A technician finally came and took the shot, returning in a few minutes with a foggy blur, which the surgeon pronounced the most inept attempt since Roentgen himself. Did he want another taken? No! There is much to learn about the surgeon. I was sure, on reflection, that he wanted that X ray because he had read about it in some journal and thought it would look good on the operative record. The practical effect of the X ray was at best neutral — the way he utilized it, at any rate.
The next day a radiologist would struggle with the X ray, trying to figure out which end should be up and why the hemostat showed in the middle of the ductal system. His report would be sheer guesswork. The unhappy ending of this episode would come later, when the surgeon said something sarcastic to the radiologist, who would smile wryly and reply that if the surgeons could organize themselves a little, radiology might be able to do something. In truth, the surgeons are often at war with everyone— with radiology, pathology, anesthesiology, the operating schedule, residents, nurses, interns — constantly surrounded, they feel, by an ungrateful and inept staff. In a word, many of them are quite paranoid.
Once the retracting had been completed, I prefaced a request to leave with a brief explanation about Mrs. Takura and was excused from the rest of the cholecystectomy. As I stepped out of the operating room into the corridor, the surgeon was still deep in his complaint about X-ray and the anesthesiologist still absorbed in his newspaper.
The work had already started on Mrs. Takura when I began scrubbing the second time. I could see the chief surgical resident and the first-year resident, Carno, busily inserting subcutaneous clamps. Carno and I had come to Hawaii at the same time, for the same reason — to get away from the pressure and have a little fun. In the first few days we had hit it off pretty well, and had even considered getting an apartment together. But now our schedules made it hard to get together.
Friendship among medical people is difficult and elusive, much harder than in college. There is so little time for it. Everyone tends to draw more and more inward, become almost autistic, even when free. In the later years of medical school, the on-call schedules are so different that you can't count on anybody showing up for dinner or a party. Sometimes I couldn't even count on myself. I'd often make plans and then feel too washed out to carry them through.
Also, there was the unavoidable competition. It had settled on us from our very first day, like the spores of a fungus, beginning with the premise that medicine was at its zenith in the research-oriented university center. That was where the "good guys" ended up. To get there, you first had to have a residency at a university center, and for that you needed an internship in one of a handful of princely hospitals. We had been told right off that the top four or five in the class would be asked to stay on as interns, the golden ticket to advance one more giant step. Pressure! There were about 130 of us, all good students in college, and all stumbling around in a haze, sopping up facts as fast as we could and accepting the value system that told us we had to stay on the top. The alternative, too horrible to contemplate, was that we would FAIL and end up in a small-town general practice. That was made to sound bad, really bad, like going from the executive suite to the mail room.
It didn't make any difference if you did well; everyone in the group could do that. After all, we were horses trained to run, and we ran like hell. The real point was to do better than the next guy. That didn't create a congenial environment for friendship, especially when you were short of time, and the time you did have you invariably wanted to spend with a girl.
The system affected that, too, especially during the last couple of years. At first, being a medical student gave you a certain mystique at cocktail parties— everybody thought you were sure to make it into the big money someday. But gradually, since your schedule was so screwed up, you couldn't count on being anywhere at the right time, and you came to be considered a bad risk. All those lovelies from Smith and Wellesley, the ones you were used to, drifted away to more fertile ground. So we had turned to the girls who were there, the ones with the crazy schedules just like ours. And they turned to us. The hospital was full of girls — technicians, instructors, nurses, nursing students — many of them damn nice, and most of them conveniently available.
As our training forced us into the mold, we withdrew into ourselves and into the artificial world of the medical school and the hospital. The change was imperceptible, almost unconscious, but steady; once on the escalator leading to the ivory tower, we stayed on it, intellectually. Even though I'd come to Hawaii, I hadn't split totally. Never would. I still had a foot in the door back east; at least, I hoped so. I wasn't a rebel or a revolutionary, just a little worried about where I was going.
Right now I was going into the OR with Mrs. Takura, backing in again with my hands up, ready to be gowned and gloved. They were just getting into the abdomen, and the chief resident motioned me to his left side. After I had squeezed into my position between him and the anesthesia screen, he handed over the legendary retractors and we settled, in, this time for eight hours.
It was hard to recognize nice old Mrs. Takura. Instead of being her usual agreeable and considerate self, she was bleeding all over the place. She had had a cholecystectomy several years back, and it was difficult operating through all the adhesions and fibrous tissue. About two hours into the operation, we took time out to plug a little puncture in the bowel, and then a strong "bleeder" that was squirting on Carno's chest. As her blood pressure sagged, full bottles of blood replaced the empty ones. It was a tough, long procedure, but the chief resident seemed to be doing a good job. Any levity that might have existed earlier disappeared as fatigue crept over us.
Although you would never know it from watching television, humor plays a big part in the operating room. To be sure, it is often grisly, and often at the expense of an unwitting and innocent patient. Most surgeons can regale an operating team for hours with bizarre and off-color tales from the past. With my limited experience, and therefore a limited repertoire, I was mostly silent during these performances, but just before getting serious about Mrs. Takura, when everybody was still feeling good, I ventured a story that was a favorite in my medical school.
It seems that an enormously obese lady had once appeared at the hospital during a time when the OR was covered only by two interns and a resident. She complained of an agonizing abdominal pain. Elbow deep in fatty tissue, the three examined her, conferred, re-examined, and conferred again, unable to agree on a diagnosis. Finally those who thought she had a hot appendix won out, and up the lady went to the OR, where she was literally draped all over the table. Hearing of the action, a small band of six or seven others had gathered by the time the resident began cutting down through the layers of fat toward the peritoneal cavity. After repositioning the retractors several times, as he moved in deeper and deeper, he suddenly stopped and had the overhead light readjusted. Then he asked for a pair of tongs, and while everyone watched in anticipation, he brought up through the lady a piece of white cloth. A stunned silence fell over the assemblage until, simultaneously, everyone realized that the resident had cut all the way through to the operating table. The patient's abdomen, being so large, had skewed off to the left, causing the resident to miss the abdominal cavity entirely.
But the laughter from that story had long since drifted away. We labored now inside Mrs. Takura, and the muscles in my hands and arms were numb from maintaining tension on the retractors in that awkward position hour after hour. As lunch-rime approached and receded, my stomach growled in protest, a counterpoint to the itch on my nose. My bladder was so full I didn't dare lean against the operating table. Time crept on. I seldom saw into the wound, although I could tell what was happening from the surgeon's comments. Fastidiously the vessels were sewn together — a side-to-side anastomosis — and the final suture was placed and run down with tired fingers. When I was at last relieved of the retractors, I couldn't even open my fists; they stayed clenched until I bent the fingers back one by one and soaked them in warm water.