Sunday, March 17, 2013

Sunday Column

Based on something I wrote several years ago on my better blog, now heavily revised and, hopefully, improved (but minus illustrations and links), here's my latest Sunday column, appearing today in our local newspaper.
Forget politics today. Instead, come into the operating room with me, for a look at how spectacular you are. Well, okay, maybe for some it's “were.” Before you got a little thick in the middle, smoked, or just breathed city air for enough years, ate or drank too much, or did a few drugs, there was a time -- and maybe it's still true -- when you were knock-down, take-your-breath-away gorgeous. Sometimes while operating I've had to stop for a moment, just to admire it, called to the others in the room, "Come look at this amazing anatomy. Isn’t it beautiful?" Because it's true. Really, you should see yourself. 
Operating as intended, on sick people, more often than not things aren't so unspoiled inside. Diabetic, or old, or overweight, or with concomitant diseases affecting various organs, typical surgical patients rarely retain the born-in beauty and peach-fuzz perfection with which they came into this world. But sometimes bad things happen to the well kept or the young, and, in one of those paradoxical disconnects of the surgical mind, we are given a moment to find pleasure despite another's pain. Sometimes it's all just look-at-me laid out, undistorted, not hidden in adipose; the logic of it, the relationships, the purity so bright as to be stupefying. 
Singular among the other organs, all earth-toned, the gallbladder is robin’s-egg blue; adrenals – surprise! -- yellow as yolk! If unsullied by dietary excess, your liver is reddish-brown, firm as muscle, sensuous and slippery as an athletic beach-beauty’s oiled body. To know these things, experience them, is a privilege given to few. 
Through tissues showing age or abuse, we dissect, and probe, and burrow through fat to find what we need. Sometimes, though, breath-stopping, there’s a too-rare glimpse of the body’s flawless internal beauty. Not only is the operation made immeasurably easier, it allows a view of exquisite elegance as it was meant to be. 
A basic surgical technique is traction and counter-traction: tugging on tissues a little, applying tension in opposite directions to stretch things out, making dissection planes more visible. When you pick up a section of bowel to do that, most often there's work to do until you find the feeding vessels. But sometimes it's all right there, clean and orderly, displayed like an English garden. If you love doing surgery, it's impossible not to feel a little giddy. Like rounding a bend after a long climb and being able to see forever, you stop and savor it. The work becomes the art form it’s meant to be, a kind of music, teamwork coalescing with easy precision; there’s sublime pleasure in carrying it out, sadness when it’s over. 
Down the backside of the abdominal cavity runs all the plumbing: the aorta, bigger around than your thumb, carrying blood from the heart; the vena cava, bigger still, bulging and blue, bringing it back; the ureters, conveying urine from the kidneys to the bladder. Most likely they'll be hidden by fat. When you can see them -- the aorta, at least, and its branches -- they're often pocked and corroded, rocky and irregular. But just often enough to be a thrilling surprise, they’re perfect. Shiny with vitality, they ought to sizzle like high-tension wires. 
Those veins, like the ones from the legs as they join the vena cava, are both turgid and tender, scarily so. Their thinness signals danger. As with a powerful waterfall, your knees might feel weaker the nearer you get. The aorta, in the young and healthy, is life most literal. Thick-walled and strong, it intumesces with each heartbeat. Retaining its natural elasticity (before inevitably giving it up to cholesterol) it throbs and pushes against your fingers, both static and coursing with force and energy. There’s thrilling power in there, barely contained. Smaller branches, curlicued as they supply the bowel, lift and uncoil, stretching out and falling back, to the rhythm of the heart monitor. It can be mesmerizing. 
Not simply passive tubes, ureters produce silky muscular waves, subtler and less frequent, more pleasing than those of the gut. When unsure what you're looking at (a surgeon knows that looks can deceive), rather than wait for the next undulation you can pinch with a forceps or give a little flick with your finger: it'll respond with a lazy roll. On occasion, just for the pleasure of seeing it, I've done it more than once.

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