15
A couple of nurses and the anesthesiologist and I use Squillante’s bedsheet to lift him from his wheelable bed to the fixed table in the center of the operating room. It’s not that he weighs anything, but that the operating table is so narrow you need to get him perfectly squared up on it or he’ll fall off. As it is, his arms flop down until I lock a couple of armrests into place under them.
“I’m sorry,” he says as I screw them to the rails.
“Shut the f*ck up,” I say through my mask. Squillante’s the only one in the room not wearing scrubs, a mask, and a shower cap.
The anesthesiologist gives Squillante an opening salvo through one of his IVs. A mix of painkiller, paralytic, and amnestic. The amnestic is in case the paralytic works but the painkiller doesn’t, and Squillante spends the whole operation conscious but unable to move. At least he won’t remember to sue.
“I’m going to count backwards from five,” the anesthesiologist says. “When I get to one you’ll be asleep.”
“What am I, a f*ckin infant?” Squillante says.
Two seconds later he’s out cold and the anesthesiologist has a steel laryngoscope that’s curved like a crane’s beak down his throat. Shortly afterwards there’s a respirator tube down there too, and Squillante is, as the anesthesiologists say, “sucking the plastic dick.” The anesthesiologist checks airflow, squirts some K-Y-looking shit onto Squillante’s eyeballs, and tapes the lids shut. Then he bags Squillante’s head so that just the respirator tube sticks out. It instantly makes Squillante look like a medical school cadaver, where you bag the head for the first few months of anatomy class so it won’t dry out before you get to it.
I push Squillante’s empty bed out into the hall, where it will shortly be stolen and given to another patient, probably without the sheets being changed. But what am I going to do, use a bicycle lock? Then I go back in and velcro his arms and legs to the table, like in a monster movie. “Is this table electric?” I ask. Somebody laughs. I find a crank and arch Squillante’s back by hand.
A nurse finishes cutting Squillante’s gown off with scissors, revealing the fact that his scrotum drapes halfway down his thighs, like an apron. The nurse reaches for an electric razor. Another nurse is wrapping Squillante’s limbs in what looks like an inflatable mattress. If anyone remembers to turn it on later, it will fill with hot air and keep him from getting frostbite.
“Sir,” one of the medical students says, behind me.
“You want to scrub in?” I ask.
“Yes sir!”
“Go,” I say. To my other med student I say, “Go look up the LD50 of defenestration.”
Then I ask the circulating nurse to get Dr. Friendly on the phone.
Friendly answers after five rings, out of breath. Instead of “Hello,” or any other acceptable thing, he says, “I’m not the father. Kidding. It’s Friendly. Who’s this?”
“It’s Dr. Brown,” I say. “Your patient’s almost prepped.”
“I thought you said he was prepped,” Friendly says, when he finally shows up. Stacey comes in behind him, sheepish in her own mask and cap. Friendly has his hands up, soaking wet, with the backs facing forward.
Squillante is prepped. He’s just not draped.
Draping is when you cover everything but the precise area you’re operating on. Most surgeons want to be there when it happens, so that the patient doesn’t turn out to be, say, face down by mistake.
Then again, most surgeons don’t wear knee-high rubber boots to a gastrectomy, like Friendly is wearing. It can’t be a good sign.
Washing your hands, by the way, which Friendly has just done and which I did forty-five minutes ago, is the best part of surgery. You do it in the hallway, smacking the front of the steel sink with your hip to turn the faucet on. Despite the frigidity of the air, perfectly hot water comes out. You peel open a presoaked sponge pack that you get from the dispenser (presoaked in either iodine or an eight-syllable synthetic sterilizer made by Martin-Whiting Aldomed—your choice, though iodine smells better) then wash the shit out of your hands, including under your nails. You always wash upwards, from the fingertips to the elbows, making sure no water runs back down toward your fingertips. You’re supposed to do it for five minutes. You do it for three, which feels like a vacation, then bang the water off. The sponge you just drop in the sink. Cause you are done doing anything menial for the next few hours.
Right now, the five of us in the room who are “scrubbed in”—Dr. Friendly, the scrub nurse, the instruments nurse, my med student, and I—literally can’t scratch our own asses. In fact, we can’t pass our hands above our neck or below our waists, or touch anything that isn’t blue.*
Dr. Friendly dries his hands on a blue towel, then does the little dance where you plunge your arms into the paper gown the scrub nurse holds out, then into the gloves, and then you tear the cardboard card off the front of your gown (touching only the blue half) and hand it to the circulating nurse, who holds it while you spin around once, so that the belt of your gown tears loose and you can tie it. Friendly does his best to look bored during this, but I don’t buy it. It probably never gets old.
“I’ll take chain,” he announces. The instruments nurse opens a pair of chain-mail gloves and drops them onto the scrub nurse’s large blue table, where Friendly picks them up himself and puts them on over his rubber ones.
He clanks his fingertips together. “Now another pair of Dermagels.” He winks at me. “HIV risk. The patient was wearing a pinkie ring. And in my book, gay gets you the chain mail.”
The scrub nurse, a small Filipino man, rolls his eyes.
“Oh, what?” Friendly says. “You’re offended? I can’t say the word ‘gay’? Worry about that on your own time. Let’s work.” To the circulating nurse he says, “Music, please, Constance.”
The circulating nurse goes over to the boom box on one of the carts, and shortly afterwards that U2 song comes on about how Martin Luther King was shot in the early morning of April fourth. Martin Luther King was shot in the evening, even if you’re on Dublin time, but the U2 greatest-hits album is something you learn to live with in medicine. Every white surgeon over forty plays it. You learn to be grateful it’s not Coldplay.
The scrub nurse and I unfold a blue paper sheet over Squillante and tear out the section above his abdomen. Then we drop a square of iodine-perfused polymer onto the revealed skin. It fuses to Squillante’s wrinkles.
Friendly, meanwhile, wanders around with a stapler, stapling the paper sheet to Squillante’s skin. Stapling is pretty shocking the first time you see it. But the damage it does is minor compared to the damage from the surgery, and the old-schoolers swear by it. So people who want to act like the old-schoolers swear by it too.
As Friendly’s finishing up, my other med student comes into the room and whispers “The LD50 of defenestration is five stories, sir.”
To review, “LD” is “lethal dose,” and the LD50 is the lethal dose for 50 percent of people. Defenestration is being thrown out a window. So the student is telling me that if you throw a hundred people out a fifth-floor window, half of them will live.
“Jesus f*ck,” I say. I threw Skinflick out a sixth-story window. What does that make the odds?
And why can’t I catch a break? “What’s the usual cause of death?” I say.
“Aortic rupture,” the med student says.
“Okay.” The aorta, our largest artery, is essentially a long thin balloon, like the ones pedophiles twist into the shapes of animals.* Since it’s filled with blood, it makes sense that it would burst on impact. “What’s next?” I say.
“Head injury, then bleed-out from organ laceration,” the med student says.
“Good work,” I say.
My mouth fills up with bile as I think about it. Although my mouth has been filling with bile regularly since I ate my last four Moxfanes half an hour ago. At least I’m alert.
“Labs from the needle stick aren’t back yet, sir,” the med student says.
“Don’t worry about it,” I say. True, my forearm is throbbing, but Assman’s sample has probably long since been thrown out. If it ever got sent in the first place. Too many people’s workday would be lengthened by five minutes if it survived.
“Let’s do this,” Friendly says. He kicks a metal step stool into place on Squillante’s right and gets on it. The scrubbed-in med student kicks a stool into place farther down. I go to Squillante’s left side. The instruments nurse is already on a stool by the head, with his trays in place on their various booms.
“Okay, everybody,” Friendly says. “The patient is PMS. I know we’d all like to treat him specially because of that, like he’s a cop and we work at a drive-through. But we don’t work at a drive-through. So let’s be professionals.”
“What do you mean by ‘PMS?’” my med student asks.
“Post–Malpractice Suit,” Friendly says. “Settled a claim nine years ago.”*
I’m thankful my student asked, since I didn’t know what Friendly was talking about either. But I’m distracted. The Moxfane has just given me the weirdest feeling. Like I just lost consciousness, but only for a thousandth of a second.
“Signor?” Friendly says.
I shake the sensation off.
“Pen,” I say.
An instant later there’s a pen with the cap off in my hand. I’m not sure if the scrub nurse just uncapped it and handed it to the instruments nurse incredibly quickly, or whether I blacked out again for a moment. Either way, it’s creepy.
I stare down at Squillante’s abdomen. I’m assuming the incision is going to be vertical, since the only times I’ve seen transverse incisions on an abdomen have been in C-sections. I just have no idea how long the incision’s supposed to be, or where it’s supposed to start.
So I wave the pen slowly through the air above Squillante’s midline, like I’m trying to make up my mind, until Friendly finally says, “Right there is fine. Go, already.” Then I draw a line from that spot, which is just below the ribs, to Squillante’s pubic bone. I curve around the navel, since that’s basically impossible to repair if you slice it.
I hand the pen back to the instruments nurse and say “Knife.”