Saturday, October 18, 2014

Rock Star


“There he is, Dr. Ryan Lockheart, casually resting in the lounge. He certainly looks like he is ready to tackle anything that comes along and run his winning streak to an unheard of three hundred fifteen,” the announcer shouted into his microphone. “ Hello, I’m Ted Blaylock coming to you live from Halsted Operating Theater in Atlanta where Ryan Lockheart, MD FACS is about to make his way to the operating arena. Joining me here in the booth is our color analyst, former superstar surgeon and renowned textbook author for the Johns Hopkins Jays, Dr. Seeee-Mooour Fielder.”
Applause off screen
“Welcome, Seymour…”
“It’s Dr. Fielder.”
“OK, welcome Dr. Seymour. What can you tell us about this exciting young surgeon who seems to be indestructible and unbeatable. Is he worth the two million dollars he’s paid for each operation?”
“He has set the surgery world on fire, Ted, just like I did during the 1970-71 season. I remember that year. Liver resection after liver resection, Whipples, pancreatectomies, nothing could stop me…”
“Until you made that hole in the portal vein and the patient died. Now back to Dr. Lockheart…”
“That wasn’t my fault; it was the G-D resident. Mark my words I’ll be back on top before you know it. This Lockheart is just a flash in the pan. He hasn’t done anything really noteworthy.”
“Except date the hottest Hollywood starlets and cure people from cancer and save, let’s see, last count was over two thousand lives. Wait I see some stirring in the back of the theater. Could it be? Yes, it’s the patient. A Mr. George G.
“Diagnosis is…wait for it…there it is on the big scoreboard: Carcinoma of the Stomach. That should present quite a challenge, Don’t you agree Dr. S.”
“It’s Dr. Fielder, F-I-E-L-D-E-R. Stomach cancer? Minor league stuff. Why I used to do those cases blindfolded with just an intern.”
“The patient is walking through the crowd. It looks like high fives all around. He’s stepping behind the screen…the air is just electric with excitement, I can just feel the anticipation in this crowd, he’s emerging, yes… here he is in his gown. This looks like it’s going to be quite a challenge for Ryan. Just look at these numbers: five foot three, three hundred pounds, Hemoglobin of 8, BUN 40, Creatinine 2.1, Glucose 198.”
“Just your average patient in East Baltiomore. I’d be in and out in under an hour.”
A loud roar comes from the crowd.
“They’re on their feet. What’s that chanting?
“Well, Sy, the crowd is screaming ‘IV,’ do you believe it? I’ve never seen such wild enthusiasm and that’s just for the preop nurse. I think I’m going to need earplugs when the real operating starts.”
“I think this could be the highlight of the evening, Ted. Just look at that nurse. She’s going through at least an inch of blubber to find a vein.”
“He’s on the table now, IV is in place and antibiotics are going in. If Dr. Lockheart follows  protocol the surgery should be starting very soon. The  audience is quiet again and there’s some commotion at the North entrance, Yes, it’s the crew. On Surgical tech we have Candy Kane, displaying her usual healthy “attitude.”
“I’d like to lick that Candy, Ted.”
“I’m sure you would, Seymour.”
“And, now, hand in hand, Dr Ernest Pill and his lovely wife and circulating Nurse, Angie.”
“You know, Dr. Pill stole Angie from my OR in Baltimore. Let me tell you, that Angie, she brings new meaning to the term ‘head nurse’.”
“Well, Sy, I’m sure she got out of Baltimore as quickly as she could. The audience is on their feet now. Listen to the enthusiasm and, how can I describe it? It has to be love.”
Ryan (softly), Ryan, Ryan (louder), Ryan, Ryan (even louder), Ryan, Ryan (now at 110 decibels) RYAN, RYAN, RYAN.
“There it is, the fabled surgery pole. It shouldn’t be long now. Dr. Pill is pushing the propofol. Just look at that intubation, smooth as silk. Candy has the clippers, she’s going for a clean shave. Just look at all that hair. Either it’s a full moon or this patient is part wolf. Angie’s got the Foley. It looks like it’s going to be a slick catheterization. There it goes. Wait, something’s holding it up. It could be a stricture. This could be a kink in Dr. Lockheart’s performance. She’s still pushing. Just look at that technique.”
“One of her better skills, I must say.”
“Wait, there it goes. We’ve got urine, it’s a go…it’s a go.”
“I can hardly wait,” Dr. Fielder sighed while he tapped his pencil on the microphone.
“Oh, sorry.”
“Everything’s ready and this crowd is really on edge. Listen, there it goes again.”
“Ryan, Ryan,  Ryan, Ryan, Ryan, RYAN, RYAN, RYAN, RY-AAAAN.”
“Lights are on now, the famous surgery pole looks like a circus side show. It should be any moment now.”
“RYAN, RYAN, RYAN, RY—AN.” (louder cheers erupt)
“There they are, I can see them now, the famed surgery boots of Doctor Ryan Lockheart MD. He’s on his way down the pole and, just listen to this adoring throng of humanity. I don’t know how he’ll be able to perform surgery with such noise.”
“I’m sure he’ll muddle through. Now if it was me…”
“Just a moment, Dr. F. He’s …”
“It’s Dr. Fielder.”
“Oh yeah, did you see that, a topless woman just ran out of the crowd and kissed him. So much for sterile technique. This crowd is up on its feet now, cheering, stomping those collective feet in unison. Wait, wait, Ryan is motioning for them to sit. It’s amazing the power he has over them. It was like a huge vacuum descended and sucked up all the shouting and cheers.”
Blaylock whispering now.
“Ryan is stepping up to the scrub sink now. I’m not sure, but I think it may be a full ten minute scrub today, instead of his usual Avagard rub. Yes, he’s at the sink, he’s turning the water on, he’s reaching for the scrub brush…wait, I don’t believe it. His foot’s on the pump and he’s squeezing out the Avagard, one, two three pumps. And, listen to that roar.”
“He’s walking to the table now, Candy is gowning and gloving him. Is this it? Is he about to start? But, he’s stopping. He’s about to address his circulator. Let’s see if we can pick up his words.”
“time out?”
“You heard it. Can you believe it, what perfection. Tell me, Sy, did you ever initiate a timeout? I’ll bet back in your day, a time out was unheard of.”
“It’s Dr. Fielder. D-O-C-T-O-R Fielder and no, I never did such a demeaning thing. I knew what I was doing. Time outs are for wimps and mediocre surgeons, both of which describe Dr. Lockheart.”
“Of course, Doc-tor Fiel-der. Let’s listen to Angie.”
“This Mr. G. 63 years old, born 4/12/1951. He’s having a total or subtotal gastrectomy. Dr. Lockheart is our surgeon (loud roar). He’s had two grams of Ancef and no allergies. Are we in agreement?”
“Yes, I concur, I agree.”
“There you have it, a near perfect timeout. Now let’s wait for Ryan Lockheart’s trademark start. The crowd is silent (Blaylock whispering again).
It’s showtime.”
“There you have it. The famous ‘it’s showtime.’ Now the surgery should commence.”
“I’m all agog.”
“As we all are, Dr. Sy. Scalpel is in hand. Just look at that hand. I’ve never seen such steadiness, nerves of steel. I don’t know how anyone can watch this and not know that there is a god this world. Only a deity could create such perfection.”
“You’ll excuse me while I go into the hallway and vomit.”
“Suit yourself, Sy, but you’ll miss this extraordinary performance. And it begins. Just look at that perfect incision, the way it swerves around the xiphoid and then the gentle curl around the umbilicus, this is sheer genius. Look at the precision; the depth is just to the fascia but not through it. He’s taking up the cautery now, although it’s almost not necessary. There can’t be more than a few drops of blood.”
A door opens and Dr. Fielder returns.
“Have I missed anything exciting? If it were me down there you better believe there would be some real excitement.”
“Well, Dr. Feldstein, the operation has just started and so far it’s a masterpiece.” (Blaylock’s voice lowers). Let’s just watch in silence for a while…”
(Blaylock whispering) “He’s moving along the colon now, separating the transverse colon from the omentum, what style, he makes it look effortless and clean. What’s this?  There seems to be a hangup, the tumor is growing in the transverse mesocolon.  This could put a kink in the operation, no…just look at that. He’s taking the mesentery with the tumor and the colon is just fine.”
Applause rises from the crowd, growing louder and louder.
“Well, Sy, any comments?”
“An intern could do better. I’d rather talk about Angie. She’s a real hot one.”
“Well, I can’t argue with you there, Dr. Shithead, oh I meant Dr. Fielder. Now back to the operation. (Blaylock’s voice lowers) He’s up around the spleen. Look at that dexterity. Weren’t you well known for having to take the spleen out on most of your gastric cases, Dr. Fielder?”
“It was necessary.”
“Lockheart’s cruising along now.  My god, that’s a big tumor and all that fat. But, he makes it look like child’s play. He’s up by the esophagus now. It could be; maybe, no it won’t be a total. The tumor stops well away from the G-E junction. What a break for our patient and our esteemed surgeon. Looks like there won’t be any chest crackin’ today.”
“I’m overjoyed.”
“As you should be Dr. F. We’re in the homestretch  now. He’s down to the left gastric artery. He’s being very careful and I don’t blame him. Just look at the size of those lymph nodes. I don’t think Dr. Lockheart, wonderful as he is, will cure this patient. Hold on, what’s that…?”
‘Whoosh”, a stream of blood shoots out of the patient as Dr. Lockheart grabs the suction while thrusting his hand into the patient.
“Oh my God, how terrible, what a tragedy. Lockheart must  have cut a pretty big artery to have so much blood.”
(Dr. Fielder smiles) “Well, it looks like wonder boy may be a mere mortal after all. Well, it happens to the best of us.”
“It looks like the left gastric artery has broken loose right at its origin. I’ve never seen so much blood. And, look at the blood pressure, (everyone stares at the huge scoreboard hanging overhead) seventy, sixty, fifty forty…”
(Fielder chuckles) “It looks like the mighty Dr. Lockheart is just another hack surgeon after all.”
“Well, you should know, Sy. But wait. He’s closed his eyes and now he’s looking up.”
“That’s right, only divine intervention will help him now.”
Blaylock scowls at Dr. Fielder.
“What’s he doing? Is that a…yes, it’s a 5-0 Prolene. How can he see to suture anything through that morass of blood?  He looks determined, however. The stitch is in, he’s tying now. The blood is not welling up anymore. Pressure’s coming up, sixty-five…”
(Crowd chanting) Seventy, eighty, ninety…cheers and applause.
“Do you believe that, do you? Blaylock hugs Dr. Fielder around the neck, jumping up and down. Fielder pushes him away.
(Fielder scowls) “Some surgeons are just lucky. Even a blind squirrel finds a nut once in awhile.”
“You should know about that, Sy. Nuts seem to be your specialty.”
Fielder gets up and leaves the booth.
“And there it is, the specimen. Now all that’s left is putting it all back together. He’s reaching for the stapler, a GIA 75. He’s dividing the bowel. Pure genius is all I can say. He’s putting in a 3-0 silk. Just look at the way he flips that needle around. He’s cool. That’s the only way to describe Ryan, cool, supercool.”
Loud murmurs run through the crowd of spectators as the final anastamosis is finished.
“Now it’s just closing, dressings and off to the Recovery Room. What an amazing performance. What, what’s going on? Who’s that old man? He’s going to contaminate the entire operative field. Sy, do you see that? Sy? Wait, that’s Dr. Fielder down there and he’s got a gun.”
A roar from the crowd causes Dr. Lockheart to look up as he puts the last staple in the patient. Seymour Fielder aims a handgun at Lockheart and squeezes the trigger. Angie pushes him as the shot is discharged, harmlessly hitting the scoreboard as security arrives and takes Fielder away.
“I just don’t believe it. He had his day, he was the star once. It’s sad, but true, we all get older and lose that edge. Well, there’s never a dull moment around Ryan Lockheart MD. Stay tuned for our post surgery show. We’ll have an interview with Candy and also with our lucky patient. And, don’t miss Dr. Lockheart’s next performance at the Harvey Cushing Center in Philadelphia, PA. Dr Lockheart is scheduled to tackle a retained intrabdominal foreign body, no doubt a sponge left behind by our own Seymour Fielder. So it’s goodnight from Atlanta, but stay tuned for the post surgery show. Goodnight.”