It’s Real

I thought they were all out. I thought I had taken the last one out weeks ago. I had thought this before, and had been wrong, of course, every time. They come in batches of three when they come and they come often, like sets on the North Shore, reg­u­lar (but not pre­dictable) and men­ac­ing. The appen­dix. What is it? Why do we have one? I have answered this ques­tion many times, but really I have asked it to myself and asked it of the gods, just as many times. Bleary, I pulled my scrubs on last night and did the rou­tine. It was 1:30 when the ER doc­tor called me. It is so fre­quent that the con­ver­sa­tion can lit­er­ally be as short as this (and this one was just this short – this may actu­ally be an exact transcript)…

”Stephen, hey sorry to wake…” ”Uh-huh, thanks, whad­dya got” ”45 year old man, appen­dic­its” ”Antibi­otics yet?” ”Ordered” ”See you in a few.” Click. Me: ”Damn.” ER doc­tor (I imag­ine) ”He was his usual sweet self.”

Based on that stel­lar his­tory and my insight­ful ques­tions, I call in an OR crew, an anes­the­si­ol­o­gist and my assis­tant. Key in igni­tion, stereo loud or soft or I don’t even hear it. I see the patient, rally my sense of decency to be a real per­son with him (and I am) and do paper­work, 30 min­utes. I answer the ques­tion I asked on the drive over: It’s a small lit­tle appendage on your colon. No, we don’t know what its for. Odd isn’t it? Maybe it is there to keep sur­geons busy. Hahaha…ugh. Then I wait. The wires get crossed some­where in the base­ment of the hos­pi­tal and the wrong instru­ments get pulled and we wait. Or the antibi­otics don’t come up or the preg­nancy test isn’t done or I for­got to do some piece of the paper­work puz­zle. It is a real, human endeavor. This is not TV time surgery. This is 3 am , every­one has been work­ing for 18 hours or 4 hours or not at all. The key com­po­nent is the 3am part. No mat­ter what else has hap­pened, 3am makes every­thing turn to mor­tar and watch­ing a hos­pi­tal try to turn a cor­ner at this time of day is excru­ci­at­ing. Not always, of course and espe­cially not if the stakes are crit­i­cal as in a true this-person-might-die-this-instant sce­nario. But for the rou­tine appy, we are all tired, includ­ing the patient, who, in spite of find­ing him­self in a scene rem­i­nis­cent of a very slow motion key­stone cops scene, is at a life threat­en­ing cross­roads. Lit­er­ally. Its funny and not, I know.

Finally every­thing arrives, patient asleep, fam­ily mem­bers curled like a team of nau­tilus on the wait­ing room couch. Usu­ally this oper­a­tion takes about 30 min­utes. It is kind of like wait­ing on the tar­mac for­ever for the fog to clear in Port­land to make a 30 minute flight over the Cas­cades. No mat­ter how rou­tine that flight is, every part of every­thing has to fall in to place, no mat­ter how slowly.

The next morn­ing, which in this case came an hour and half after I got home, brings the elu­sive sil­ver lin­ing. I walk in to the patient’s room and he is alive and the mir­a­cle of him heal­ing is already begin­ning. He is ask­ing for some­thing to drink, look­ing for his wife, half watch­ing the tv while I tell him all the fas­ci­nat­ing lit­tle tiny details. In short, he is mov­ing on and get­ting back to the liv­ing of his life, and not really look­ing in the rear view at the men­ace he just swerved past. I like that part, but the longer I do this…wait. Let’s just stop and really know that: I do like that part and that is real.

Still I feel the long hours of the night paint them­selves on the walls of my inte­rior through the next day. It affects me. It is not like stay­ing up to watch a movie, these oper­a­tions in the mid­dle of the night. They truly bring clar­ity to the def­i­n­i­tion of toll. They take one. I don’t want to com­plain, but some­times I do. I do. I admit it. I know this job is a priv­i­lege, rare and won­der­ful. I get tired though. I am tired now. I want to write more and make pho­tographs and talk to you and engage but I am just tired and I am going to sleep now. And that has been the work day for today.