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  • Writer's pictureMara Cao

Portrait Of A Surgeon

“This is a 38 year old man who was run over by a light rail train and extricated from the tracks” reports the EMS. We transfer the man from the gurney to the bed. He yells, “Turn me over! Turn me over!” His right lower leg is crushed, exposing bones and muscles and torn ligaments. Dr. Phan holds the foot for me as I cut away the blood-soaked sock with trauma shears, afraid that his leg might fall off at my touch. His sockless other foot is mangled, gnarled, with the toes twisted at right angles to each other. We get ready to roll him over on his side to check his spine. Every second I expect his whole body to come apart. Blood is coming out of his rectum, dripping on the floor. There is blood everywhere. His BP is 78/25 and he is tachycardic. We start transfusing blood.

Dr. Phan tells me to step back. I look around. The scene is surreal. There is a stern calmness within the chaos. The nurse wipes the blood from the board the man arrived on and the janitor sweeps the floor while people in the room decide how to save this unknown man’s life. There are no questions as to who this man is, where he is from. No consideration about money, politics, administrative details. It is simple: he is on the table and it is our job to do what we can to save him. Dr. Phan orders, “To the operating room” and we roll the man to the elevators.

In the OR, teams of nurses are prepping the tools and the different surgeons discuss what they are going to do. Ortho is going to amputate the right leg and left foot. Urology is going to pack the hemi-scrotum. Dr. Phan and the trauma surgeons cut open the abdomen to find the source of the bleeding and pack it. Anesthesia intubates the patient and his body is still. They hang up the bags of blood for transfusion, push the content through his body, change bags and throw away the empty ones. I count the bags of blood products: RBC, platelets, cryoprecipitate, FFP. A nurse comes in with a red biohazard bag containing more blood products. They cannot bring the bags fast enough. I organize the empty bags into piles and tally. Slowly, the man’s blood pressure starts to increase.

The nurses prep the man’s body, sudding his naked body with chlorhexidine sponges. Dr. Phan is already scrubbed in, enveloped in his half-tied surgery gown and lopsided bouffant. He makes an incision, his movement sure and precise. He stands on his toes. I catch a new strange flicker in his eyes.

I first met Dr. Phan during my first year of medical school at a South East Asians in Medicine mentor mixer. He was the facilitator at my table where I sat with other medical students. He looked like a monk with his shaved head and calm face. He spoke quietly with preciseness. Dr. Phan came to the US when he was 14 years-old from Vietnam. He started medical school thinking he wanted to be a family medicine doctor. “All I knew growing up were family medicine doctors. But when I first stepped into the OR, I knew I was going to become a surgeon. I just knew.”

These memories come back to my mind as I stand at the head of the table behind the sterile drapes with the anesthesiologists who are pushing in medications, switching out blood packs, and monitoring the vitals. Dr. Phan retracts the abdomen. He calls out: Debakey. Clamp. Right angle. He takes out lap towels soaked with blood. I watch him, fascinated by the transformation of this reserved, unremarkable man on the floor into a dynamo in the OR. And yet in the chaos of the OR, he is the embodiment of the calm within the storm. The scene reminds me of a photo I once saw of a monk who set himself on fire during the Buddhist protest in Vietnam back in the sixties, sitting perfectly still and erect in lotus position as flames engulfed him.

My chief resident Katie’s face mask is splattered with blood. She has her hand in the right abdomen of the patient. Dr. Phan asks her, “Where are you? Put your finger here under the spleen.” Another resident comes behind him and just about reaches his hand into another part of the abdomen, but Dr. Phan catches it. “No no no,” he says, and taps the resident’s hand away. “I need a step stool!” Dr. Phan calls out. He is not tall, just a few inches taller than me, and I am only 5’1”. Dr. Phan scoops out the bowel and runs his hands along it. “Scissors. Needle. Debakey.” The scrub nurses pass the tools across the table to Dr. Phan and Katie moves her torso intuitively out of the way as she examines the liver for bleeding. The smoke from the boveys rises as the surgeons cut through flesh. Blood is drained into metal pans that look like the ones that hold scrambled eggs at a buffet table.

“Distal femur- For permanent?” calls out the nurse. The orthopedic surgeon answers, “No, trash.” And the nurse places the bone that just got removed into a red biohazard bag. They guillotine off the crushed leg with the foot from which I had cut the sock off earlier. A few minutes later a disembodied left foot sits on the table surrounded by tools patinaed in dry blood. I go over to help place the foot in the biohazard bag.

They continue to pack the abdomen. Dr. Phan pulls out a bloody spleen. The surgery goes on for hours. Blood products pile up, with a tally of 57 units of blood product transfused by the end of the surgery. The floor is spattered with blood and strewn with used gloves. They decide to keep the abdominal incision open. There is something almost inhuman in Dr. Phan’s eyes as he steps back. He tears off his surgery gown and his scrubs are drenched in sweat.

Another surgery awaits him. He will barely have time to change.

Mara Cao, MS3

June 2020

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