Before I became an Emergency Physician, there was a part of me that fell madly in love with Trauma Surgery.  I did many electives in that field, and even applied to Surgery (along with Emerg and Pediatrics) during my residency applications.  Sometimes, I still miss the art of it. 

October, 2005

Surgery is like art: fluid, the dexterous surgeon’s hands paint the knot they tie onto a canvass of the human form, supine beneath.  Musical, the anethetist’s machines tap the patient’s heartbeat like distant drumming on a beach in the afternoon; any change and the heart catches in me until the rhythm is back in step with my breath.

In the ICU I lean at the foot of the bed watching rapt as sunlight streams onto the blank page ahead of me; the patient’s abdomen open and ready for the surgeon’s thread to piece it back together like a long-scattered puzzle.  They gown up with ease, a dance of sterility as they cover every inch of skin and prepare to approach the man lying before us.  One on either side they prepare their instruments as I assist from my position at the patient’s feet.  Needles poised they begin to sew, and like an old dress being refitted the skin begins to take back it’s once anatomic position.  Soft concerto plays in the sunlit room with soft conversation over the quiet form of the man we are trying to heal.  My mind takes it in and my heart feels something like a butterfly stirring from it’s cocoon, pulsing, pushing to fly free.  In another day I find myself back by this man’s bedside, and it is I who holds the needle while my resident holds his, and together we stitch the remainder of my patient’s fragile skin.  A first glimmer of a new world, I have now sewn my first sutures that will hold a man’s body together.  Awestruck I feel the sun on me and hear my own words in conversation with concerto and sterile procedure and surgeon’s tools in my hands – I hold the needle, I thread the suture.

In the trauma room they wheel him in quiet; he says not a word as we inspect the stab wound to his side.  I take the history, I get his consent for surgery, he is my patient.  In the OR he goes under the knife with ease, anesthesia a gift, and when we are done he comes to agitated, fighting the tube.  Nurses try to hold him down, orderlies call for restraints, and I push through to the head of his bed.  Calmly I take his hand, use my other hand to grasp his chin and firmly turn his head towards me.  I tell him to look at me, look in my eyes, calm down, you were stabbed and now you’ve had surgery, you’re in the operating room, remember me?  Relaxing he lies back quiet and the nurses can’t believe it; but they must know all it takes is compassion!  Later I go to his room to check on him, and he asks me “where have you been?  I’ve been waiting for you!”.  Two days ago, healed, we parted ways and he went home to recuperate.

Another night, another young man stabbed.  In good shape with no need to operate, instead we must suture his long slash wound to the flank.  With instruction from my resident, I set up, prep, drape the patient and begin to sew.  Outside the trauma bay his friends gape through the windows, to them it’s like ER, it’s like Grey’s Anatomy, they watch me suture their friend.  But I don’t see them; I am lost in the art of the needle, the skin, the blood and the knots.  I am watching the future scar under my hands take shape, the close approximation of the tissue, the tiny holes my needle makes as it glides in and out smoothly.  My hands dance with eachother like swans intertwining their long necks; out of their waltz comes beauty and elegance, little square knots millimeters apart. 

Surgery is like art; unknowing I have become part of the canvass yet also one of the painters.  I am a fresh white page waiting to be written, as is the patient I tend, as are the stories yet untold.  There are now some doodles on my self-portrait, and so much more yet to be drawn.  Surgery is magic, surgery is beauty, surgery steals your soul in months of sleepless call that is so wonderful somehow that you almost forget you ever needed to rest.  And when you do rest – sleep is heaven and my bed is a cloud.  But surgery – it beckons again before sunrise and with no reluctance whatsoever I walk to the hospital with a skip in my step and a pale moon above.

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