Instruments of doom

Tell you what, all this disturbed sleep and emotional neediness is having one fortuitous effect - I have been writing like all get out.

And today, for no particular reason, I shall share with you my feelings about surgery, in a post that could have been titled "Why I am not a surgeon".

When I was in junior high school, we had things different. Boys did metalwork and woodwork, and if they were lucky, learnt how to strip down a diesel engine. Girls learnt cooking and sewing, and if seen as worthy, typing. I should point out that since then I have sewed on buttons and darned the very occasional tear in clothes, and I have cooked and eaten a considerable number of meals. And I have typed hundreds of thousands of words.

But I rarely have had to construct dove-tail joints, I have had little use for spot-welding, and with car engines - I barely know my expensatron from my povertiser.

Anyway. I was an exceptional student at woodworking. I was, apparently, the most exceptional student the teacher had seen in his twenty one years at my high school. I was so truly exceptional that the mark Mr Dour wished to give me was actually forbidden by the school, and he was forced give me a mark that did not truly reflect my aptitude, diligence and promise in this field.

"But the bastards won't let me fail you," he snarled at me one memorable summer afternoon, "so I'm pushing for a D double minus, you dopey bastard. You reckon you're up to that?"

Truer words were never spoken. The woodwork curriculum began at a doorstop (two bits of wood nailed together) and progressed to a wooden pencil case (six bits of wood nailed together). After that came inlaid tables, lathed lampstands, folding chessboards and finally a decorative jarrah cabinet with panels of deep red sheoak and honey-coloured blackbutt. Each boy's craftmanship was exhibited behind the desk, and each week Mr Dour would select a particularly fine journeyman's piece and discuss it before the class, noting precise joins, smooth finishes, beauty and functionality.

But he didn't pick my pencilcase. He could have picked my doorstop, but it wasn't a good doorstop, because the little bit fell out of the big bit after a while, and it ended up being a doorstop that would not actually, you know, stop a door. I had coated the thing in varnish until it glistened like a slug in the first dew of morn, but beauty wasn't enough. It had to have functionality, and so I was passed over.

Enraged, I set about the pencil case. As I said, six bits of wood. Soft, malleable, any-fool-can-do-it pine, the ligneous equivalent of play-dough. Already cut into approximately the right size, requiring only grooving, sanding, some other arcane practice I've forgotten, and hammering together.

Couldn't do it.

Seriously. I could groove, I remember grooving with the best of them. Sanding was bad, I tried sanding, and the sander made deep grooves. Lining things up was next to impossible - simple "shapes that should fit together" no longer fit, my right angles became wrong, my rectangular sides of the pencilcase assumed the dimensions of a Moebius strip. I remember at one point holding something in my hand that seemed to be a square but had four corners and five sides.

I hurled it all away and began again. This time the sander bit right through the side of the lump of wood, making a loud snapping sound and hurling a fragment of a hundred year old tree skittering the room, like the work of a vengeful dryad. The next time something went wrong with the staining - I tried to conceal what I had done, but Mr Dour lifted the six slices of wood that had assumed the colour and stickiness of freshly spilt blood and asked the class for feedback.

And the last time - twenty one weeks later, two hours a week, and not a thing to show except a door stop that didn't stop doors - the last time I got as far as joining the thing together and hammering the nails in, only to turn it over and find that every single nail I had hammered now protruded into the interior space of the pencil case, and it was less a case for pencils than a device for returning them to the True Faith - a pocket Iron Maiden, for the travelling Teen Inquisitor (TM TduCN!).

Anyway. Worst student in twenty one years. And metalwork was no better, I remember being sent off to the metalwork shop for a "long weight" and actually standing there waiting a very long time before "getting it" and slumping back to class. Basically, not good with hands and machines.

(Weirdly, my sutures are pretty neat, and my chest drains seem to work, and the time I was going to stab that kid in the chest with a bloody big needle I was looking at the right place. But I still have to practise every three months, rather than six, with the defibrillator).

Anyway, second year medicine we did a surgery, and I hated it and it hated me. You can't talk to patients during surgery. And cutting people up always seemed violent to me. And my first attendence at a surgical operation involved me holding a retractor (a kind of bladed hook thing) for a Whipple's procedure (a horrible kind of surgery for an only marginally more horrible disease - less than ten percent of people who have the operation are alive after five years, and it's not always a pleasant five years. But it's probably better than pancreatic cancer. Probably.).

The Whipple's lasted four and a half hours (removing gallbladder, common bile duct, part of the duodenum, and the head of the pancreas takes time) and for me that was four hours of hunching over, unmoving, applying not too much and not too little tension to a metal handle and trying to keep out of the increasingly irascible surgeon's way. This, by the way, is why Frankenstein's assistants are always hunched, grimacing, subservient and have dubious social skills. Their formative years are spent hauling on a retractor, cringing beneath the iron hand of the surgeon and breathing in ether - no wonder they don't impress.

So - thank God we're not living in the old days where it was deliver a baby at three o'clock, set a bone at four, whip out an appendix at five. Emergency medicine is the possibly the least specialised of the specialties, but there is nothing more reassuring than seeing a good surgeon arrive to assess and treat the "probably appendicitis, but could be ovarian" patient whom you have stabilised and worked up. If you're not a surgeon, under the skin of the abdomen is a black box. Kudos to the good ones, and Christ in His mercy help the patients of the rest.

One last thing - surgical instruments. I love the names. If you want to look up some elderly man's hooked and patrician nose, you use a special pair of forceps called a thudicum. Thudicum. Is there a more beautiful, euphonious word? Possibly, somewhere, but is there anywhere a more beautiful, euphonious word for something that goes up your nose? Not really.

And the others. Strange names - gall stone scoops. Lens spoons. Rongeurs and proctoscopes, the Breuning otoscope and the Quire Mechanical Finger, mastoid chisels and Gerzog mallets.

Terrifying or wondrous names - vein strippers. Muscle clamps. Brain sectioning knives. Iris Suturing Forceps and the Wells Enucleation Spoon (don't ever ever ask, especially if you want to eat anything, anything, with a spoon ever again. Ever).

Rich names full of history - The Metzenbaum scissors. The Olsen Hegar needle holders. Lister bandage scissors, and even, oddly, Kevorkian forceps. The McGivney Hemorrhoid Grasping Forceps and the McGivney Hemorrhoidal Ligator.*

By the by, don't click on that link unless you really want to. They put it right where the name suggests. And bran: eat lots and lots of bran.

Anyway. To each their own. I suppose every time I hear of one of my patients kept overnight in the surgery ward with inadequate pain relief because they are, quite clearly, junkies, or hear about someone whose was sent home with (insert terrible tale of surgical arrogance here) I should think about me, standing over some comatose man, trying to tease out pathology from normal variation without nicking anything vital, in someone who will die by my hand if I don't get this right. Like I said, Thank God for the good ones, and thank God twice that none of them are me.

Thanks for listening,
John

*Product Description: Improved model with offset handle for better vision and comfort. 7" (17.8 cm) working length. Can be disassembled entirely for cleaning. Supplied with drum loading cone and 100 Latex O-Rings.
Grade: German Stainless Steel
Price: $420.39).