Sometimes when I’m working I am struggling. There is tissue in front of me – part of a person – a mixture of normal and abnormal anatomy. I work to restore order, to recreate anatomy as perfectly as needed to best restore function. This is a strange and sometimes stressful job. Often there is great worry in the midst of it – will this really go back where it needs to go? will the body I’m working on know the difference if it does? Bodies are strange. Some are bothered by imperfections and some are not. In the middle of fixing, you can’t know, however, if this particular body will be bothered and sometimes you just struggle based on the best available evidence and the prevailing wisdom that closer to normal anatomy is better. Well, I struggle anyway. A millimeter closer here, a millimeter closer there, i slowly move the pieces back to where they belong. And there is blood, always in the way, distracting you from the task at hand. And nerves. Things you have to respect and work around gently. Struggling with delicacy, combining great effort with tenderness, creates focus and tension that I do not often feel consciously. Then I bark at someone who is trying to help and doesn’t know how and even as I am doing this I recognize the piece of shit that I’m becoming in snapping at them.
When these cases are over, something happens in my head. I can feel this strange and eery sense of thickness in my head. Its similar to the feeling you get after a very hard workout, when your body just wants to be still for a bit and recover. The front half of my head feels that way. Stop. Recover. No attention can be paid now, to anything. We are rebooting.
The times I am struggling the most are when there is some element of time pressure in the work. I’ve worked with deadlines in all sorts of fields before, but the time pressure with a body open in front of you is different. Almost every minute the thought “I might not be able to fix you” crosses my mind. Its like I’m running into a burning building to save my kids. And every few seconds longer I’m there and I’ve not saved them they are closer to dying. I could lay down there myself and let go, but I can’t leave them. That is the struggle. Often this struggle comes in the form of a double-down time pressure – This person is open in front of me, and I’m supposed to be somewhere else – meeting my wife for dinner, picking up daughters, etc. and these are like Sophie’s Choice in my head. Of course I know they are not that, but that pressure of only being able to save one being I love – the patient or my family – is my pressure of finding a way to beat Sophie’s Choice, to find a way to save both. Sometimes I do, and sometimes I do not.
The punch in the gut is when I get to my family my brain is not there. Not in a conscious way. My attention is turned off. And then I have only saved one. In the midst of only saving one, the resident has succumbed to “friendly fire”. Or I miss the time with my family, and there is fury at home.
this is the life of a surgeon
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