Cutting Through The Crap

Sunday, October 13, 2013

Sunday Column



After pushing the timeline back a little, I've finally published the last one, a non-controversial smooth glide out:

My first wonderment in med school might have been the nephron, the basic functional unit of the kidney. Its biochemistry and physiology are perfect examples of the body’s complexity, the precision of its inner workings. (Don't ask me to recount it in detail; that part of my brain has long since been emptied and refilled with concerns about adequate fiber intake.) Looking at it one way, the essence of medical school is the building of a sense of wonder at the elegance of the human body, and the essence of becoming a surgeon is realizing how ephemeral it all is.

What a marvel, that nephron: microtubules coming and going, the physics of glomerular filtration. And then the brain, electric with traveling ions! Muscles and mitochondria, teeming with practical alchemy; and, yes, DNA and RNA really are as marvelous as you think. Or, wow: that manufacturing powerhouse, the liver. It's simply astonishing. Whereas the torrent of new information raining down during those years is more than enough to swamp even the most absorbent skull, it's impossible not to be thrilled by the privileged glimpses you get of the wondrous workings of the human body. That it’s so complex just reinforces the magnificence of it all. Trauma, with its power to destroy, is the last thing on your mind. Constantly dazzled by unending revelations, you’re anxious to see them in the context of actual people, albeit sick ones.

Impossibly, time passes. Now you're in an operating room, staring deep into a stellate smash of livid liver, a polluted palette of discolored destruction: fragments of hepatic mush coddled among clots and rivers of blood, stained with bile and mixed with enteric contents. Its exquisite enzyme pathways are invisible, chemistry irrelevant, micro-worlds of organelles within cells of no concern. Steel clamps, strong sutures, and a gentle touch, not classroom recitations, are what’s needed. Weak is the capsule holding it all in, split apart like broiled bratwurst. How little it takes!

Grey bits of brain on a stretcher hardly reflect the crackling within its synapses, sodium and potassium flashing along axons, or the effects of countless interconnected neurons as they influence each other’s electric potentials, making a mind. A hand, with its pulleys and cables, its capabilities that set us apart, when rent apart looks frail and helpless and pathetically flimsy. That most singular marker of humanity, when wounded, always made me a little queasy on the first viewing. Strangely, none of the rest of it bothered me much; not physically, anyway. And I confess that repairing a hand, using microscopes or loupes, the finest of hair-fine sutures, the most delicate of needle-drivers and forceps to reconnect sliced nerves and tendons, was a joy to a still-budding surgeon in training, a laboratory of eye-hand precision, exposing that almost embarrassing, unspoken, paradoxical pleasure surgeons can feel at the moment of another’s pain. The only operation my wife ever saw me do was one such, when I sneaked her into the county hospital in the days when the nurses were okay with it, and before rules made it impossible.

There are times, when driving, or walking, when wielding a knife in or out of the operating room -- or just breathing! -- when an unintended recollection will appear, from experience, of how tenuous, how easily broken is this dazzling work of nature inside of which we locate ourselves. It's gelatin, it's a wet paper bag, it’s more breakable than antique glass. I know the thought isn’t unique to surgeons, or health-folk in general. But we get a uniquely intimate view, and there are times when it haunts me. I see dead people. After operating on an injured child, I couldn’t wait to get home to hug my own, fighting the desire to lock him in his room, encase him in soft blankets until he grew up.

So cinch your seatbelt, and keep your eyes on the road. Put down that cellphone, and, for God’s sake, take a pass if you’ve drunk too much. Don’t tailgate. Wear a helmet when cycling, don’t ignore stop signs. Look both ways when you cross the street, take a deep breath. You’re fragile as a flower.
 
And that’s that. Thanks for reading, and for the great emails. Thanks to The Herald. For those who’ve suggested otherwise, the decision is entirely mine, and the only criticism that’s stung is my own, of myself. If you miss me, search “Sid Schwab blog” for politics. If you like my doctor stuff, track down “Surgeonsblog.”
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