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Program Manager, Community and Department Education, Neurosciences Center



Oct 22 2013
A Window Into the Inner Sanctum
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You cannot connect the dots looking forward; you can only connect them looking backwards.

-Steve Jobs

"Doesn't that window open any wider? Bring in another fan!" the surgeon demands.

Beads of sweat gather at the edge of his cloth cap and the circulating nurse steps up periodically to wipe them away. Heat and city noise roll through the open windows and into the operating room. The brief morning rain shower has left the shiny, green floor nearest the windows glistening and wet. A few levels below the OR, people are talking and laughing at the bus stop in front of the hospital. The diesel fumes from the bus and the cigarettes of the passersby blend and waft through the screens. A car honks on the boulevard. Pigeons land on the window sill and peer in. It is summer in Chicago in the early 1970s. Air conditioning won't be installed in the hospital for a few more years.

"Sorry, Doctor. We don't have any more fans."

He scowls. “Can you at least get me a sterile cup of ice water?”

I am home from college on break and working as a hospital orderly. Whenever I return for a few days, the hospital hires me back and offers me the opportunity to peek behind the curtain of Medicine. I am allowed to visit a place few people ever see except as a patient. It is a chance that, at the time, I take for granted.

For this particular stint, I am assigned to the OR – cleaning rooms, restocking supplies, transporting patients, setting up cases, folding linens, making coffee, running errands, finding X-rays, mopping hallways, scrubbing locker rooms…whatever is needed. Occasionally, when one of the OR staff is at lunch, I am pressed into duty as a surgical assistant. As a pre-med student, I am in heaven.

Today, I am assisting one of the orthopaedic surgeons. He looks at me from across the table. "Remind me your name again, son…Bruce?...Okay, here, Bruce," he says. “Hold her leg steady. I need to fix the hip fracture and it will go a lot more smoothly if all of the parts stay still.” He is a folksy, hardworking surgeon.

He grabs my hand and wrist and shows me exactly how he wants things to line up. He sets to work.

These are the days before CT scans and pre-fabricated femoral prostheses. The repair will be based on the physical exam and a couple of plain X-rays. The surgeon learned many of his trauma skills as a military doctor in Viet Nam. He will figure out how to best use the available metal plates, screws, wires, pins and plaster, drilling the holes with a power drill like the one my dad keeps on his workbench in the garage.

“Back when I was in school, these sorts of fractures were treated with casts, traction, and bed rest,” he tells me. “These days, we fix ‘em.”

It isn’t an easy fracture and he has to be creative. I want to help but I know little of surgery and am ignorant of the approach. I try to hold still as best I can. Eventually, we find a rhythm. Things move along and I get the hang of how he wants the leg stabilized. Soon, he is humming an aria as he lines up the fragments.

We move her to the recovery room and, soon, I am back in the OR holding a mop handle rather than the patient’s leg. I realize how much I enjoy being in surgery – at the table – helping.

A few days later, I am called to one of the floors to transport a patient. “Take the woman in Room 15 Bed 4 to X-ray,” the nurse tells me. “Be careful with transfers on-and-off the cart. She had hip surgery last week.” I walk into the room. Sure enough, it is the patient from the OR. She braces herself as she is moved from her bed to the cart. “Still really sore,” she tells me.

We talk as I take her down to Radiology. She doesn’t recognize me and I don’t tell her that I was the assistant for her surgery. She tells me about her family and her plans for going home.

She is recovering. Her hopefulness will stay with me for years.

Decades later, the memories of my first hospital job remain fresh. I can hear the hum of our original Bovie electrosurgical machines. I feel the conductive strips tucked inside my shoes to prevent sparks, although the use of explosive anesthetic agents like cyclopropane and ether had, by then, been abandoned. I sense the warmth of an open abdomen, retracting the liver as the surgeon removes a gall bladder through a large incision.  

Even more than the technology and the procedures, though, I remember the people. There is one general surgeon who is comfortable performing essentially any operation and another surgeon everyone avoids whenever possible. There are specific patients and their families who stand out. And, even though almost all of the people with whom I worked in that OR years ago have retired or died, I hear the voices and see the mannerisms of the nurses, assistants and secretaries.

These are the people who will inspire me to pursue a career which will allow me to spend much of my professional life in the operating room.

Of course, surgical technology and practices have evolved dramatically. The rooms themselves are now twice the size they were in the 1970s to accommodate all of the computers, endoscopic equipment, monitors, microscopes, and robots. The only windows we have now are Microsoft Windows®. Almost everything about surgery has changed although surgeons still scowl, on occasion.

The people, though, and the sense of the operating room as a place set apart for a purpose – those things have not changed. I still love my work and feel as though I am coming home every time I enter an operating room. When I started, crossing that threshold always felt like stepping into an inner sanctum. Even after forty years, it still feels that way.

_____

A version of this essay will appear in the November-December issue of Surgical Products Magazine. I would like to thank my roundtable at Red Bird – Red Oak Writing.


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