Monday, July 1, 5:20 p.m.
Mitt raised his eyes to look at the wall clock and marveled at the position of the hour hand. In many ways he couldn’t believe he was still on the same case. It had been close to eight hours since he’d entered OR #12. Even more impressive, Dr. Washington, Dr. Rodriguez, and Dr. Wu had been working for almost ten hours.
As a medical student Mitt had heard of exceptionally long surgical procedures, but he’d been led to believe they involved unusual cases like face transplants or the separation of conjoined twins that require the participation of multiple surgical specialties and not more routine conditions like an abdominal aneurysm. Never in his wildest imagination could he have guessed he’d be caught up in such a rite of passage on his very first case as a surgical resident. Was such an unusual, luck-of-the-draw circumstance a good omen or a bad one as far as his residency was concerned? He had no idea, and there was no way to guess. All he knew was that he was currently bored silly.
On the positive side, since the conclusion of the difficult suturing of the proximal section of the graft when his view of the operative field had been completely blocked, he’d been able to see—and thanks to Dr. Washington’s explanations to understand—what was transpiring even though he wasn’t contributing much. Consequently, he knew exactly why the case was dragging on for so long. It was all because the patient’s aorta, at least the abdominal portion, had extensive developmental abnormalities, causing its wall to be considerably thin and friable. It was this problem that explained not only the origin of the aneurysm but also why Dr. Washington had had to remove more and more of the vessel to find a portion strong enough to hold sutures. He was doing this by taking progressive biopsies and sending them off to Clinical Pathology. Unfortunately, as this process continued, it involved sacrificing sections of the aorta with branches that provided arterial blood to various abdominal organs including the kidneys. Each of these vessels had to be separately connected to the graft, requiring a ton more suturing and lots more time.
But the technical difficulty of the surgery wasn’t the only reason the case was taking so long. The tension between the surgeon and the scrub nurse had continued, underlining for Mitt how important it was that their interaction be smooth. Not long after the forceps incident, there was an awkward handoff of a needle holder. At the time, Dr. Washington reached for it without taking his eyes from the site where he intended to place the next suture, but then moved his hand. As a result, instead of the instrument being slapped into his waiting palm, it hit up against his thumb and fell onto the drapes.
Again, from Mitt’s vantage point, there was blame on both sides. Dr. Washington’s hand had definitely moved at the last second, but it was also true that the scrub nurse had let go of the instrument too soon in her eagerness to pick up the empty needle holder the surgeon had just dropped onto the drapes. It was like a miscue between track-and-field sprinters exchanging a baton in a relay race.
Since there was already a degree of acrimony in the air from the previous miscues and since both the surgeon and the scrub nurse were strong-willed and highly confident in their professional abilities, neither was about to accept responsibility. The result was a harangue from the surgeon followed by one from the scrub nurse followed by a pregnant pause as if a time bomb was about to go off. It took the anesthesiologist to speak up and remind everyone that, in his words, “time’s a-wasting.” “Come on, guys,” he added. “Call a truce! We need to finish up this case.”
Luckily for all concerned, 3:00 p.m. rolled around soon after, which saw a shift change, and a new scrub nurse and circulating nurse arrived to take the place of those going off duty. Dr. Washington made a point to greet the new scrub nurse as if she were a savior, immediately complimenting her on how smoothly she took over. From that point on, the atmosphere improved, and things continued apace.
Fortunately neither Mitt nor any of the other members of the surgical team had to stay in the OR continuously, as the case dragged on for hours. Everyone got to take a bathroom break, which meant leaving the OR. An hour previously, it had been Mitt’s turn. When the urge to urinate had reached a critical state, he’d hesitantly brought up the subject, and Dr. Washington responded by saying: “Of course you can take a break. I was beginning to worry you weren’t human.” Dr. Washington laughed at his weak attempt at humor. He, Rodriguez, and Wu had all already taken their breaks.
Mitt couldn’t believe how much he appreciated getting out of OR #12 even for a few minutes. And he made the best of the time. After relieving himself in the men’s locker room, he paused in the surgical lounge to check his phone for messages. There were two. One from Dr. Van Dyke saying that he had been assigned three patients who were being admitted that afternoon for surgery tomorrow: Ella Thompson, age eighty-two, for an aortic valve replacement; Roberto Silva, age sixty-three, for a pancreatectomy; and Bianca Perez, age seventy-one, for a colectomy. She went on to say he would be responsible for doing their histories and physicals and presenting them briefly on rounds in the morning before scrubbing in on their surgeries.
The second text was from Andrea, asking him to give her a call when he was finished with his case. Although Mitt wasn’t done with the aneurysm repair, he took the time to call her. He felt the need to complain to someone and get a bit of sympathy, and there was no one better qualified than Andrea.
“It’s about time,” Andrea said immediately on answering, pretending to be miffed. “Where have you been? Why haven’t you called? Did you not get my text?”
“If you can believe it, I just got it now,” Mitt said. “Seriously, I’m still caught in OR #12 on the same case I was initially assigned. I was just allowed out a few minutes ago to take a leak.”
“Jesus,” Andrea remarked. “That sounds terrible. Has it at least been interesting?”
“Not for the first couple of hours. All I was doing was holding a retractor. And to make it worse, the assisting surgeon, a fourth-year resident by the name of Geraldo Rodriguez, had to essentially step in front of me to help the surgeon, who was working up under the diaphragm. That meant I was holding the retractor under the assistant’s arm, and all I could see was the back of his surgical gown. It was miserable.”
“Yikes! Not fun.”
“Tell me about it,” Mitt agreed. “Later, after the proximal portion of the graft had been finally attached, things improved. At least I could see something, and Dr. Washington provided more explanation. He’s a vascular surgeon.”
“Is he good?”
“He must be to be on the staff here at Bellevue, but I don’t know how to judge, to be honest. Personality-wise I’m not overly impressed. He’s rather narcissistic. He and the scrub nurse practically fought on several occasions, and I kind of sided with the nurse, who wasn’t about to take any crap. Anyway, the atmosphere was pretty tense for a time.”
Mitt was tempted to explain more but feared it would take too long. Despite recognizing he was hardly a key figure, he felt guilty being out of the OR.
“Bummer,” Andrea commented, using one of her favorite words. In her personal vocabulary it was both a noun and an adjective.
“How was your gallstone case?”
“It was fine. It was almost over by the time I arrived, so I didn’t see much. The surgeon was Dr. Kevin Singleton, another fourth-year resident, who is a great teacher, inordinately personable, and really patient. The main thing I learned today was how important it’s going to be to spend time in the simulation lab to get accustomed to handling the laparoscope. Let me tell you, it ain’t easy, especially when you are looking at a video screen in one direction and handling an instrument in a completely different direction.”
“I hadn’t thought of that,” Mitt said. “God! It’s intimidating to think of all we have to learn.”
“To say the least,” Andrea said. “By the way, you’ve been assigned three cases to do the admission and scrub in on. Did you know?”
“Yes. I just read a text from Dr. Van Dyke. I’ll get to it when I get out of the OR. Where are you now?”
“I’m on my way home. I finished admitting my three cases for tomorrow morning and couldn’t think of any reason to hang around. Sorry.”
“Don’t be sorry,” Mitt said. “I’m sure I’d do the same if the situation was in reverse.”
“One thing I have to say, the floor nurses are all terrific and surprisingly helpful and understanding, knowing how little we know about actually taking care of patients.”
“That’s encouraging,” Mitt said. “I’m sure I’m going to need some help tonight when I’m on call.”
“I think you will be pleasantly surprised by the nurses’ attitude. I was. I expected them to be a lot more impatient. I advise you to go around and introduce yourself to the evening nurses. I did, and I think it was a great way to break the ice, as they definitely run the show. Anyway, good luck tonight. I’ll be eager to hear what it’s like and how it went when I see you bright and early.”
“Thanks. I’m probably going to need a degree of luck. See you in the morning.”
After Mitt had disconnected the call he hesitated for a beat, wishing he, too, was on his way back to the safety of his apartment. Taking a fortifying breath, he headed for the swinging doors leading into the main portion of the operating room area.
“How are you with suturing, Dr. Fuller?” Dr. Washington called out the moment Mitt pushed through the door to OR #12 after rescrubbing his hands and forearms.
“I haven’t had much experience,” Mitt admitted guiltily as he went through the process of re-gowning and re-gloving.
“It’s his first day of residency,” Dr. Rodriguez explained.
“Yes, Dr. Van Dyke mentioned that,” Dr. Washington said. A moment later after a final check that all the suture lines of the graft were holding, he abruptly stepped back from the operating table and snapped off his surgical gloves. Looking directly at Mitt, he said: “Well, here’s a perfect opportunity for you, young man, to get some experience by helping close the wound.” He then added: “I trust that the three of you can somehow manage without me.”
“I’m sure we can,” Dr. Rodriguez said. He glanced at Dr. Wu for confirmation.
“Absolutely,” Dr. Wu added on cue.
“Fine,” Dr. Washington said condescendingly. “I’ll be in the surgical lounge if you people run into any problems.”
“I’m sure we will have no problems,” Dr. Rodriguez said.
“Thank you all,” Dr. Washington said as he waved over his head on his way to the door. In the next second he was gone.
A brief silence followed the surgeon’s sudden departure, everyone momentarily frozen. Mitt sensed a feeling of relief on the part of all, including the anesthesiologist who’d replaced the original anesthesiologist at the same time the new nurses had come on.
“Exactly how much suturing experience have you had?” Dr. Rodriguez asked Mitt, breaking the silence.
“Just the rudiments,” Mitt admitted. During his third-year surgery rotation, Mitt had attended a couple of afternoon sessions arranged to teach the medical students the basics of suturing and knot tying, but he hadn’t taken the opportunity too seriously. Nor had his assigned partner. At the time he had still been debating which specialty he was going to pursue.
“Okay,” Dr. Rodriguez said. “Dr. Wu and I will close the fascia with wire. After that Dr. Wu and you, Dr. Fuller, can close the subcutaneous layer followed by the skin. What do you guys say?”
“Sounds like a plan,” Dr. Wu said with a nod.
“Sounds good to me,” Mitt said. He was encouraged, thinking that maybe the day could be salvaged as a decent teaching day after all.