āPatient 202. 26 year old female. Admitted over a year ago. History of gynecological complaints which I diagnosed as endometriosis through laparoscopic surgery 9 months ago. No history of any other health complications. Are we ready to begin?ā
I look from the anesthetized woman on the slab in front of us to my intern across the table, in full surgical garb, hands clasped in front of his chest as he was taught to keep the sterile field. The mask can do nothing to hide the excitement in his eyes.
āScalpelā I announce as I hand him the tool, ābegin with a deep incision laterally starting directly below the clavicle. Ending at the breastbone.ā He looks up to me for confirmation so I nod for him to begin. This is the first time I let my intern cut into a live patient himself. Weāve done similar in cadaver labs but this is his first time putting scalpel to live human tissue under my guidance. āA little more pressure, do not be afraid of going too deep.ā I instruct as I watch. The first incision is concluded āGood. The same on the other side now.ā Heās gaining confidence now and makes his second cut with more trust in his own steady hand. Looking up at me when the second incision meets the first. āNow continue the incision down to the pubic bone, try to keep your depth consistent, and ensure you maneuver around the navel.ā He completes the incision flawlessly, the cheesy grin beneath his mask obvious through his eyes when he looks up for my approval; āWell done. You may begin dissecting away the tissue and exposing muscle.ā The young doctor in front of me eagerly begins the tedious task.
Once we have the skin folded open and retracted I have the boy name each muscle as I point them out. Instructing him to feel here or there. What we do next will differ from what we do in a cadaver lab, when we dissect through the muscle we have to do so in a way so that we can reattach everything for functionality since this is a patient who will go on to live many years with these scars.
It when we exposed her ribcage the excitement in the room became palpable heās going to see his first beating heart! I had let him complete most of the process thus far but he knows how delicate the next step can be, āMay I do the honor?ā He asks tentatively, gesturing to the bone saw āSheās your patient, you will be doing it all. Sheās all yours.ā I see then young doctor in front of me attempt to contain his excitement but he stumbles over his words āy-yes sir! Thank you, s-sir!ā Every resident feels this way when they get to manage their first patient all to themselves, even with an attending presiding above. An experience most donāt experience until at least the second year of residency, and typically a simple case like an appendectomy. But this is not your usual teaching hospital and this is not your usual intern. His knowledge and technique surpassing some third year residents.
Being given a patient-in the most literal sense. He will complete her non-medically necessary exploratory surgery, absorb every ounce of information he can from her precious insides. Then stitch her up and tend her wounds. He will manage her medications and sedation. Monitor her recovery. He has been given a patient. Not just for this procedure, āAs a graduation gift!ā Doctor Larch had insisted despite him not quite at the end of his intern year. 202 is one of his special patients, the ones that never leave. The rumors of these patients is what lead the intern here.
It does not take the skilled young Doctor long to have her chest cracked and precious heart and lungs exposed. The amateur surgeon places his tools down and clasps his bloodied gloved hands in front of his chest again to take a moment to admire her beauty. The complex muscle in front of him beating a consistent 74 beats per minute. āItās a sight to behold, isnāt it?ā I ask after allowing the intern a moment of silent reflection. āI remember my first open heart, I got to observe a valve replacement my intern year. I was not lucky enough to touch the heart myself though. I was a fly on the wall.ā My gloves were still pristine white, I had scrubbed in but thus far had kept my hands clean, allowing my intern to do it all. I reach in the chest cavity and gently touch the beating muscle. āYou can touch it, if youād like. While delicate, the heart is a strong muscle. She can take it.ā I slide my hand underneath the heart moving slowly and cautiously. āJust like this. Nice and gentle. Have you seen open chest compressions? Just like this..ā I give her heart a squeeze causing her to beat at my will, throwing off her own rhythm. We both hear the change in tone on the monitor causing my intern to switch his gaze to the screen. I withdraw my hand and we meet eyes. I nod giving him permission and he slowly reaches out a steady hand.
He just caresses her heart with two fingers for a moment, gauging the firmness of the muscle before slipping his hand beneath to hold her heart as I had done. After a moment he looks up to me again, eyes glistening. āGo on, make her heart beat for you. Youāre the surgeon. Her heart has to obey you.ā I didnāt think his smile could grow beneath his mask and yet it does. He beams when he gives a gentle squeeze, it was a weak beat. But heās still learning how much a heart can take. He gives another squeeze, eyes glued to the monitor as he sees her beat, his beat throwing off her rhythm again. He did it again as if to confirm what he just witnessed was real.
Despite what we may say about ourselves surgeons are power hungry. We want to exert control over the human body, even life and death. There is no more control than making oneās heart beat in your own hand, knowing also, how one slip of the wrist could make it stop.
āItās magnificent, sir.ā Is all my intern has to say. This is a high he will be chasing the rest of his career. There is nothing more intimate, more controlling, more beautiful, than holding a heart in your hand.
