The Operating Room and Elsewhere
Surgery as Reconstruction
Here’s the funny thing: It actually does resemble TV. The scrubs, the instruments, the surroundings are nearly indistinguishable from what Grey’s Anatomy would have one believe. Even the terminology that floats through the air feels familiar from actors’ lips. I hurried back and forth, evading wires, sterilized metal, and women in scrubs. I strove, hungrily, to watch the minutiae, even though, having dabbled in quilting, I felt familiar with thread. The OR team had taken likely unintentional pains to disguise the difference between this room and the living rooms where I’d stitched continents for a baby quilt. Pale blue coverings concealed the patient’s face and nearly all his body.
As I watched, the world became—suddenly, tantalizingly—small. It shed domestic violence and malnutrition and inaccessible documentation, the concerns that, for the patients and their physicians, dwelt beyond these sterile walls. The surgical foreground was, briefly, all meaningful existence: The hand cut open in two places to free its immobilizing scar tissue. The leg draped in yellow that had donated skin. The many clamps, metal and scissor-like. The blue cloths that no longer, in my mind, stood for ocean and sky. It was enough to associate them with this young boy’s hand.
Playing Surgeon
I sat among the finest today at Massachusetts General Hospital, among some of America’s most gifted surgeons. And I pretended to belong, a feat made easier by the white coat my mentor temporarily procured for me. I learned about liver resection from an Asian man—someone who, like me, did not quite match the demographic of the hall’s portraiture but came close.
* * *
The resident taught us sutures today, so we tied square knots through blue dish towels. They really were surgical towels and thus disposed after contamination by use, but the two look much the same. The Brazilian pediatrician tried to help me perfect my technique and laughed when I, frustrated, took to knotting up my shoelace instead of the sutures. The laces’ thickness rendered easier that great challenge of aligning the knots.
Dangers
We paid our visit to bacteriology today, and I squirmed internally with a fear of infection. But I could not help crying out in awe at the beauty of the purple-pink Gram-negative stains, even knowing the colors demarcated our most dangerous pathogens.
* * *
In clinic, an infant cried the moment she entered the examination room. Babyhood PTSD? Or is such a response common? One might be faulted for diagnosing liberally and vaguely, where psychiatry is concerned. But physicians could argue endlessly over what comes down to the partially subjective. A gift of a stuffed animal offered some brief respite from tears. But, mostly, she was inconsolable, even in her mother’s arms. Fear, I have learned, is powerful—fear of the unknown and, in her case, fear of the known.
The Acute Care Unit
Accounting
Four years old. One push. One fire. Five lonely weeks. Zoloft administered to a tiny child. They say she scarcely spoke and would spit. She is the tiniest on our ward, though not quite the youngest. She will, I suppose, leave the unit soon. Her singed flesh has healed enough to let her bones and muscles bear her own weight. She walks the ward, her unbandaged hand in the grasp of her small and silent mother. Other countries, in hospitalizing even the youngest of burn victims, send families home overnight. And cannot or do not dress wounds properly. The anguish that comes of such physical pain and isolation, say the psychiatrists, begins to bleed across the borders into PTSD. So, Zoloft. In a four-year-old girl.
She stands, with her hair in ladylike buns, or she lies, swaddled in a blanket like an infant’s. Either way, our existence is not her priority. She stays withdrawn, though not playfully so. Her affect is no four-year-old shyness. She would need to lose interest, would she not, to survive these last few months? With a body torn open by flame, she would need to forget what it is to be held.
Girlhood
I watched physicians and nurses strip the dressings off the tiny, burned body of an anesthetized Bolivian child. Despite the raw-looking pink patches and the blood that dripped from the hand, we were relieved: her grafts took excellently. By afternoon, she was resting outside the unit, sitting with her mother, wide awake.
* * *
They brought in a miniature eight-year-old girl overnight. Supposedly nonverbal, autistic, and unable to feel pain, she spoke, walked, looked straight at people, had felt her burn’s hurt enough to cry out. I am struggling to accept her autism diagnosis: Nothing in my brief observation indicated it, and so little of her story added up—particularly those pieces intended to confirm her neurological status. She is a pigtailed child who appears beautifully healthy.
* * *
Our older little girl left the hospital today, and the younger will this week. I will miss them. But I am glad—genuinely: They have healed. The little boy can make it only as far as the wheelchair, so he reminds me daily what it is to be bound to the ACU.
Love Ferocious
I held a baby girl’s hand today as an hour passed outside her quiet room—so that she would squirm less when the nurses adjusted her dressings and IV, so that she would not feel alone in this unknown hospital crib while her mother sat somewhere she could not see, so that I might mitigate any sequelae of such strangeness. Consequently, I was late for the lesson on mechanical ventilation. But I could not bring myself to step away from the 18-month-old fingers gripping my 19-year-old ones. The doctor knew where I was. I hoped he understood.
She has seven siblings and an eighth due in April. Her surgery today was bloody, layers of dead skin sliced away until she bled before her arms could be wrapped up again in dressings. Her mother told us she likes to hold up her 18-month-old fists to her brothers and father and cry, “Fight.”
She spent a feverish weekend healing her own face. She reaches for hands to hold, always. Even with so many other children at home, her mother tends to her and her father sits by her bed—in a rocking chair almost too small for his form.
A Burn Survivor’s Commencement
When they awoke, I did also—from their weeks of burned agony and my habit of worry for them. They said he kissed them on the cheek, asking, “I’m healed?” The shy boy, remarkably mature for four, was willing to enjoy himself. His fun was his gift to us, indelible now in our lives. And the little girl danced. She imitated the movements of anyone she could charm into joining her. She insisted that we select Spanish children’s songs from Child Life’s iPad, and she remembered fondly her nurse from the ACU upstairs. She was bold, opinionated, strong-willed. She was garrulous. We smiled. We laughed, in awe and in shock. She never used to speak or dance or interact except when prompted—and then it was only “hola” and “ciao.” She reemerged into childhood, breaking readily through the boundaries of what I could imagine for her. And so there was joy to close their long illnesses. They reminded me, then, what it is to feel.
Note: Some details are altered to protect patient privacy.
Image Source: Flickr/World Bank Photo Collection, Wikimedia Commons