"Your name's Peters, huh? Where you from?
Where'd you go to school? Oh, one of the big boys from back east, huh?"
There it was, reverse prejudice. It seemed crazy now that one of my strongest motivations for applying to medical school had been the idea of becoming a member of a highly educated fraternity, a group whose dedication and training put it beyond the trivialities and pettiness of everyday society. Needless to say, I no longer labored under that delusion; it had been riddled early in medical school. Nevertheless, the competition to get in was so keen that if you made it to one of the top few medical schools, it almost invariably meant mat you had really whizzed through college, usually with straight A's. Therefore, the guys who had to settle for their fifth or sixth choice of medical school usually felt like victims of a system in which performance was gauged by the harsh and immutable reality of the transcript. They thought the ivory-tower types looked upon them as second-class citizens. It was all nonsense. Everybody came out on the other side of that huge medical machine looking and thinking exactly the same, and with the same license to practice medicine. In fact, it was the sameness of these men that frightened me, not their differences, which were superficial. I had begun to suspect of late that the machine was producing a lopsided product.
Scrubbing is an invariable, monotonous, ten-minute routine. First under the nails, then a general wash, then the brush. Each surface in turn up to the elbow, then each finger. Start again. Back and forth.
The scrubbing done, I backed through the door, ass first — the perfect symbol of the intern's position — my hands raised in surrender and submission. That’s too theatrical. Actually, I was resigned by now. After all, it had been my own decision to go into medicine; no Romeo had ever panted harder after his Juliet. Too bad she had turned out to be such a bitch. These pseudophilosophic ramblings bore no fruit, changed nothing, but they did help to pass those interminable hours in the OR.
Towel, gown, then gloves, from a rather perfunctory nurse whose eyes I couldn't catch, and the routine was complete. We draped the patient while the surgeon, who was part Hawaiian, and the anesthesiologist, an Oriental, maintained a half-intelligible conversation in pidgin English.
"I go Vegas next week. You want go?" It was the anesthesiologist, looking blankly over the other screen.
"What, you think I that kind gambler?"
"You surgeon, you dat kind gambler." "Fuck you, pake. At least I ain't no fly-by-night gas passer."
"Ha! No gas, no work for you, kanaka."
I was on the right side of the patient, between the surgeon and the anesthesiologist, so that such priceless wisdom and Hawaiian linguistic exotica had to go right by me. The resident stood on the other side, inscrutable.
With everything ready, the surgeon picked up a knife and made the skin incision under the right rib cage. About halfway through the cut, everybody realized that the patient wasn't anesthetized deeply enough. In fact, he was twitching and moving about as if he had a generalized, unbearable itch. The surgeon and the anesthesiologist simultaneously gave nervous little laughs, the surgeon's a bit cynical, because he actually wanted to tell the anesthesiologist he didn't know what the hell he was doing. I don't know why the anesthesiologist laughed, except maybe to fend off the surgeon's broken-record sarcasm. Surgeons are not known for their tact or their love of anesthesiologists.
"Hey, brudda, whatcha madder wich ya? You saving da kind gas for the next patient? Geevum, man, geevum."
The anesthesiologist didn't say anything, and the surgeon continued, "Looks like we going to do this case with no help from the gas passer."
I was unavoidably a kind of referee in this verbal pugilism, literally squashed against the draped anesthesia screen by the surgeon. Not until they were finally inside the belly was I handed the all-too-familiar handle of a retractor, the intern's joy and raison d'etre. There are thousands of different kinds of retractors, but they all do the same thing: hold back the edges of the wound and the other organs so the surgeon can get at his target.
The surgeon positioned one of the retractors to his liking, motioned for me to take it, and told me to lift up rather than pull back. Well, I'd lift up for about two or three minutes, and then I'd pull back. From where I was standing, my leverage on the retractor handle was negative. Two or three minutes was my limit. "Lift up, goddamnit. Here, let me show you." The surgeon took the retractor out of my hands. "Like this." Amid further comments on my ineptitude, he lifted on the retractor for about two seconds before giving the handle back to me, whereupon I lifted up for two or three minutes and then pulled back. It was unavoidable. Show me the man who can lift up rather than pull back through a five-hour cholecystectomy, and I'll follow him to the ends of the earth.
Cholecystectomy is simply the medical name for the removal of a gall bladder. The gall bladder is tucked far up under the liver, and the intern is needed to pull back the liver and the upper portion of the incision so that the surgeon, with the help of the resident, can take it out. The gall bladder is a pretty unreliable organ, and, therefore, removing it is one of the most frequent surgical procedures. Of all the memory aids I'd learned in medical school, I best remembered the one about the average gall-bladder patient: the four fs—fat, female, forty, and flatulent.
Throughout the operation, my arms were more or less under the surgeon's left arm. He was pivoted away from me, presenting his back, which totally obscured the incision, somewhere over his shoulder. When the anesthesiologist switched on his portable radio and began glancing through a newspaper, and the surgeon began alternately humming and singing, both out of tune, the scene came less and less to resemble the tense silence of medical school — except for those outbursts of displeasure by the surgeon. They were the same.
"Okay, Peters, take a look." I peered over into the incision, a red oozing hole with surgical tapes holding back the abdominal organs. There was the gall bladder, the cystic duct, the common duct, the… "Okay, that's enough. Don't want to spoil you." The surgeon moved back, muscling me out, chuckling with the anesthesiologist. The operating room is a feudal world, with an absolute hierarchy and value system, in which the surgeon is the divine and almighty king, the anesthesiologist his sycophantic prince, and the intern his serf, supposedly grateful for any small scrap of recognition — a look inside or perhaps even the chance to tie a knot or two. That glimpse into the wound had been my reward for being there holding the retractors and watching either the surgeon's back or the hands of the wall clock as they crept slowly around.
The atmosphere was congenial enough, however, until the surgeon asked for the operative cholangio-gram, an X-ray study, to make sure he had the common duct well cleaned of gallbladder stones. This could be determined by injecting an opaque dye into the ducts and then X-raying the area. Any remaining stones would stand out.
When no X-ray technician appeared magically at the snap of his finger — all were busy on other cases — the surgeon cursed and waved his scalpel about, threatening dire reprisals. The nurses were immune to this display, as was the anesthesiologist, whose radio continued to drum out its patter of music and news. This familiar scene was played just about every time the need arose for a mid-operation X ray.