Her Doctor’s Jargon
by Margaret Carrasco Arias
Later that week, I’d observe other surgeries and the residents would introduce me. Push me up to the patient and say, “Mrs. Dean, this is Margaret. She’s a premedical student and she’ll be with us today.” They’d ask if I had been trained in patient confidentiality as we wheeled Mrs. Dean to the operating room, and when I answered yes, they’d let me peek at the relevant pages of her patient file.
But that day, that first time, there were no introductions and no files. There was just a woman. Maybe in her seventies, the woman had wrinkles that swam up and down her face in patterns. Her hair alternated between grey and white waves, all carefully tucked into a surgical blue mesh cap. Her hands were clasped together over her chest, long fingers with interlocked age spots trembling with her breath. She looked stuck, between practiced calm and increasing panic.
Shortly beforehand, I’d stood on my tiptoes, knocking on the double doors that divided the hallway and the pre-op waiting room. My no access Premedical Student ID badge hung uselessly on the pocket of my extra large scrubs. The Franklin Hospital of New York City only bought extra large scrubs so it could have a one-size-fits-all policy. Smalls never ran out and mediums didn’t get stolen. Extra-large, quick, and convenient. I, at five three, stood out in this costume, transformed into a small child playing dress up.
Now I rolled this female patient with Grace, the surgical resident who still refused to go by Dr. Wang, into Operating Room 16. Inside, Nicole, the OR nurse, turned to us with a quick snap of the neck. She was a black woman with large curves, who stood regal and upright on a footstool as she organized medical tools—scalpels, scissors, and stiches—all on a stainless steel table covered by a deep blue sheet.
She followed me, the stranger, with her eyes, and, after asking why I was there told me not to touch anything. I must have looked ridiculous, drowning in dusty blue, or she was in a chatty mood for she began telling me about Dr. Richards. “He is the worst,” she said while pulling out a scalpel from its sterile cover. “Strolls in whenever he wants to. Asking if everything’s done.” She moved the scalpel onto the blue sheet. “As if he’s not supposed to talk to his patients before surgery. As if he’s not supposed to be here too. The nerve.” At the same time, Grace and Matthew, the anesthesiologist, cradled the woman, curling fistfuls of the white sheet beneath her, and transferred her onto the operating table, lifting her up then over.
Grace taught me how to strap the patient’s legs to the operating table, only to come back and tighten the black bands herself. So I tried to bring them both supplies, but by the time I knew where to find Matthew’s latex gloves, he could have grabbed them himself. Five minutes inside the OR and I knew I had only increased their workload. So I shrank into my scrubs, more comfortable as an observer.
I sat on a small circular stool to the patient’s right and watched. I tried to memorize all the actions done in clean haste, all the jargon tossed back and forth. I stared, the way I do at notes, hoping to convert pages into picture frames. I like to paint and knew that one day I’d color in these sketches with details. One day, I would call upon this moment and proudly pull it out, my first time in the OR. I memorized the smell—coffee from the Starbucks in the lobby. The whiteness of the walls and of the tiles and how light bounced back and forth in the room. I memorized the black flat computer screen in the corner of the room, where Matthew picked his music. Like office temps and mechanics that play Pandora in the background, Grace, Matthew, and Nicole listened to Dave Matthews as they worked.
I memorized the crisp, tidy way Nicole counted tools and rattled them off. The way she set gloves and surgical gowns on the table, ready for scrubbed surgeons and their residents. I memorized Grace’s speed as she floated from one side of the room to read to charts, to the other to clip the oxygen monitor on the patient’s thumb. I memorized Matthew’s readers that beeped numbers and rainbow lines—oxygen levels, carbon dioxide, blood pressure—as Matthew started an IV, gently rubbing his fingers on a green vein. They worked with a gracefulness that only comes with familiarity. This was their office.
Meanwhile, the patient, the woman on the table, lay still. Her arms splayed out onto black armrests, an IV in one hand, oxygen monitor on the other. She was awake but she remained as still as when we’d first wheeled her in. She was a painting of anxiety as minutes ticked around the operating table. Sometimes, she nodded when Grace whispered an explanation or a question. But I never knew her name and never heard her voice. Though, I assumed she’d been given drugs to help her relax, her face was scrunched up with tight eyes that blocked out fear. If she could, she would have curled into fetal position, back slightly turned to protect from the overhead lights.
From my chair, I noticed her chest start to rise and fall shakily. Slight tremors in her shoulders like California earthquakes. Standing, I could see the light reflecting off the small droplets leaving her eyes and crawling to meet her ear, where the water got stuck like rain on flower petals.
Matthew was filling syringes; Grace was setting up IV poles.
Nicole asked about the head surgeon. “Any word from Dr. Richards?”
“I paged him,” Elaine, another nurse, replied. “Nothing.” Nicole grunted from her footstool.
I could feel indecision strumming tendons in my hands and legs. ‘Maybe I should get up and hold her hand. Wait. I needed to put on gloves first. Right?’ I thought from my stool. But what if she doesn’t want anyone to notice? We hadn’t even been introduced’. The woman took a deep breath and turned her face towards me, as if to display her pain and anguish. But her eyes were still closed, so she did not see me, staring at her, swimming in extra large pale blue scrubs. The path of her tears still illuminated by fluorescence.
“Grace, it’s time,” Matthew called and ended the silence. “We’re going to administer you the anesthesia now,” Matthew explained as he emptied a syringe with a milky white liquid into her IV. “You should be getting sleeping. Tell us when you begin to feel the effects. Now, breath in deeply.”
He held the breathing mask over her nose and mouth. The mask was a clear protective cup attached to a machine delivering a hundred percent oxygen. The lining was swollen with cushioned air that curved over her nose, followed sagging smile lines and ended at her chin. On the graph, the blue oxygen line rose above red carbon dioxide and green nitrogen.
“Can you hear me? Nod if you can hear me. Can you hear my voice?” When the woman did not respond, Matthew quickly removed the breathing mask and titled her head back to begin intubation.
During intubation, the patient, under heavy anesthesia cannot breath for herself. The lungs are filled with pure oxygen to last a couple minutes as the anesthesiologist connects the lungs to a machine with a plastic tube. Matthew used a laryngoscope to pushed the woman’s tongue away and expose her trachea. Then he smoothly inserted the plastic tube into her trachea and connected the end of the tube to the machine. He confirmed the tube was in her lungs, not her stomach, by first looking at her now rising chest, then the condensation forming along the tube’s edge, and finally the machine. He secured the tube and taped it along her cheek and then taped her eyes shut. Intubations were routine, but I was in awe.
Then as the excitement faded, I realized something smelled. The room smelled like defecation, like plumbing in old bathrooms that never flushed properly. When no one else noticed, I blamed my imagination. But soon after, Nicole straightened and turned her head towards the operating table.
“Grace. Matthew. What is that?”
Grace followed her own nose to the foot of the operating table. She lifted the white blanket from the woman’s legs. A brown puddle was seeping into the white sheet beneath the patient.
“Ugh, can you believe this?” Grace cried. Uncovering the source of the smell only made it stronger.
Matthew groaned from the other side of the room. “Yeah. That’s disgusting. My god, you’d think that…”
“Matthew, you need to come here and help me with this. Margaret, you too.” Grace commanded everyone effortlessly. “Matthew and Elaine, lift her up when I say so. Margaret, bring the trash can over here…under me.” She grabbed the edge of the dirty sheet. “One…two…three…lift. Like that.” Grace yanked the sheet from beneath the woman and dragged it into the trash can. The sheet plunked down, carried by its own weight. “Elaine get this out of here and get us a new one. Please.”
“Can you believe old people?” Matthew said as he took of his blue gloves and put on new ones.
“Yes. I can. Disgusting. Did this happen when she was awake?”
“I don’t know. If so, she’s just rude. She couldn’t have let us know?”
“She was crying! She was crying!” I didn’t say. I wished I had gone into that operating room and proven myself to be more knowledgeable, confident, and skilled than any other premedical student they’d seen before. But more than that, I’d wished my empathy had translated into courage.
“I can’t begin to explain.”
“They aren’t supposed to eat at least 24 hours before surgery right?”
“Yes, especially cause it’s her abdomen. People are so stupid.”
Matthew shivered. “I feel pretty fucking nasty.”
“I know how you feel. Damn. Can we get an air freshener or something in here?” Grace said as she used a wipe to gently clean the woman. “Dr. Richards has obviously decided he doesn’t feel any need whatsoever to be here. He’ll just scrub, waltz in, and scream about whatever isn’t perfect. And now with this insane shitter on the operating table.”
I quietly stepped back away from Grace and Matthew, creeping backwards until my legs hit the metal stool and I sagged down onto it. I was glad she was asleep. I hoped she’d wake up with no memory of being in the operating room, no memory of crying.
Through their faces, I could see Nicole, standing on her footstool, overlooking her OR. There was a strange mixture of sadness and understanding on her face. Slightly furrowed eyebrows, slightly downturned eyes, face of empathy.
Suddenly, she moved her face and our eyes met. I wanted to look at her and her brown eyes, to somehow read into them the meaning I was trying to give this moment. I wanted her to tell me that this was rare, that talk like this never happened. Or that yes, because there are always risks associated with surgery, doctors had to detach themselves from their patients, but not this much, not this nameless. I wanted her to be able to tell them to stop, to shut up. I wanted to be able to do so myself.
But I turned away from her eyes, scared. Because maybe her eyes would tell me is that this too, this frustration and detachment would happen to me. Or that in my silence and in my passiveness, I was already on my way there. Maybe she would tell me that they had started the same way I had and this was the only way to cope. That ethics in a book or in a story or even in a painting was much different than in an operating room. And if so, I didn’t belong.
So I turned away and sat on my stool, just as Dr. Richards walked in asking if the body was prepped.
Later that week, I’d observe other surgeries—laparoscopic hysterectomies, kidney transplants, cardiac bypasses—but I never got to be as involved as that day, that first time. A little later I stood on a stainless steel footstool over the operating table with three doctors. We were all covered in dark blue gowns of detachment and protective masks of sterility. Our hair was stuffed into surgical caps and the differences in our hands had been gloved. Here, over this table, we looked alike. Here, I was only distinguishable the footstool I needed to see.
Dr. Richards inspected the bloodied liver, probing with skilled fingers. Then he looked up, met my eyes, and instructed. “Put your hand here.” So I did; I let go of the retractor that held the right side of her abdomen open and put my red-gloved hand into her body, near his.
I could feel an artery, blood keeping time beneath my fingers. I could feel the way her body was working. And as she worked, the fear faded a little. I don’t know everything, but there are some things I know I don’t want to forget. The same things that drive some, if not most, doctors to do the work they do every day. So I had to find ways to remember.
“Do you feel that?” Dr. Richards asked. I nodded. “That’s the hepatic artery. It feed blood to the liver. Now grab the retractor again.” I inched my hand out from the softness of her exposed cavity and placed it back on the cold instrument, middle and pointer finger still thumping. I’d never felt anything like that before.
Grace had said Dr. Richards was an ass, but a great teacher. She was right. She stood to my left, prepared to snip away at the body with sharp scissors. Dr. Clark, another surgeon, leaned in, ignored the hepatic pulses, and concentrated on the disease—hard, bubbled white mass on the gallbladder. The rest of the room lay in darkness, but severe lights illuminated the surgeons and body. We could see her organs and vessels, parts of her no one had seen, in such great detail. The surgeons used the bovie, the buzzing pen that razored and cauterized skin and tissue, to open her a little more. They’d become desensitized to the smell of burning flesh.
They had covered her body with a blue sheet, leaving exposed only a square segment of vulnerable abdomen, like a textbook image. They had lifted and pinned the top half of the sheet to IV poles on either side of her head, creating a barrier, a sloping blue hill. On one side, our hands worked in the valley. On the other, the anesthesiologist’s side, a machine inhaled and exhaled for the patient.
I leaned in to see the surgeons’ fingers as they removed a tumor from her gallbladder and then her liver. I just held the retractor, pulling on it the way Dr. Richards had taught me. But I was closest to the barrier and, every now and then, peeked behind it to look at the white haired woman whose eyes were taped shut.