I went in early to work today. I needed to look at as many
diseased cervices as I could find in a textbook before 8am. At 8 procedure
clinic would start and I’d be supervising the Superstar. On the docket were 2
lipoma removals, 2 colposcopies, and a punch biopsy.
I wasn’t sure if I remembered how to do any of these things,
let alone supervise them.
See, a colposcopy, for example, is about two things. Thing 1
is sheer awkwardness: setting up cameras and screens in front of a nervous,
half-naked woman. Then you spend another grueling 20 minutes finding a speculum
and adjusting the camera and adding a filter and zooming in and clumsily
knocking the camera over and contaminating the biopsy tray and asking for
another and adjusting the light and the camera again, between the mortified
woman’s legs.
“Oh, sure, just like at home,” our nurse JHot said when I
explained this to her (she lamented never having watched one. For reals.)
Thing 2 is pure pattern recognition. Mosaicism, leukoplakia,
bridging. Immature metaplasia. Punctation, nabothian cysts, papilloma.
Decreased uptake. Ulcerations. Algorithms.
I’m better at thing 1.
Thing 1 is all about finesse. Thing 2 takes frequent,
repeated exposure. Hard work, at that one thing. Studying with your eyes, as
much as with your mind. But I’m willing to put in the work.
The good news is, it went well. In an hour I brushed up just
enough to know what to biopsy.
Also, I’m good at surgery. Relatively, I mean. I had
forgotten this about myself. I’m not a surgeon because instead I trained to be
a family doctor. I just mean I have the aptitude. I know how to handle the
tissues. My fingers know what to do.
If I’d done surgery maybe I’d be a better surgeon than the
family doctor I am today. Maybe I’ll try not to think about that too much.
I watched the Superstar cut through the epidermis overlying
the lipoma. I told her to hold the knife a little different. She obliged.
Dermis. Connective tissue. Fat. She dissected. I dissected. We got out fancy
instruments. We uncovered the fatty tumor, used a clamp to lift it and found
the tissue plane between it and the fascia below.
Then it was out in a satisfying glump. We closed the wound
with two layers of stitches. I showed her ways to hold the skin, to produce
better tissue eversion.
Blood and tissue equals gore, but surgery is heady. How many
nights did assisting on a c-section awaken me from half-sleep? Blood means
business. It narrows the focus to the present, life and death, meanings
therein. It’s messy and euphoric. Once I even got cut in surgery with a
scalpel, and I didn’t notice. Only when the Dragon asked “did you just punch me
in the scalpel?” did I realize I was bleeding into my glove.
I like it, and I have something to offer in teaching it.
Relatively speaking, of course.
That felt good.
I finished clinic early (for me) and stopped by the hospital
on my way home. My patient had delivered
the day before.
She’s the one I worried about, with possible cholestasis,
then liver issues, then renal insufficiency vs atypical preeclampsia. I wanted
her delivered sooner, but couldn’t pin a diagnosis on her. Plus she was going
to try a VBAC.
She didn’t make it. When her bag of waters broke, there was
meconium and the baby’s heart rate went down for a while.
The love of her life had left her when she became pregnant.
“I guess he wasn’t ready for the responsibility,” she told me. When she was
about to have her baby, though, her mother drug him to her bedside as she
writhed in pain without an epidural and people ran in and out of the room. He
went into the c-section that ensued, watching the blood that poured onto the
floor. “Mom thought he deserved a front-row seat,” she told me.
Her baby rests now, on her chest. He doesn’t want to leave
her, not for a moment.
Last year in the worst of times G.B. told me I didn’t know
how to love anymore. I spouted off something angry and doubted myself for days.
He was wrong. I do know how. But love is not what we’d believed it to be,
maybe. Love is blood. Love is war. Love is backbreaking, work in the trenches,
elbows deep in carnage, debt, dirty diapers. Love is a clear blue sky torn
through with screaming missiles, fire sweeping the fields, children cowering in
tents. Why else does cupid shoot you in the heart, but that you may bleed?
Blood is love. It is not all of love. But what else but love
and blood, rushing through our veins, keeps us alive?
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