“That hulk,” said Bellows to the students while motioning toward the laughing character by the X-rays and loud enough for all in the OR to hear, “is the result of staying in the program too long. That’s Stuart Johnston, one of the three senior residents. We only have to put up with him for four more months. He had promised me he’d be civil, but I cannot be sure of that.”
“You’re just a poor sport, Bellows, because I stole this case from you,” said Johnston, still laughing. Then to his two assistants he said without laughing, “Let’s get the patient draped, you guys. What are you trying to do, make this your life’s work?”
The draping proceeded rapidly. A small piece of tubular metal arched over the top of the patient’s head and separated the anesthesiologist from the surgical area. By the time the draping was completed, only a small portion of the patient’s right upper abdomen was exposed. Johnston moved to the patient’s right side; one of the assistants went over to the left side. The scrub nurse moved over the draped Mayo stand, straining with a full compliment of surgical instruments. A profusion of hemostats was lined up in a perfect array along the back of the tray. The scalpel had a new razor-sharp blade snapped into its jaws.
“Knife,” said Johnston. The scalpel slapped into his gloved right hand. With his left hand he pulled the abdominal skin away from him to provide countertraction. The medical students all moved forward silently and strained to see with a foreboding curiosity. It was like watching an execution. Their minds tried to prepare themselves for the image that was going to be imminently transmitted to their brains.
Johnston held the scalpel about two inches above the pale skin while he looked over the screen at the anesthesiologist The anesthesiologist was slowly letting the air out of the blood pressure cuff and watching the gauge, 120/80. He looked up at Johnston and gave an imperceptible nod, tripping the poised guillotine. The scalpel dived deep into the tissues, and then with a smooth soundless slice, slid down the skin at an angle of approximately 45 degrees. The wound fell open and little jets of pulsating arterial blood sprayed the area, then ebbed and died.
Meanwhile curious phenomena occurred in George Niles’s brain. The image of the knife plunging into the skin of the patient was displayed instantly in his occipital cortex. Association fibers picked up the message and transported the information to his parietal lobe, where it was associated. The association spread so rapidly and so widely that it activated an area of his hypothalamus, causing widespread dilation of his blood vessels in his muscles. The blood literally drained from his brain to fill all the dilated vessels, causing George Niles to lose consciousness. In a dead faint he fell straight backward. His flaccid neck snapped his head against the vinyl floor with a resonant thump.
Johnston spun around in response to the sound of George’s head smashing against the floor. His surprise quickly metamorphosed into typically labile surgical anger.
“For Christ sake, Bellows, get these kids outa here until they can stand the sight of a few red cells.” Shaking his head, he went back to catching bleeders with his hemostats.
The circulating nurse broke a capsule under George’s nose and the acrid smell of the ammonia shocked him back to consciousness. Bellows bent down and felt along his neck and the back of his head. As soon as George was fully conscious, he sat up, somewhat confused about his whereabouts. Realizing what had happened, he felt immediately embarrassed.
Johnston meanwhile wouldn’t let the matter rest.
“Holy shit, Bellows, why didn’t you tell me these students were absolute greenhorns? I mean, what would have happened if the kid fell into my wound here?”
Bellows didn’t say anything. He helped George to his feet by degrees until he was satisfied George was really OK. Then he motioned for the group to leave OR No. 18.
Just before the OR door shut, Johnston could be heard angrily yelling at one of his junior residents, “Are you here to help me or hinder me …?”