Vascular Surgery

This piece was previously published in Close2TheBone.

Vascular Surgery

There’s a good reason women make the best surgeons, she thought.  Quick, deft hands, single-pointed concentration, focus.  She thought of the women jet engine mechanics she had met in the Air Force.  Not that she had been in the Air Force; but in the course of her duties as a civilian surgeon under contract, she had met them.

 Now, reining in her reverie, she was intent on the task at hand.  Drat this light, she thought.  She really needed a more direct light source, but one has to work with what one has at hand.

 Slowly, painstakingly, she drew the outlines with a surgical marker:  carotid triangle; carotid vein;  carotid artery.  This, the artery, was what she wanted.

 She steadied the syringe she had readied with an oh-so-fine 27-gauge needle.  2% lidocaine with epinephrine should be enough analgesia for comfort, and enough epinephrine to ensure a relatively bloodless field.  She couldn’t help chuckling: bloodless indeed.

 Squinting in the insufficient light, she injected the layers:  first the skin, then the loose fascia of the neck; lastly, the layer surrounding the vessels of the neck, careful to avoid direct injection into the wall of the vessel, which might cause a spasm.

 Now it was time to cut.  She picked up the number 11 scalpel and steadied her hand.  Carefully, carefully she opened the delicate skin of the neck, noting with satisfaction that the epinephrine had done its job.  There was no need for the tiny hemostats she had ready in case of superficial bleeders.  The next layer, the loose fascia, pulsated bluish, overlying the great vessels of the neck.  These she would blunt dissect with the larger curved hemostats.  She injected a bit more of the anesthetic, just to be sure.  No need to cause discomfort, which might result in unwanted movement.

 At last the artery was exposed.  She marveled at its pulsations, at the tiny arteries that nourished the big one itself, and the miniscule veins that issued from it, carrying its waste into the larger system of veins, to be cleansed by the liver and kidneys downstream.

 Holding her breath, she slid the first hemostat, jaws open, under the artery.  Clamp.  The vessel, trapped in the jaws of the hemostat, stopped pulsing abruptly.  There was no going back now.  Now the second hemostat, exactly one and a half centimeters below the first: clamp.  She raised the surgical scissors, poised for the definitive cut between the clamps. 

 Tilting her head to see better in the mirror, she cursed the dim light in that bathroom again.  And then, the definitive cut!  In a single motion, she swiftly removed the two clamps and was instantly drenched in red liquid.

 A scream of agony split the night as she sat bolt upright in the bed, heart pounding, drenched in sweat, clutching the sodden bedclothes as she struggled, locked in the arms of the Angel of Death like biblical Jacob.

Clutching her throat, she rushed to the bathroom, the very same bathroom, and strained toward the mirror in the same dim light.

 Nothing.  Her throat, graceful and bluish white as ever, shone back at her from the reflection.

 Sucking in a deep gulp of air, letting it out in a sigh that brought the dog running, she splashed water on her face and neck, toweling off the sweat.

 “It’s OK, buddy,” she whispered to her whining canine companion. “Just another nightmare.”  The dog smiled anxiously, wagged his tail tentatively, and licked her calf.  She reached down and patted his faithful head. 

 “Good thing I have you, she murmured.  Stripping off her sweat-soaked nightgown, she rinsed off in the shower before throwing on a fresh one.  She sank into the recliner with a book: sleep would not visit again, not tonight.

 

 © Laura P. Schulman, MD, MA 2012 All Rights Reserved

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12 Comments

  1. absolutely terrifying! i would not sleep after that either. that must have been so utterly disturbing, blurring the lines between reality and dream. i am so glad for you that it was not real.

    Reply
    • Yes, it was. It happened during the time when I was losing everything, including my mind. I spent every waking hour in suicidal fantasy, dreaming up more and more sophisticated methods.

      Reply
  2. Ahhhh….elegant indeed. Mine not so fun…a running car and ethylene glycol..but it would ‘do the job’. Oddly enough, we have an ethylene glycol on ECMO right now. I was just called for my opinion on dialysis options. Poor kid. If she survives, she will most likely be dialysis dependent.

    Reply
    • Hmmm, on ECMO….what does EG to do the CV system? I don’t know much about it, other than drunks in the ED and how to get rid of wild dogs that are killing your livestock…so that’s a one-two punch if ever I heard one. My real one I don’t tell….and I’m going to write a post that will dissuade all but the most desperate from doing the deed.

      Reply
      • Still investigating…may have been more then one substance. I don’t know all the details, I was just called to give an opinion as to the dialysis piece. Mixing drugs for OD is a disaster if one survives. I was surprised too, as EG is supposed to kill the kidneys mainly, but we have little experience of it.

        Reply
        • What’s really awful is the people, usually teens, who take a bottle of Tylenol as a “cry for help” or a way to get a boyfriend back (I’ve seen that so many times 😦 ) and they don’t realize that it will kill their liver….they think that Tylenol is safe….when I worked in the ED I saw so many accidental suicides….we had a saying, “there are two kinds of suicide attempts: serious, and more serious.” We took them all seriously, although I must say I was not nice with the girls who balked at drinking the charcoal. Large bore OG tube, honey.

          Reply
          • Yes I have had to dialyze more then one kiddo waiting urgently on the transplant list from Tylenol (mostly ammonia removal, although that requires aggressive treatment). We don’t have the MARS system. Perhaps someday.

            Reply
  3. I want to apologize right now to the a) traumatized people, b) those who have had suicide attempts, and c) those of you who don’t know what we are talking about. Sometimes people in the medical field get traumatized from the work we do, and we need to talk it out. That’s what this piece of “fiction” is about. It’s a suicide attempt that I dreamed, and it incorporated many aspects of my PTSD from being an ER doc. Sorry if it triggered anyone (although if it did it’s unlikely that you’re reading this…)

    Reply
  4. Wow! You are an amazing writer. I’m sorry that you have such traumatic and vivid dreams though. I can understand why you awoke bathed in sweat. I think it’s a good idea to write that dissuasive piece too.

    Reply

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