Читать книгу Confessions of a Park Avenue Plastic Surgeon - Cap Lesesne - Страница 11

I never forget a face. Of all the faces I have laid eyes on in my life, hers may be the most unforgettable.

And when it was all over, I had fallen in love.

Use any of the clichés – struck by lightning, head over heels, shot through the heart – because they all apply. One day my life is heading in one direction. Sixteen hours later it’s headed in a completely different, and absolutely unwavering, direction.

It happened at two in the morning, a sweltering July night in 1979, in Durham, North Carolina, in the trauma room of the ER, at Duke University Medical Center. Two surgeons and the ER staff were hunched and busy over a dying woman that night.

In saving one life, they also managed to transform a second one.

She was an all-American volleyball player. Earlier that night, the car that she and her boyfriend were driving had hit a tree. She flew through the windshield. She was spirited to the emergency room – and I do mean spirited, because not a person who saw her being rushed on a stretcher into the triage area in the ER expected her to survive the night. The ER team began to work on her, but the extent of the damage was historic. Her face, in particular, was crushed beyond recognition.

I knew nothing of all this. I was home, sleeping, dead tired from another night of medical school. I was three days into my newest rotation, surgery.

The phone rang. Bolting upright – a skill that after a while becomes reflex, once you give your life over to doctoring – I saw my alarm clock read just past 2:00 A.M.

“What?” I barked.

It was another intern, a friend on call that night at the hospital.

“Cap, man,” he said with wonder in his voice. I was half-asleep, though, and couldn’t detect anything besides an unwelcome wake-up call.

“I’m sleeping,” I said.

“Get your ass over here,” he said.

I threw on my pants and white coat and walked, bleary-eyed, the quarter mile to the hospital. In the all-American, five-foot-ten volleyball player, I witnessed the most devastated physical presence imaginable. Every major bone in her face was broken. Her eyes were dangling from their sockets, each one trying to peek into an ear. Every tooth was broken. Her nose was crushed in the middle. Her scalp was nearly torn off. She had multiple lacerations. Blood was everywhere. It was hard to determine what remained of her face, and if what was left could even be reconfigured as human anymore.

For the next sixteen hours – the first couple in the ER, the last dozen or so in the OR – I stood right beside a plastic surgeon and his resident and watched as they worked with a team of ophthalmologists and oral surgeons to reconstruct the woman’s face. Calmly, and with ease, the surgeons used wire and high-speed drills to refit the bone back around her eyeballs. If the doctors were off by even one millimeter, they could blind her.

At one point during the surgery – we’d all lost track of time – the resident shook his head. “Hell of a way to make a living,” he said gently.

The girl recovered.

I, however, would not. The next afternoon, when I finally walked out of the OR after a night of standing almost frozen, of no sleep, of staring intently for a dozen hours straight at this miracle of skill and medicine and care, I was not exhausted but exhilarated.

Plastic surgery!

A branch of medicine where you take a patient in some type of distress, and you make him or her significantly better … and you can actually see the immediate improvement? Just as powerful to me, though, was that it required such an impressive arsenal of abilities: concentration; physical dexterity and stamina; the intellectual alacrity to balance form and function; an awareness of aesthetics, structure, symmetry; a gift for understanding the human psyche and its frailties; compassion and candor and discretion.

(My initial love for the field, typical of most plastic surgeons, had nothing to do with cosmetic surgery. Our first exposure to the field is exclusively reconstructive surgery; observing and doing cosmetic surgery only comes later.)

After sixteen hours of watching a life and a face restored with the most amazing technical grace, I had found something that was miraculous for the individual patient, beneficial for society, and fulfilling for me. Plus, I felt – yes, deep in my bones – that I’d always had aptitudes that could now be exploited for just this pursuit: a love of aesthetics, a deeply visual memory. Even my ability to concentrate for hours at a time, honed while building models and sculpting clay as a kid because I was inept at sports, was now morphed into a virtue.

The day after watching the volleyball player return from the dead, I stood outside the medical school administrative office, waiting for the door to open so I could immediately change my course schedule for the coming year and focus on plastic surgery. Once I was done with that, I canceled all my vacation and holiday plans.

For the next two and a half years.

I finished the four-year program at Duke in three. I had high hopes. I was going to be a great plastic surgeon, like my mentors.

After what I had seen that summer night, a night that had unknowingly begun for me when a beautiful, athletic girl had hurtled through glass and struck a tree until she was shattered, only to be put back together again miraculously, there was no way in the world I could spend my life doing anything else.

My relationship with Tory consisted of our seeing each other every second or third weekend, alternating between Princeton and Duke. Among the med students, I was one of the few men in my class committed to a long-distance relationship. There was lots of romance between male and female doctors-to-be, and lots more young doctor and nurse couplings, too. Not that I needed to be spoken for to keep me from being distracted by the nurses and female residents. That it had become impossible for me to think of anything besides medicine should have been a tip-off to Tory, and to me, too, that making a relationship work would, now and for a long time to come, require me to be a very different person from the one I was becoming.

A few months into my surgical rotation I did my first appendectomy, as my professor stood across the table. It was the first time I’d made an incision into a living human being. This was not a sleeping dog or a cadaver. It was an out-of-body experience.

You pick up the scalpel, run it along the lower abdomen, and right away notice the particular pressure that must be exerted to open skin and expose the underlying tissue. Your fingers send messages to your brain, and vice versa, a feedback loop, so that you can adjust to this holy cow you have no clue what you’re doing. No matter how much you have read or observed, nothing can compare to what you’re going through now. There’s nothing like the real thing.

Blood is coming out. I’m scared.

Do not look up at Dr. Young. He’s right across the table watching you but you must focus on this, your fingers and brain working together, guiding you to go a little deeper…. Put your finger there, Lesesne, that’s it … any moment now you should be wetting your pants …

The more surgery I performed or assisted on, the more convinced I was that I wanted to be a plastic surgeon. Whereas my father got excited about the prospect of my being a doctor, and even more when I said I wanted to be a pediatrician, he was less thrilled about my decision to be a surgeon, and less so still about my being a plastic surgeon (though he would eventually come around). To me, plastic surgery offered an intellectual appeal that other types of surgery did not – the planning involved, the attention to detail, the fact that the entire body is the canvas, not just one organ. It’s a younger surgical discipline, too, so a sense of discovery seemed more possible. Patients get well. They don’t die. The aesthetic challenge appealed to me. I wanted to help people, to make their lives brighter. At this point I knew myself well enough to recognize that I did not have the emotional constitution to deal with what (for example) a cardiac surgeon must.

When my medical training at Duke ended, Dr. Sabiston – my mentor, the finest teacher I will ever know – offered me the chance to stay on as a resident. I’d learned so much at Duke, but I respectfully turned him down. I’d already been accepted as a surgical resident at Stanford, a top program. I treasured the doctor’s offer as the penultimate compliment from him to me.

I say penultimate because he would pay me the ultimate compliment years later, when a woman showed up at my Park Avenue office to consult about a face-lift. When I asked how she’d heard of me, she said her longtime friend Dr. David Sabiston down in Durham had said I was the best.

As I left North Carolina, I hit the gas, breaking the speed limit in every state I crossed, so I could get to California as fast as I could and start being a surgeon.