Читать книгу Confessions of a Park Avenue Plastic Surgeon - Cap Lesesne - Страница 12

June 20, 1980, I graduated from medical school. Two hours later I was speeding westward, all my belongings stuffed into my blue Datsun 310 hatchback. The trip took sixty hours. I slept in the car. As I crossed the middle of the country, rocketing toward my apprenticeship in one of the most prestigious surgical programs in the world, I thought:

I’m scared.

I don’t know whether I’ll make it through. Will I screw up? Will I kill somebody?

I rocketed past sights I’d never seen before, vistas that took my breath away – the Great Salt Lake, the Sierra Nevada – but as I neared California, I felt, mixed in with my excitement, a sense of solitude that bordered on loneliness. Out here under the big Western sky, I was far away from family and far from Tory, who had started law school in New York. Fair Acres Road and the leafy streets of Grosse Pointe were only a thousand miles behind me, but it might as well have been a thousand years.

I hinted to the surgery registrar – okay, more than hinted, begged – not to start me on the cardiac surgery unit. How about urology? No night call. An easy start. Just please don’t make it cardiac, not to start with. I would have to cycle through cardiac at some point, I knew, just like every surgery resident, but it was legendarily awful – long hours, physically and psychologically demanding, the toughest rotation around. I was simply hoping for a little bit of time to adjust, maybe start with something a little less taxing. Even neurosurgery would have been a relief. I hadn’t had a light week in three years.

They posted the schedule for all the first rotations.

LESESNE, CAP: CARDIAC.

One door closes. Another one opens.

So I wouldn’t get a breather. But it was in the cardiac surgery rotation that I really learned to be a surgeon, and I suspect the same is true for most surgeons. That first month was the most intense, exhausting, frightening, chest-thumping of my life. I started out feeling stupid. Knowing nothing. Before getting too frustrated, though, I relied on all that solid Duke Medical School training to help me.

Sort out the problem. Think it through.

And then a funny thing happened: I liked cardiac. A lot. Having first dreaded it, I now found it so invigorating, and my surgeon mentors so likable and inspiring, that I thought I might become a cardiac surgeon. The team I worked under was first-rate: Several of them are chiefs of surgery at top hospitals across the country today. None was more encouraging to me, and on top of his game, than Norman Shumway. I worshiped him. My very first day on the job – June 28, a Saturday – I showed up for 6:30 A.M. orientation in my white coat. As I walked down the hall, Dr. Shumway approached and did something no one had ever done before.

He called me Dr. Lesesne.

At the orientation, we new guys were all told, repeatedly, that if we found ourselves in any kind of trouble or confusion, we were to call for help. That was the main lesson for the day. Otherwise, it was reasonable, even quiet. I left the hospital at 6:00 P.M.

Hey, this isn’t too bad, I thought. Maybe cardiac wasn’t always brutal.

The second day I was given something to do. A patient – a lawyer from Ogden, Utah, scheduled for a heart bypass the next day – had come in for his pre-op visit, and Dr. Shumway, busy with other patients, instructed me to “work up” Mr. Jensen – get his medical history and examine him (blood pressure, heart, lungs, etc.). But as soon as I walked into the examination room and explained to Mr. Jensen why I was there, he looked disgusted. Sensing how green I was, he insisted I fetch Shumway.

I obeyed, found the doctor, and brought him back to the exam room with me.

“Dr. Shumway,” said Mr. Jensen, “I’m not letting some high school kid examine me.”

I meekly opened the door and started to shuffle out, but Dr. Shumway put a firm hand on my shoulder. “Stay here, kid,” he mumbled. I would learn that Dr. Shumway mumbled almost everything, in or out of the OR.

Dr. Shumway turned to the patient. “Mr. Jensen, Dr. Lesesne is my associate. If you don’t let him examine you, I’m not operating on you. So if you’re not up to being examined by him, you might as well get the hell out of my hospital, okay?”

“Okay,” said Mr. Jensen.

“Good,” mumbled Shumway, and gave me a pat. “So Dr. Lesesne will examine you, and I’ll see you on the table tomorrow morning.”

“Okay,” said Mr. Jensen, nodding obediently.

In surgery, particularly cardiac surgery, there is no such concept as zero to sixty. You start at sixty, put the pedal to the floor, and leave it there. That’s what happened during my very first operation at Stanford.

I was working under Dr. Shumway and Alex, his chief resident. A banker was getting a heart bypass. Such an operation is a big deal. Critical vessels to the heart are obstructed. People die.

The actual bypass – an unobstructed vein “harvested” from elsewhere on his body (in this case, his leg) – would be sutured on the outside of the heart, circumventing the obstruction.

In a few moments, we would be stopping the banker’s heart and transferring pumping responsibility to a machine, while the doctors sutured vessels.

I was assigned to make an incision in the leg, starting at the inner groin and going down to the ankle. To free up the vein we wanted – the saphenous vein, which looks like a pipe with multiple branches – Alex cut all around it, then tied off the little branches leading out of it (called perforators). This stopped the bleeding. The saphenous is the perfect vein for a bypass: long, continuous, dispensable.

While Dr. Shumway placed tie-over sutures in the aorta to allow the bypass tube to be inserted, I began my lowly job of suturing up the skin on the leg. Alex occasionally glanced at me. In the last year of his residency, he was far more experienced than I.

“Dr. Shumway,” the chief resident said casually, “he’s screwing up the leg.”

I’d left some gaps in the skin, which would require adding a few more sutures.

“We’ll deal with it later,” mumbled Shumway. “Duke guys are slow learners,” he teased.

Surgical humor. Everything was going nicely.

Dr. Shumway lifted the patient’s heart to get access to the left anterior descending artery. As I continued to sew, I heard Alex say, “Holy shit.”

I looked up. Alex, whom I had always admired for his cool demeanor, was frozen. His face was chalky, and his eyes, over his mask, had gone wide. I looked to see what he was staring at.

It must have been the blood pouring out of the patient’s chest. A Vesuvius of blood.

There was a tear in the heart. The back wall of the heart had come apart when Dr. Shumway had gently lifted it to sew.

The patient was now bleeding and dying before everyone’s eyes. I was frozen.

“What do we do now, chief?” Alex croaked.

“Alex,” said Dr. Shumway, whose hands had not stopped moving, “this is what separates the men from the boys.”

Blood was on the OR floor. Blood had soaked through the surgical towels surrounding the patient’s chest. The patient had flatlined.

Dr. Shumway mumbled to switch the patient onto the bypass immediately, skipping normal preparatory steps such as checking the pump volume or asking about the readiness of the scrub tech – an OR assistant who had been with Shumway for years and probably knew the doctor’s rhythms better than he did himself. Dr. Shumway had to assume that everything would work.

“Pump on,” said Shumway.

The bypass pump whirred on. The bleeding stopped.

A machine was now pumping blood to the outer vessels of the patient’s heart, although the amount needed to replace what had been lost was staggering.

Plus, the heart was still damaged. If it wasn’t repaired soon, the patient would never leave the OR table alive.

Dr. Shumway called for a 4–0 prolene suture. The scrub tech had already slapped the right suture into the doctor’s palm. Dr. Shumway, the smoothest surgeon I have ever seen, deftly began to repair the torn heart with the two prolene sutures. His fingers were moving fast, back and forth, back and forth, gently, sewing, tying off perforators. The concentration and skill were incredible. Alex and I stood motionless. Dr. Shumway’s fingers kept moving.

Finally, they stopped. Shumway barked, “Vein.”

Dr. Shumway took the vein he was handed, cut it for the right length, and performed a three-vessel bypass.

Once he completed this job, it was time to get the patient off the bypass machine and restart his heart. The doctor called for potassium and medication and now the paddles, and he was telling us all to stand clear so we didn’t get electrocuted. He placed the paddles directly onto the patient’s heart.

Boom!

Buh-bum. Buh-bum. Buh-bum.

The banker’s heart was going again.

Dr. Shumway had no change in expression.

“Next case,” he mumbled, and left the room.

Alex unfroze. He would go on to become one of the great heart surgeons in the Deep South.

One week later, the doors to Stanford University Hospital whooshed open and a banker – a leg vein now running from his proximal coronary artery to the base of his heart – walked out into the California sunshine.

My very first operation as a resident.

What’s important in life?

To help people not die. That’s one. But you see people die all the time. Old people, young people. Teenagers, pregnant women. There’s no justice to it, no value system, no right, no wrong. They just die. Bad genes, bad luck. You don’t know what to make of it. You’ve seen it happen like this before, in bulk, and then it involved children, lots of them. Do you get used to it? Does anyone? You were raised Anglican, went to Sunday school; throughout boarding school and college you attended church. You’re not sure what you believe. You’ve read the Bible, the Torah, the Koran, the Bhagavad Gita.

People keep dying.

When you see death day after day, you have to do something positive with it. You help people, yes. Well, that’s good. Keep them from dying too soon. Keep them from living with sickness, from living too unhappily. Good.

But what about for yourself? How do you keep from losing it? How do you keep despondency at bay?

You cultivate a healthy appreciation that every day is special. You appreciate that every day may also be your last.

Welcome to the life of a medical resident, cardiac rotation.

Tory, my girlfriend of five years and in her first year of law school at New York University, said she wanted to get married.

I told her I wasn’t ready.

We broke up.

A year later, she would marry someone else.