Once the anesthesiologist’s drapes come up, it’s always a little hard to remember there’s a live human being on the surgical table. We take our green sterile cloths and we drape, and drape, and drape, until there’s only a dismembered part of the original apparent to us. Reality becomes focused in on the triangle of skin exposing the left inguinal hernia. The thyroid. The right breast– more specifically, the lump in the anterolateral aspect of the right breast. Some might argue this is a type of cruel objectification of patients. Others would argue it’s a necessary principle of surgery.
“No crushing the face, little one,” the anesthesiologist says to me as I lean over the patient’s chest to get a good look at the right breast, not realising my elbow has been smushing into her chin beneath the external reality of the green drape. She’s one of the nicer people in the room, but the experienced anesthesiologist has already called me out on 2 close calls of invading the sterile field on this case alone.
But that’s because everything becomes zeroed in on the layers of skin, subcutaneous fat, fascia, and tumour that comprise the surgery. That’s all that exists for the surgeon with the cauterizing scalpel in his hand deciding where we should go next, how much to take off, how urgently to send it to pathology, and what this woman’s outcomes might be. Hot, bright surgical lights zone in an area of skin 6 centimetres squared. Three heads in surgical caps hover over it, staring intently looking for what we might have missed, all previous small talk about Oilers this and Conservatives that having dwindled down and now only our breathing is audible. My face is inches away from my resident’s, and it’s still just our breathing as we look at each other over our masks, knowing her prognosis isn’t good.
We took out a huge honking tumour in a small, slight woman, digging far into the pectoralis muscle. Uncommon in lumpectomies. We stitch her up and wait as the surgeon speaks to the pathologist outside. I ask my resident about the unlikely chance that we would change anything now that we’ve already closed, and can’t we just clean up already, and he tells me a story about what happened to him in med school in Montreal–how furious the attending was, how the whole team had to come back, get the patient reintubated. We are laughing at the unlikely horror as the surgeon swings open the doors. “Open her up!”
There were two tumours. He was supposed to remember that, but he had seen her in clinic weeks ago, and I can understand how patients begin to blend together. We cut open the sutures we had put in just moments ago and felt a second giant, honking tumour not even inches away from the first, clearly palpable in shallow fat in the anterior direction that we had been neglecting. The surgeon and the resident silently worked, now opening up her axillary lymph node as well. Her prognosis really, really isn’t good.
Suddenly, my distilled sense of focus I’d had on the 6 square centimentres of skin was now gone as I stared at the wound get opened up for the second time. Made larger now, it almost looked like a mastectomy and I could see her ribs clearly. There under her ribcage, on our thin little woman with two scary tumours, a heart beats furiously. I almost couldn’t believe what I was seeing, though I don’t know what I was really expecting–gross anatomy dictates that the heart lies directly under the ribs, duh, so it might be expected to see outline of the pericardium through the intercostal spaces, especially in someone so small.
But there it is, in all its living human glory. It’s persistent. It’s adamant. It’s tenacious. Determined. It will not let us forget that there’s a person under all this greenery.
I forgot about the scalpel. I knew I should be paying attention but I couldn’t get my head back into the surgery, ignoring what was likely to be a great unique learning experience and probably one of my objectives for the rotation. I didn’t care. I needed to touch it. I reached out with the pad of my fingers over the part of her heart that moved the most fervently. Like an idiot, I stood there with my hand over her heart, ignoring the surgery taking place a few inches away. Lub dub. Lub dub. The exact same sound of hearts everywhere.
This was the heart that beat violently as this patient was coming into the OR, under bright lights and half-exposed. This was the same pounding heart of a newborn baby screaming its lungs out, announcing to the world its arrival. This was the same thready pulse we feel for in the septic 90-year-old as she finally succumbs to her pneumonia. This was the same thudding flutter I feel jump up in my throat every time I see him, the man of my dreams; every time I think I hear my phone vibrate and hope it’s him, every time I picture my future, every time I imagine the purpose of my being here on this earth and feel him, the lifeblood of me, coursing through my veins. Suddenly it seemed like the dots of the universe had connected and I could feel a common harmony between her, myself, and everything around me.
We had taken her apart and now we put her back together, cleaned up, and I forgot everything about her case. I forgot her name, her relevant history, how it was found–everything. I dismembered her in my mind just as we had done in the OR. She blended in with all the other breast cancers that day, that whole week. I hate to admit it, but it’s true.
But I won’t forget the feeling of putting my hand out and touching my first beating heart, not a formaldehyde soaked cadaver but in here the flesh, feeling its lub dub under just a few millimetres of rib. I won’t forget the sensation of the hot surgical lights above our heads as we took apart a woman we knew almost nothing about, other than the fact that she had two lumps. Most importantly, I’ll try not to forget the lesson I took from all these warm and wet experiences, fingers in breast tissue, palm over ribs, eyes closed as I feel a pulse–this first, real, wonderful connection to something beyond me. I won’t forget the person that lies underneath the drapes–the real person with that adamant, unremitting beating heart.