Free surgery
I hereby offer to perform any surgical procedure on you.
If you would like for me to perform some surgery on you, all you
need to do is present yourself to me and tell me what sort of surgery you need. I'll
take it from there. I even have cool surgical stuff.
And the best part is that it's free. You read that right, it's
free.
No, in case you're wondering, I'm not a surgeon or any sort of
physician in the sense of being licensed or anything like that. But that works to
your benefit, and here's how: I don't have any of those pesky medical school student loans
hanging over my head, and I've invested absolutely none of my time or capital to the study
or practice of medicine. Consequently, I do not need to charge you for your surgery.
So, I hear you asking, what are my qualifications? I figure I
have surgery figured out from having been in the actual operating room where an actual
procedure took place.
By virtue of being a claims adjuster I was on
speaking terms with the Chief of Orthopedics of Northwestern Memorial Hospital, a
well-respected teaching hospital in Chicago. A couple of times over a period of a
year or so I asked him whether I could watch an autopsy at his hospital, because I'd
always wanted to see what the inside of a person really looks like, but he kept putting me
off. Then one day he said, "Hey, Johnny, you know how you've been asking to see
an autopsy? How about if, instead, you watch me do a surgical procedure on a live
patient?"
You bet.
I showed up at the hospital at the appointed time, and Dr. Robert's
nurse, who had been expecting me, took my briefcase and my suit coat. She slipped
some sterile booties over my shoes and pointed me to the scrub room, where she gowned me
and told me to wait.
A few minutes later Dr. Robert entered the scrub room and asked me
to accompany him to pre-op, where the patient was lying on a bed behind a curtain in this
extremely high-tech room. The patient, a white male about 80 years old, seemed
oblivious to our arrival. Dr. Robert pulled back the sheet, and I saw
that every square inch of his left foot and most of the lower
six inches of his left leg were 100% black.
Diabetes had rendered his left lower
extremity necrotic, meaning literally dead or dying. No nerves, no blood, no lymph,
no nothing, just useless rotten, rotting tissue. The necrosis had been rapidly
working its way up the patient's leg and, according to Dr. Robert, was going to kill him
in short order if he didn't get an above-the-knee amp stat (see how I can use these
cool hospital terms?).
Dr. Robert then whipped out a camera and took several Polaroid
photos of the patient's left ankle and foot. He asked me to sign and date each one,
which I did. I knew that taking photos like this before surgery was unusual, and
when I questioned him he told me that the patient's son had been disputing the need for
the amputation and was threatening to sue Dr. Robert if he took his father's leg off. It seems the son, who was a lawyer but no more a doctor than I am, was pretty
darned sure the amputation was unnecessary, but I think the fact he was set to inherit
some money when his father died might have colored his judgment. Dr. Robert told me
the son was talking about suing for malpractice, and he wanted the photos to prove that
the patient did indeed need an amputation. Have you ever seen a white guy with a
100% black foot and ankle? It's extremely . . . well, unnatural-looking. It has the sort of look that fairly shouts, "Amputate me,
quick."
Dr. Robert's nurse escorted me back to the scrub room and handed me
a Betadine sponge package, turned on the water, and told me to scrub my hands and lower
arms. I took this as good news, because I'd expected to be high up in a gallery
looking down on the procedure from several yards away. If I was to scrub, presumably
I'd be right there, on the floor, hovering behind the surgeons and the anesthetist and the
nurses, sneaking up-close peeks between the bodies surrounding the table. I was so
excited.
Purple lines
I had just started to wash my hands when Dr. Robert and the assistant
surgeon entered the scrub room, all gay and happy and unconcerned that they were about to
whack off a guy's leg. We chatted for a while, maybe a minute or two according to my
recollection, by which time I was all done washing up. I looked over at the two
surgeons and realized they were still scrubbing the same fingers they'd started
on. When I inquired as to whether I'd perhaps been a bit careless in my scrubbing,
they set me straight. They told me to do what they were doing, so I started over,
working on just one finger for as long as they did. I scrubbed that finger and then
I scrubbed it some more, and after that I kept scrubbing it. We spent about five
minutes washing and scrubbing and washing and scrubbing and finally rinsing our right
hands and lower arms, and then we spent another five minutes washing and scrubbing and
washing and scrubbing and finally rinsing our left hands and arms. Ladies and
gentlemen, I am here to tell you it's not like you see on TV. When surgeons scrub,
they really scrub. Later a nurse told me each surgeon develops his own little ritual
to make sure he's scrubbed the living hell out of every square micrometer of his hands and
lower arms to the point where they've pretty much removed a whole layer of skin. I
had no idea how seriously they take this germ thing.
Now, in case you're wondering whether I'll be as scrupulous
scrubbing for your surgery, the fact is I probably won't, because it gets pretty
monotonous after the first couple fingers. But I'll wear two pairs of gloves if you
like, which'll save us both a lot of time and me a lot of Lava soap.
Anyway, immediately after we'd rinsed a nurse (Note
to self: Should there be a comma after "rinsed"?) swooped in and gloved us and put paper hats on us and masked us (attached to
the mask is a little strip of metal that rests over the bridge of your nose that you sort
of squeeze into shape so your mask stays put, which they never show you on TV because it
looks stupid when you do it) and held the doors open for us to enter the operating room
(we just call it "the OR").
The chatter in the OR (see?) stopped abruptly,
and the nurses scurried about placing trays full of implements where Dr. Robert wanted
them, and then one of them proceeded to scrub the patient's freshly shaven leg while we all stood around
and watched and gabbed.
I will spare you the details of that scrubbing, but suffice
it to say that man's left leg was really, really clean. I got bored watching, so I wandered to the periphery of the room and lit up a cigarette.
Half a minute or so later a nurse came running over to tell me, in what I thought was an unnecessarily insistent tone, that you can't smoke
there. She also said, and I quote, "And stop playing with the machines!"
As for your free surgery, you as the patient may smoke
anytime you like, even during the procedure if you want to. I certainly plan to.
After the interminable and far-ranging scrubbing (why is she
scrubbing way the hell up there?), a nurse raised the table up to about chest level, which
seemed awfully high to me, and certainly higher than I'd ever seen on TV dramas, which is
where I've gotten most of my medical training. Dr. Robert, the renowned surgeon, the
Chief of Orthopedics at what is probably the finest hospital in Chicago, explained to me
that he couldn't bend over because he had a bad back.
The assistant surgeon, who was about five feet five inches tall to
Dr. Robert's and my six feet, hauled out a metal box, and it was on this that he stood throughout the whole surgery,
sometimes having to step off it and kick it to a new location. No one else
snickered, so I didn't too.
Dr. Robert produced a purple felt-tip pen and
leaned over the patient, preparing to draw lines showing where he would make the first
incisions. He was leaning over the wrong leg, so of course
everyone laughed. When you're the head dude, you might not be as
humorous as you think.
Tip: Every so often you read
about some doctor operating on the wrong body part, so if you're scheduled for surgery on
a body part that you have two of, like an arm or a leg or a kidney, keep in mind that by
the time they start to operate, you're gonna be 100% unconscious (or at least you sure as
hell hope you are) and therefore 100% unable to defend yourself. So, what you should
do at home, just before you leave for the hospital, is haul out your own felt-tip pen and
write in big letters, on the other body part, "NOT THIS ONE."
Really.
Speaking of which, here's a quick interruption for another
story from when I was a claims adjuster. We had a claimant who had lost his hand in a
thresher that had jammed. He had attempted to unclog the jam by sticking his hand in
it. He did manage to unclog the jam, immediately following which the thresher
went about its business and threshed off his hand at the wrist. Through his employer's Workers' Compensation policy
we paid for all his medical expenses, plus a big lump sum for the loss of his hand, plus
what it took to fit him with a prosthetic hand, plus which we were paying him two thirds
of his wages until he finally returned to work. About a year after he did return to
work, that same thresher clogged again, and he chose to solve the problem the same way: He
shoved his hand in and it was promptly amputated. Pretty stupid huh? Well,
listen to this: The hand he shoved in was his good one.
Speaking of which, here's a joke. A city slicker walks
up to an old country geezer standing next to a dog. The city slicker asks,
"Does your dog bite?" The geezer says, "Nope." The city
slicker reaches down to pet the dog, which promptly bites off two of his
fingers. As he's writhing in pain holding his hand he says, "I thought you said
your dog doesn't bite!" The geezer looks at the city slicker for a moment and
says, "That ain't my dog."
Anyway, later Dr. Robert's nurse told me that the single most
difficult part of that surgery, the part that requires the longest experience and the best
judgment, was drawing the lines for those initial incisions. Not some fancy scalpel
work, not some flashy suturing, just drawing eight zig-zag lines around the leg -- which makes four flaps -- with a purple felt-tip pen.
Apparently it's really
easy to screw up the drawing of these lines, whether for an above-the-knee amputation
or any other amputation that leaves a stump. If the resulting triangle-shaped
flaps and the tissues beneath them are not incised and later reconnected properly, the
outcome is a permanently painful stump.
Dr. Robert instructed the anesthetist to begin, and a nurse covered
the patient with a big blue drape and aligned the hole in it over the incision site.
Then, just like you see on TV but way less dramatically, Dr. Robert called for a #10
scalpel, which was handed to him by the tool babe.
(I'm pretty sure that's not her proper title, but in the case of
your surgery it doesn't matter because I won't have one.)
Before he agreed to let me watch the surgery, Dr. Robert had asked whether I would have any difficulty watching a surgical procedure without
getting nauseated. I had told him I didn't think so. And as she was gowning me
his nurse asked me the same thing. Apparently they don't like it when kibitzers puke
in their precious OR, especially during surgery. (They really make too big a deal of this germ
thing, if you ask me.) Anyway, as it turns out I was allowed, even expected, to
belly -- well, chest -- right up to the table, smack-dab next to Dr. Robert, to watch this whole thing.
I was in heaven.
Dr. Robert proceeded without hesitation to slice through the skin
under one of his purple lines. I was surprised at how little blood emerged.
As it turns out, seeing that for the first time didn't bother me a bit. Dr. Robert
made the cuts much faster than I thought he would, and I'm sure I was the only one in the
room who thought it was the least bit dramatic, that first cut.
He proceeded with care and confidence to incise through the skin
layers, and every so often he'd say, "Bleeder," and the assistant surgeon would
whip out a variable-temperature cautery tool and heat-seal a capillary that was
leaking. He'd touch the tip of the device to the spot where the blood was coming
from, there'd be a quiet "pfft" noise and the merest pufflet of smoke, and the
bleeding would stop. For cautery during your surgery -- which, I remind you, is free
-- I will be using the soldering pencil that I bought in 1967 to fabricate custom-designed slot car frames.
Below the skin are fat and muscle. And in short order you run
into major blood vessels, which you can't just cauterize. You have to tie them off
with suture or anastomose them. Dr. Robert had been narrating every step of the
operation for the benefit of the assistant surgeon, but he also clearly enjoyed keeping me
up to speed, telling me things everyone else in the room already knew. When it came
time to sever the femoral artery, which is the big one, he explained how he was tying off
the section above where he was going to make the cut. He proceeded to tie a fancy
knot (I think it was a Cuban Eight) really fast, and then he had the assistant surgeon
scissor through the artery. As it turns out, surgeons never use scalpels if scissors
will do, and they've got an interesting selection of special scissors to choose from.
Then he held the upper portion of this huge blood vessel, the artery
that supplies blood to the leg, between his thumb and forefinger and said to me,
"Would you like to see how powerful the heart is?"
He asked the tool babe for a Framiss bowl (OK, OK, so I can't
remember the exact name of it, but it looked like a big Dixie Cup if that helps you to
picture it), and then he put it in my left hand.
He said, "Hold that bowl down here," pointing just below
where he was holding the femoral artery closed with his fingers. I could hardly
believe it. Here I was, a complete stranger to anything more seriously medical than
a Band-Aid, being asked to hold a Framiss bowl to catch the real arterial blood flow of a
real patient in a real operation.
Then he said, "With your right hand, just take the femoral
artery from me. Aim it at the bowl and release the pressure."
"Just take the femoral artery." That's
what he said.
Well, if that isn't an endorsement, I don't know what is. I am
the surgeon for you, unless someone else you know -- who will also do it for free -- has held a
live patient's femoral artery in his hand.
As it happens, the actual performance of this procedure -- taking
the femoral artery from Dr. Robert's fingers and aiming it into the big Dixie Cup and
releasing the pressure a bit -- was easy. I mean, it's not like all of a sudden your
muscles begin to twitch and your mind reels. Still, I was so happy to have been
asked to participate in a surgical procedure, however simple the task. As you can
tell, I still remember it.
Yipes
When I released the pressure between my thumb and forefinger and
aimed the artery at the Framiss bowl . . . nothing happened. No pulses of
blood like everyone expected, just a moment of uncomfortable silence. What had I
done wrong?
Dr. Robert asked me whether I had released the pressure.
"Yes," I said. He looked puzzled, and he reached in and took the artery
from me. He held it down over the wound and allowed it to dangle. Still no
blood.
I was sure I'd done it right. I mean, after all, I've peed my
initials into the snow several times in my life, including the periods. But I sensed
the others in the room weren't so sure of my surgical prowess. As I watched with
about as much concentration as I have ever mustered, Dr. Robert ran his fingers down the
exposed length of the artery the way you'd squeeze out the remnants of a ketchup
package. He hummed a kind of "Aha" noise when he felt the blockage that
had been preventing blood from gushing through it as it should have. He worked the
blockage down towards the open end and squooshed it out. It was white like gristle
and vaguely cylindrical.
That's as close as I've ever been to performing surgery
. . . so far. Although, now that I think of it, there was this one other
time involving a trocar . . .
After you have scissored your way through the various layers of a
thigh you eventually get to the last part, the innermost part, which is the femur.
The femur, which is the biggest bone in the body, is the bone that connects your hip to
your knee. After seeing all the precise little cuts the surgeons made to slice
through all the other layers, the way they handled that bone surprised me. While a
couple of nurses held the two portions of what was left of the patient's leg steady, the
assistant surgeon looped a length of what was essentially surgical-grade barbed wire
around the femur and put his index fingers through the rings on each end.
Then he
began to saw. It took me a sec to realize what I was seeing. I was surprised
because this method of severing the bone seemed so low-tech.
It took a lot longer than I thought. The assistant surgeon
would stop every so often, but when he did stop he never moved his hands. He just
waited for a few seconds and started up again from exactly the same angle.
It turns out they don't want to burn anything by the heat of friction, and
they also don't relish breaking new ground, if you see what I mean.
When the assistant surgeon neared the end of the task, Dr. Robert
took over the sawing. He drew the rope saw within a few millimeters of the center of
the bone and then he asked me to reach over with both hands and take the leg when
it fell off.
I know that by now you think I'm just making this stuff up, but I'm
not.
I reached under the leg, with my right hand under the knee and my
left hand under the calf, and took hold of it. The nurses moved their hands out of
the way. Dr. Robert made a few more precisely plotted sawing motions and the leg
fell free.
Into my two hands.
I had not been bothered by the first incisions into the flesh.
I had not been bothered by any of the slicing and scissoring of the other body
parts. But something about feeling the weight of that leg part dropping into my
hands did get to me. It wasn't until that moment that it dawned on me: This guy just
lost his leg. Somehow I had it in my head that if they wanted to they could sew
everything back together, that all that cutting and slicing was reversible. But when
I took the weight of that leg (which, I remember, was heavier than I thought it'd be), that's when it
first sank in that this poor guy was now permanently short of a full complement of legs to
the tune of one.
Carrying the leg, I was closely escorted by a nurse to a cart on the
periphery of the room, where she instructed me to lay it down. I did so, and she
wrapped it in that surgical-grade Saran Wrap stuff they use. She wrapped it in maybe ten
layers of the stuff, which I thought was excessive. You may be sure that in your
surgery I will not go crazy with the real Saran Wrap.
I returned to the operating table to observe what I regard as the
moiety of surgery, which is that whatever you did by cutting you need to patch up by
sewing.
Fast and accurate
Dr. Robert was rounding off the end of the femur with a really fancy-looking stainless steel, variable-speed osteal grinder (in order to save expenses, for
your surgical amp I'll be using a drywall rasp), then he worked his way back up the
layers, suturing some parts together himself and having his assistant do others.
Occasionally they would discuss exactly how to mate one tissue with another. When it
finally came to the skin flaps, everything slowed down while Dr. Robert took a few
stitches and then the assistant took a few. They use special-built locking pliers called
needle-holders, with which they manipulate these teeny curved needles through the
layers. (For your surgery I'll be using a pair of Channel Lock pliers and some fishhooks, if that's OK.) When the surgeons knot a
suture it looks like magic it's so quick and so certain. From rote repetition, they
can tie knots literally blindfolded with one hand. (As far as your surgery goes, I'm
almost positive I know the difference between a square knot and a granny knot.)
Towards the very end of the sewing, they actually removed a few
sutures and redid them, the way you might write a sentence and then decide to go back and
fix it because it wrong, except in the case of surgery no one knows you sn't havbe a
delete key.
The surgery lasted a relatively long time because that's the nature
of an above-the-knee leg amputation, but I haven't yet told you how fast everyone
worked. Once the patient was rendered unconscious, the pace was unrelenting. Not a moment was wasted (except to entertain the insurance guy who paid some of Dr.
Robert's bills every year). As one surgeon cut a vessel the other was there in a
flash to cauterize it. Almost before a surgeon was finished with one implement, the
tool babe was slapping another one into his hand. It never looked rushed, but there were no rests,
no time-outs. It was like a dance choreographed for hands. I learned that
surgeons are all the time trying to break their own speed records, and it's not just
because they'll be late for their tee time.
It's because every moment a patient is under general anesthesia is
another moment during which he might up and die on you. Anesthesia is a kind of
managed state of near death. You have to knock the patient out so much that he
doesn't feel the pain but not so much that he croaks. It's a tough balancing act,
which is why nurse anesthetists and M.D. anesthesiologists are sued for malpractice more than any other brand of physician
except ob-gyns.
And it's for the same reason that surgeons treat patients' bodies
more roughly than I initially thought was necessary -- because they want to get them off
the gas as soon as possible.
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This is the business end of what's called a Wiener skin hook, a steal at $32. |
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This is called a rigid rake retractor, available in the two-prong version (shown) or the three-pronger, for around $25. |
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I prefer not to tell you what this retractor retracts, but I will tell you that as of July 2003 it'll cost you $425.70.
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They grab big hunks of tissue with clamps and pliers and hooks and
yank 'em hither and yon, they pull and push on the skin in ways that would be
extraordinary torture if the patient were awake. They do all this quickly, not gently like you think you'd like. Physicians have learned that
causing patients extra post-op pain from all this tissue torture is worth bringing them back from being half-dead
sooner. General anesthesia is a blessing fraught with more
danger that I thought before I observed this leg amp and asked some questions.
When I saw Dr. Robert again a month later I inquired
about the patient we had operated on. He told me the patient's son apparently
dropped his ideas about suing and that the recovery was still uneventful.
He
also told me that the patient was so far out of it mentally that he still didn't know he'd
lost his leg, which somehow made me feel better.
So, here's what you've been waiting for: the details of the free
surgery offer.
- I will perform any surgery you like.
- I will not charge you.
- I guarantee your satisfaction, subject to what turns out to be a
total of 404
provisions you agree to agree to.
- I will supply the #10 and #11 scalpels, a pair of toenail clippers I stopped using when they started rusting, a Kmart™-brand sphygmomanometer (b-p cuff) ((blood-pressure
thingy)), a surgeon's mask I used one Halloween to protect me from your germs, a real
stethoscope, a pair of Channel-Lock pliers and some fishhooks, assorted
woodworking clamps, a soldering pencil, and some nearly new dishwashing
gloves. Oh, and a drywall rasp.
- To keep expenses down, I'll be passing up on the whole concept of
anesthesia unless you count beer.
- I prefer Pabst Blue Ribbon.
To take advantage of this offer, which I probably won't be able to
honor more than a few times, just
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If you'd like to know just how bad surgery can be, read next about a young woman in the prime of her life and
in perfect health who went in for some and isn't anymore.
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