By Jurgen Stahl
So much blood.
A bubbling sea of red, its shiny surface reflecting the overhead LED lights.
Everything had gone as it always did. She had separated the tissue planes. The muscle, fascia, all came apart without a hitch, opened by her confident touch. Only minimal cautery to burn off the tiny blood vessels. Finding the mesenteric artery, clipping it, all routine from then on. No hesitation, no doubts.
It had never happened before. Not to her. Magic guided those hands, some said. Others looked on in envy.
The breathing apparatus huffed and puffed somewhere behind the screen, the soothing mechanical sound of pumping air through the tube, as if nothing had changed. Same with the heartbeat.
Faster now than a moment ago?
“Pressure down to seventy over sixty, and falling, pulse hundred and twenty,” the anesthetist announced, his voice raised.
Bright red, full of oxygen.
Arterial. She froze, fingers paralyzed. Losing time.
One second, five…or more?
“Cut an artery,” she mumbled, after far too long. She tasted bile and acid in her mouth, but swallowed it down before it erupted into her face mask. Four breaths in, hold, breathe out for five or six, hold…
Michelle had followed her mental checklist and ticked off each item. As she had done a hundred times before. Cut, burn, find the next anatomical landmark, repeat. Leave no room for improvisation, no margin for error.
The nurse pushed the suction hose deeper into the foaming pool. No eye contact. The tube spluttered and choked, couldn’t keep up. Nothing needed to be said.
Michelle burned and tied off anything that resembled a blood vessel, and the stench of scorched flesh crept through the mask into her nostrils. The red leaked through the saturated linen and dropped on the floor, first in thick single drops, then in a continuous thin stream.
How long had it been? One, five seconds…? Ten? She could hear the theater clock tick. She had never noticed it before.
The fat and bowel pulsated under her fingers, out of sync with the clock.
“I can’t get access,” she barked at her junior colleague. He avoided her eyes and yanked the metal hook and pulled the layers of flesh further apart.
Fifty-five-year-old patient, in the prime of his life.
“Very common operation,” Michelle had told him, his wife, and their teenage daughter. Trusting, so assured by her confidence. Of course, there were risks…Low-risk patient, someone who took care of his body. Lean, quite muscular, into lifting weights maybe. In the prime of his life.
Textbook images floated by. An artery branching off like a deciduous tree, encircling the bowel. Each branch with its specific fancy name, so obvious on a book page.
How many milliliters lost per clock tick?
Thirty seconds now?
Michelle buried her fingers in the sticky fluid, touched and squeezed anything in there that could be it.
The red soup obscured everything that a short eternity before had been so clear, all anatomy exposed. Routine. Textbook-like dissection technique, her supervisor had commended her.
All anatomy swished away by scarlet gore.
Ten or fifteen ticks more from the wall. Why was she counting now? Two hundred, three hundred milliliters gone?
The nurse wiped the sweat off her forehead, avoiding her eyes.
More blood bubbled out from the violated branch, losing oxygen into the cavity.
Her fingers moved faster and squeezed everything they found. All soft, bloated by the pulsating fluid, slipping away from her touch.
Where was it coming from? Not from any of the usual spots mentioned in the textbooks.
“Pressure down to fifty over—” She didn’t hear the rest. Not that it mattered.
“Call Dr. Williams, I need a hand here.” It came out louder than intended. She had to keep control, not show any panic. But screaming at them might have helped.
Why weren’t they reacting?
She knew what they were thinking, her junior colleague, the nurses. All of them. Standing there like statues, waiting for her to do something.
A muffled voice talking into the phone to someone. “He received 500 milliliters a minute ago.”
Before this, she had never asked anyone to help her. To find that blood vessel for her, stop the bleeding. Clean up her mess. Tell her that everything will be okay.
Before this she never lost her nerve in here.
This was her world.
Another click of the clock.
The cold of the OR crept up under her surgical gown, but the nurse wiped her forehead again.
A quick look in her eyes this time. The face mask hid that “I knew it” smirk that would have surfaced behind the plastic.
Stiff fingers kneaded the tissues that conspired against her, hiding the artery from her touch.
Perhaps this career was not for her, and the head nurse had been correct even before all this.
The theater door swung open, and a whiff of aftershave touched her olfactory senses.
He said no more. No holding her hand, no guiding her to the right spot.
No saving her from shame.
No saving the body under her hands.
He would say more later.
Before she would leave this place.
Before she would close her eyes tonight.
Before the axes of her happy little universe changed in no more than a split second.
Universal — me and yet not me, I think. It makes me want to check my attitudes. Very good work.
Never be so confident, always let someone guide you before you earn your first medal of mastery. Thanks for that realism.
Kept my attention. Great read.
The realism is powerful in this story. Good characterization. I like that the main character does ask for help, how she steps aside in the end and you avoid the literary snare of simply allowing the character to punish herself, sort of like Jack Shepherd’s father in ABC’s Lost losing his license rather than asking for help while operating under the influence. Your character should be commended, not ashamed. Retweeting.
The fact that its a female surgeon , with the head nurse apparently looking for proof she (or any women?) cant do the job asking for help makes the story even more meaningful.
So tense, and realistic descriptions kept me on the edge of the chair, feeling for the unmentioned main character on the table. Great writing.
Thank you very much, Dan, glad you enjoyed it!
Really great. Retired pediatrician here. Have been in situations of losing ground and needing help. Very well written. Great suspense, and great way to bring an ending without just throwing disaster at us. Thank you for writing this.
Thank you for the kind comments, much appreciatiated.
Been watching “The Good Doctor.” This story transported me to that show. Even those with great mastery are only human in the end…great characterization, delving into the main characters’ thoughts, fears, doubts, sense of disbelief…and as the title suggests, how one’s assumptions can change in a split section…