone is making me put on clean blue scrubs and sterile gloves. I allow it. It isn't me that does it. I cannot stop them. Maybe it was Krakow. Krakow would know. I begin. I must begin. If not I there is no one else whether I want it or not, rather, wanting to start, to cut, to operate, to begin, to start, the scalpel in my hand I incise, that is to say I make a long midline incision, it does not hurt, the patient is asleep presumably, assuming adequate anesthesia, I ask, just in case, the anesthesiologist, yes, it is ok, to begin, I begin and the blood starts to ooze and it oozes and in some places squirts and I ask Krakow for a cautery, is it Krakow who is here, is it rather Karkov, no matter, someone please hand me the cautery, regardless, I staunch the flow of unnecessary blood and the fascia opens up, I unzip the fascia, yes, yes, unzipped and the guts come spilling out, bulging, that is to say they spill out of the patient's abdomen, evicted almost, metaphorically speaking and I know this, I see it, I will speak of this again, shall I speak of it now, this me, this surgeon I am, the intestines bulge from my inflicted wound, i am sure the wound was from me, I hold the scalpel, the knife, after all, indeed, yes, and large metal retractors are placed, Balfour and Richardsons and I look and this is not me but the patient and I am inside, for the first time, is it the first time, have i been here before, surely I would remember, one would think, as I think and try to remember, I am encouraged to make progress by my assistant, Karkov/Karkow I cannot remember which I incise the lateral peritoneum and liberate the ascending colon, mobilizing it medially and the terminal ileum and gastrocolic ligament is divided between clamps and yes I have been here before, not explicitly here, but Here, in this spot, in this anatomical configuration, in the abdomen but not this abdomen, not specifically, not here, it was me, it was here, I was here, as long as I am honest, the point is not this patient but patients in general, the point being yes I have been here yes, I remember, and Krause is handing me a stapler and verbalizing hateful thoughts toward me and we divide the colon and then the terminal ileum and that didn't take long, how long have we been here, how long, where were we, where was I when I was I in this here before long ago which time it was I cannot remember, and I see Karkov clamping and tying the mesentery as I watch and I am thinking I ought to help if only I can remember, if I start, if I watch long enough, if I am the surgeon, if this would only have a name, if I start, if i remember, scissors and cutting, yes, of course, that is to say, snipping, trimming the sutures, and the colon is free, plopped into a metal pan, and then gone, I know not where, I am tracking it with my eyes, where is it going, people are shouting, crazed, angry looks on the nurse's faces I'm not sterile they scream, it's gone, the colon is gone, was it ever there to begin with, what have i done, did I do anything, was that which is now gone, namely the colon, is that which is gone, was it ever really there to begin with, I cannot recall, I ask Krakow and he is anastomosing the ileum to the transverse colon in a way I recall from ages ago, that is to say, from a time last week when I was doing something, let us call it an operation, in a similar fashion, may I call it an operation, is that being too presumptuous, do i presume to know, I cannot say, it's all going too fast and I look and again I'm snipping sutures, scissors I assume, it may be something else, perhaps metzenbaums, how is one to know, how is one to label, it doesn't matter, the sutures are shorter, the object is achieved, if that is indeed the object, is it the object, deargod what have I done, the sutures are shorter if that is the object, if only I knew the object, can someone tell me the object, Krakow or Karkov I would feel better, in other words I would sleep better, rest, recharge, knowing the object was in fact the shortening of tied sutures if this was clear and there was no possibility of other objects I would feel better, sleep, unconscious, undisturbed, better, yes, I would sleep better if this was clear, this object being the shortening of sutures yes and the fascia is mysteriously closed I looked down and the skin is coming together with staples and I have to assist I'll never know I have to go on I cant go on I must go on....

6 comments:

surgery resident said...

I love Hemingway! Your take on that was great!

Anonymous said...

Freaking great. Loved it

OHN said...

I have been transcribing forever and can tell you, without a doubt, this is a work of art :)

rlbates said...

I love this dictation! Clapping loudly!

Bianca Castafiore said...

Brilliant!

walt dandy said...

Finding a surgeon, or any physician, with your insight and worldview is a rare thing. You are a man among men, my friend.