Bovie Smoke
It’s late in the day, somewhere between dinner and bed, and the pager goes off.
Ex Lap. ASAP.
Within 30 minutes I’m back at work, scrubs on, hair netted, walking past empty rooms. The tall ceilings with their bright fluorescents further wash out the aggressively neutral walls, adding to the feeling of sterility and professionalism. Two turns and I’m at the front desk of the OR where the nurse on call is already working on the computer to board the case. Neither she nor the scrub tech who appears a moment later are happy to be there, but I am.
Someone’s in pain, and we’re going to help.
That someone is waiting for me downstairs in the maze of curtained bays and hallway stretchers, groaning under a tangled and stained blanket. Pants and underwear are in a chair on one side of the bay, shirt and assorted personal items next to the tray table cluttered with various medical supplies, shoes somewhere on the floor, patient stickers mixed in with gloves and wrappers on the counter. Outside the curtain someone coughs, loud and hacking over the steady bustle of human activity and TVs. As I gather everything into bags and onto the stretcher I’m asking him the same questions I have to ask every patient: “dentures? Partials? Hearing aids? Jewelry?” Satisfied with the answers and with the sweep of the room we leave, through the halls I used to scrub when I was in housekeeping just a handful of months prior, up to the second floor where he’s handed off to the nurse and anesthesia.
Back in operating room three the scrub tech has made short work of setting up for the case with sterile blue paper drapes covering the tables and glistening with carefully arranged stainless steel and single use plastic implements. Normally I would just check that the room isn’t missing something I can provide and leave to stock or prepare other areas, the bulk of my job as an OR Assistant when I’m not turning over rooms or retrieving patients. But tonight everything is already stocked, already prepped. So tonight, if I can be sure to stay out of the way, I’ll watch my first surgery.
Prepping the patient takes longer than I expect; first, the anesthesia team needs to put the patient to sleep and intubate him. Once he’s firmly unconscious the nurse shaves a wide swath of his abdomen and paints him with this orange liquid that stains the floor named chlorhexidine. The scrub tech then attaches more paper drapes to the patient until he’s reduced to just a rectangle of skin in a field of blue and orange. Meanwhile, the nurse is bobbing around the room, fluidly moving from station to station opening packages, tying surgical gowns, checking the chart, placing equipment. It’s difficult to stay out of the way of everyone but no one makes me feel out of place as we dance around each other until finally everyone’s still except the surgeon and his knife.
The smell of the bovie-the hot knife-cutting and cauterizing is strong, not terrible, just strong. Even through a mask. I know from experience that it’ll permeate into the halls surrounding the room despite the airflow that’s mandated for surgical suites. But I’m not paying any attention to the smell; I’m paying attention to the gash that’s being opened up in front of me. From my perch behind the Neptune and bovie at the end of the bed I have a perfect view of the entire operation. I can see the surgeon on the patient’s left slicing through flesh like a hot knife through gelatinized butter, the CRNA peaking over the cape blocking the anesthesia machine from view, and the scrub tech on the opposite side ready to hand over massive shoe horn looking things that attach to a metal circle with teeth on the outside that’ll hold open the cavity that’s being created.
And I can see the guts.
Human intestinal tracts are really not that different from an animal’s: they’re pinkish, wet, and mildly deflated like some sort of giant flatworm. My own insides churn, and a part of me wonders if I should sit down, but I’m determined to stick it out.
My coworkers, oblivious to my weak knees, are carrying on a conversation while the doctor slowly goes through every inch of intestine with his fingers as if feeling for something, leaving the sections he’s gone through sitting outside the body, giant flesh noodles on a blue napkin.
“Did you hear about the patient who came in yesterday with abdominal pain?”
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“No, what happened?”
“They told her it was her gallbladder.”
The surgeon pauses his perusal and peers at something inside the cavity, likely another organ.
“Yeah?”
“She had a chole two weeks ago. He never removed the whole thing!”
“Oh shit! I’m not surprised though, I saw him pull one out and cut it in half; bile was everywhere! All inside the patient and all over the bed, smelled terrible.”
Once again bovie odor begins filling the room as the intestine is cut, the two ends looking like smooth and slimy tube socks. Another cut and an entire section is removed, at least a few inches long.
“Adhesions,” the doctor tells me. “It’s what was causing his pain.”
“Is it possible to cut it open and remove just the adhesions instead of the whole thing?”
“No; adhesions are scar tissue and trying to remove them just creates more until they completely block the intestine.” He accepts the suture from the scrub tech and begins sewing the intestine back together, minus the overly damaged part that now lays on the table, waiting to be scooped into a formalin cup and sent to the lab downstairs. They’re all talking again, this time about the union they’re trying to bring in, but it sounds distant as if my ears are too full of blood and the beeps of the heart monitor. Sooner than I would have thought possible the organ is whole again and is being shoved back inside the abdomen.
“They’ll sort themselves out,” the surgeon assures me when I ask why he doesn’t take the time to put them in a certain way, and they do seem to have a mind of their own as they try to fight their way back out. In my mind I can see my brother trying to reload his “snake in a can” prank toy. Eventually the surgeon wins and all organs are once more inside the body and after some careful stitching the patient is fully closed.
Activity picks up again, sutures and sponges counted, bandages applied, drapes removed, anesthesia stopped. My feet unglue themselves and I go to the core to retrieve a gown and a warm blanket.
But I’m not thinking about that as we transfer the patient, nor as we clean up the iodine and human traces. I’m not thinking about how in just a few hours this place will be bustling again, people coming in with pain and leaving with new pains. I’m not listening to my coworkers talk about who’s in what rooms with what surgeons tomorrow, I’m not even thinking about how tired I am.
It’s two a.m., and all I can think about is tangled piles of flesh tubes and bovie smell.
