Do What You Are.

I had a bicycle with ribbed pink plastic handlebars growing up.

I can’t remember much more about that bike, but somehow I can still feel those tiny ridges bending and pressing into my palms. I could probably identify that bike out of hundreds simply from the handlebars alone, down to the most minute of details. Opening this memory causes other memories from Phoenix to innately spill out as well – the plastic taste of the vibrant beads that always jingled on my wrists, the throaty call of the dove that had pulled the sun up each morning, the smell of the gritty orange scrub my dad had used to scrub motor oil from his fingers.

This is what surgery feels like to me.

Silky latex stretching over my knuckles, blue tissue-paper crunching around my waist, the steady rise and fall of a sleeping sternum, sharp clinking of steel surgical instruments, a hypnotizing metronome of a throbbing pulse.

It is a sacred world hidden from society.

A silent language of communication through eyes locking over masks in an intimate huddle of illness.

I have found my purpose.

 

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Admission Note

0012       Trauma admit arriving by air
0013       MVA w/ patient ejected from vehicle. Previously healthy, no PMH
0014       Daughter currently outside trauma bay
0015       ETA 0025
0016
0017       Alert & following commands at scene
0018       Open upper extremity fracture – pulseless
0019       1U of pRBCs and Dopamine en route. BPs running 70s/40s
0020
0021
0022       Pt arrived. Pt is unresponsive. CPR in progress
0023
0024
0025       R arm cyanosis in fingertips, immobilized in splint. Visible midhumeral bone
0026       Distended abdomen w/ bruising along flank. Absent L breath sounds
0027       Needle decompression L chest, return of rush of air
0028       Cardiac rhythm, CPR stopped
0029
0030
0031       No confirmation of airway, anesthesia at head of bed
0032       FAST ultrasound positive for intraabdominal bleeding
0033
0034       Patient being prepped for open laparotomy in trauma bay
0035
0036       Carotid pulse still palpable, faint
0037
0038
0039       No confirmed airway yet
0040       Laparotomy incision made, anesth
0041
0042
0043      Significant bleeding from abdomen
0044      Pulse check — no pulses palpable. CPR started
0045      Mask on and bagging
0046      Hanging 5th U pRBC
0047
0048      Epi 5mg push
0049
0050       Pulse check —  no pulses palpable
0051
0052       Hanging 2U pRBC
0053
0054
0055       Pulse check — no pulses palpable
0056       Rapid infusion running
0057       15 min CPR
0058       Daughter bedside. Restrained
0059       Pupil check — pupils 4 mm, non-reactive bilaterally
0100
0101
0102
0103
0104       Time of death

 

Admission note transcribed by a third-year medical student during trauma activation. Identifying details of this encounter have been modified in order to protect patient privacy.

Ice Cream Sandwich Socks.

She was the most terrifying surgeon in the hospital.

In an age where white coats were to be worn only by men, she walked fiercely into medicine anyway. She took the sneers and barking from senior physicians but she held her chin held steady. Back then, medicine was not a woman’s game. With each step she climbed, she tacked on another piece of armor and she grew stronger. It toughened and polished her, and she was built into the indestructible surgeon she is famous for today.

I have watched chief resident’s fingers tremble beside her. I have watched fellow surgeons, renowned and respected in their own right, fall silent as she stepped into the room. Scrub nurses, usually bustling and preparing while chatting with the circulator,  stand alert with fingers poised and eyes glued her hands, anticipating her next move. Medical teams in the hospital, young doctors visiting from out of state, senior doctors trailing the end of their careers – they all know her name.

For weeks, we had stood shoulder-to-shoulder in silence as she performed many of the biggest surgeries known to medicine. The infamous Whipple procedure – a grueling 8 hour minimum- was her favorite. Her fingers seamlessly twirled around the surgical instruments, and I longingly watched as she carefully cut open the belly, clamped arteries, and unsheathed the pancreas. I stood perfectly still, often for over 10 hours, with my hands carefully planted on a corner of sterile draping. Others had warned me: “She prefers medical students to simply observe. Whatever you do – don’t grab anything.”

Yet something in me resonated with her. There was the smallest hint of a smile in the corners of her mouth under her mask when her eyes met mine. I recited my patient presentations I had spent hours memorizing for her clinic and could see a flash of approval in her stone cold expression before she spun on her heel to enter the patient’s room. Then one day, she handed me her suture. That day in the OR, I was taught the sacred ritual. She began to signal for me to cut her sutures with the slightest flicker of her fingers. One day, I nearly tripped over my own feet in shock as she stepped back from the operating table and silently waved for me to assist the chief resident in stapling the bowel in half.

She was like no one I have ever met. During my last day on her service, she unwrapped the ice cream sandwich socks I had bought for her and she squeezed the breath out of my ribcage. And I will never forget the words she told me:

“Hailey, you are a surgeon. I can see it in you. Do what you are.”