A ribbon of yellow fat billowed in the wake of Ruben’s knife as he sliced through the skin, carefully following the line that Margo had etched with the tip of a blade. Sarah followed close behind the scalpel, dabbing up blood and cauterizing oozing vessels. The intern paused to admire his work. Then Margo took over the quest to remove a diseased gall bladder. Ruben’s role was reduced to tying off blood vessels. He was not very good yet. An artery squirted his face and Margo chided him. “You should have worn safety glasses. It’s lucky the blood didn’t get into your eyes.”
Sarah showed him a better way to tie. “Loop the suture around twice on the first throw. We call this a surgeon’s knot. See? Right over left. The second throw has to be in the opposite direction, left over right, so the knot lies flat and tight. Otherwise, you have a granny knot that won’t hold.”
Abdominal surgery back home tended to be endoscopic: operations almost became video games. Sarah had not often seen the belly so widely split open and was not accustomed to the work of tugging on retractors, as she and Ruben struggled to keep the liver out of the way. The human liver is much like that of a chicken—albeit much larger—slippery, soft, mottled red-brown. Sarah peered into the wound, trying to see what was going on. “Do you have a self-retaining retractor?”
Margo shook her head.
Sarah turned to the scrub nurse. “Hold my retractor. I want to see what’s on the back table.”
“Just hold what I gave you,” Margo snapped.
Ruben’s eyebrows disappeared up under his scrub cap. His lips, behind his surgical mask, were probably pursed into a tight, “Oooh!”
After an awkward silence, Sarah decided to fill the void with some teaching. “This part is very tedious. Margo has to has to seal off the stalk of the gall bladder, without damaging the common bile duct. If that gets obstructed, it’s a very bad complication. The liver won’t be able to drain.” She offered advice to Margo. “You could use a fine right-angle clamp—”
“I am doing this operation, and you are assisting. When you do an operation, I will be happy to help you.”
Suddenly the wound filled with blood. After a few tense moments of suctioning and searching, Margo clamped off the bleeding vessel. “Sarah, you should tie this.”
It was a narrow space, only wide enough for one hand. Sarah kept tension on the suture with her left hand while the fingers of right created the knot.
Ruben was impressed, “One-handed tie. Very cool.”
Margo removed the gall bladder, which looked something like a gray poached egg. Or maybe a testicle. Sarah retired to the doctor’s lounge, leaving Margo and Ruben to close the wound.
Pieter poured Sarah a cup of Masala tea, with hot milk and spices. “Today we have a treat: mandazis!”
“What?”
“Mandazis. African doughnuts.”
Irregular blobs of dough, no holes in the center, sort of like New Orleans beignets, but without powdered sugar. She took a nibble. “Delicious. Did you sense the tension in the operating room?”
“Dueling alpha females.”
“Thanks for not calling it a cat fight.”
“I saw no claws.”
“I didn’t mean to offend her. Guess I got off on the wrong foot.”
“It will be fine. She knows she can learn from you.”
She took a sip of tea. “How did you wind up here, anyway?”
“I could ask the same thing of you.”
She explained how she had gotten a grant to do research in obstetrical mortality, but didn’t share her disappointment in the position, or her struggles to get data from medical records. She didn’t tell him how foolish she felt, in retrospect, responding to a notice on the internet, accepting a position at this hospital, sight unseen.
He tilted his head. “Research, eh? Me too. I came to study altitude physiology. We compare Kilimanjaro guides to the poor souls that get admitted to the ICU with mountain sickness. Two-year furlough from my university. I’ve trained technicians to do the testing, so I have time on my hands. I volunteered to help supervise the anesthesia residents.”
“So, you’re here because of the mountain.”
“More accurately, the mountain gave me an excuse to be here. I was homesick for Tanzania.”
Margo flopped into a chair. “Ruben’s almost finished.” Pieter set down his teacup. “I’ll go wake up the patient.”
“Will I have to make my own tea?” Margo whined. “I am so disrespected.”
Sarah handed her a mandazi. “That was a tough case. Lots of scar tissue.”
Margo pulled some leftover sutures from her pocket. “Can you teach me the one-handed tie?”
“Sure.”
Pieter winked at Sarah, handed Margo a cup of tea, and left.
Sarah looped the thread around the arm of her chair. “It’s sort of second nature now. I’ll have to tie one myself first to remember exactly how to do it.” She tied one knot very quickly, and then another in slow motion. “You should practice this about a jillion times, until it just flows. My father showed me how to do this when I was a little girl.”
“Your father was a surgeon? So, what does he think of you following in his footsteps?”
“He died a few years ago.”
“Oh, I’m sorry.” Margo practiced a tying a few knots. “I think I have it now.”
“Yeah, looks like you’ve got it. You know, back home we have a surgical skills lab where we practice on models or animals. We should set one up here.”
“Great idea. Oh, and I can’t believe I almost forgot to tell you this. My father called this morning. He found the perfect car for you. Let’s ask Pieter to take us to pick it up.”
He was stooped over a patient in the recovery room. Margo pulled his stethoscope from one ear. “My father found a car for Sarah. Can you take us to Arusha on Saturday?”
“Sorry, this is the weekend for my clinic in the mountains.”
“Darn it. I forgot. We’ll have to take the bus.”
“Don’t take the bus. Not a good idea for the two of you to drive back by yourselves. Sarah hasn’t driven in Tanzania before, and you don’t drive much yourself. We can go next week.”
Margo pouted. “We’ll have to find some other entertainment for the weekend.”
Sarah smiled. “I have an idea.”