eight: don’t suck on the mother. fucking. brain.
“SHAWN!!! DON’T SUCK ON THE MOTHERFUCKING BRAIN!!!”
My elbows flexed, lifting the instruments vertically from the operative field nearly hitting my face as I jerked back, startled. The O.R. was silent and completely still. A bulb irrigator in the hands of the scrub nurse was full, but still held submerged in the pan of warm saline.
People in the room weren’t sure if it was okay to move yet. I gradually became aware of the awkwardness of the situation but didn’t look up at anyone to confirm it. If I weren’t in absolute shock in that moment I’d be laughing hysterically. Dr. Yankee was a small, quiet, reserved man with an impending comb-over. His lexicon shouldn’t include the word “motherfucker.”
Squeezing a quick glance to the left at Robert, the mid-level neurosurgery resident, I could see that jerk smirking from behind his surgical mask as he gave a nasal snort. He proceeded to inspect the exposed brain of the patient with an overly exaggerated academic frown. Six hours earlier in the ER this fucking asshole didn’t think this was even an operative case even though it the clot was thick as fuck and there was massive midline shift.
PHOTO: For illustrative purposes only… arrow, large subdural hematoma. (credit: Dr. James Heilman)
Below me, the pearly white, highly vascular cortex was intact. No bleeding. No damage. Good Lord.
I started to question the wisdom of giving the neurosurgical reins to an intern on his first day in the operating room. I hadn’t operated since three months prior and THREE YEARS prior to that. Robert didn’t even let me make the initial incision… didn’t even let me mark the incision track with a pen… and now I’m supposed to magically remove a huge thrombus right off the surface of an old lady’s frontotemporal cortex? On her dominant hemisphere? With instruments I’ve never handled before and with no other instructions than “go for it”?
Then again, I should have spoken up. This was a huge privilege.
Behind us, the on-call neurosurgery attending, Dr. Yankee, continued in a normal tone, “Just the clot, Shawn. Just the clot.”
I nodded. The Frazier suction cannula was still held clumsily in my left hand, the plastic tubing to the vacuum canister caught up somewhere on the patient restricting my range of motion. I pulled on it subtly attempting to draw someone’s attention to it, but it was ignored. I handed the empty bulb irrigator to the scrub nurse who hesitated for a long moment looking to Dr. Yankee before exchanging it for a full one. She smacked it firmly in my right hand and immediately I flicked at a small booger of clotted blood on the tip of it, showing it who was in charge.
Yet, my confident and gleeful retrieval of the large left hemisphere subdural hematoma was now replaced with shaky, tentative pokes with the suction cannula along with uncoordinated squirts of saline from my irrigation. I became uncoupled.
In my mind, I was no longer thinking of the life-saving operation I was lucky to take part in… All I could think about was, “What happened to my Dr. Yankee?” My nice, quiet, mild-mannered Dr. Yankee? Before this evening our interactions were pleasant exchanges that were often light-hearted and casual. We talked about the lab I was about to set up with the chairman and how it was going to be such a good example for the rest of the residents. In the wards, he was especially fond of talking to people about the latest restaurant he had been to and cataloguing the dishes he had enjoyed. (“Bulgogi? Ohhhhh. I love Korean barbeque! Ohhhhhhh…”) I had fond memories of my interview with him last winter. He and Dr. Charlie (they interviewed me together) tried to mildly torture interviewees by requiring us to tie a surgical knot around a ball with two forceps while they distracted you with personal questions about your family and such, but for the most part it was very—
“SHAWN, DON’T DRAG THE SUCTION ON THE FUCKING BRAIN!!!”
Goddamit.
I handed the Frazier to Robert and stepped back from the operative field.
[Medicine is one of those funny professions where verbal abuse is not only commonplace, but largely played off as “paying your dues.” We’ve all heard stories of an OR tyrant. It’s one of the many things that contribute to an often hostile work environment and poor culture and burnout in medicine. Now, 10 years later, I see it more from a place of empathy and realize the stereotypical screaming surgeon is probably really hurting inside from a deep dark place. I’ve seen that a lot of surgeons found surgery because they maybe felt powerless at some point in their lives and surgery was a way for them to use their intellect to somehow regain control of something and be recognized for it. Only… you can’t control everything and when things go off script it’s perceived as an ego threat thus leading to regression and tantrums. What is the solution? Asking for a friend.]
[PS: Names have been changed above. 🙊]
[PPS: Robert got fired eventually for fucking nurses off-site, on the clock. I remember one time I really needed him in a patient room and he was no where to be found for HOURS. WTF.]