Cutting for Stone - Abraham Verghese [206]
“No, sir,” I said, dropping my eyes.
“I see. You trusted the pathologist to read the biopsies for you?”
I said nothing.
Deepak's voice wasn't raised. He could have been talking about the weather. Dr. Ronaldo couldn't hear him.
Deepak explored the pelvis, swept with his fingers to those places we could not see. Finally he said, almost under his breath, “Marion, when it's your patient and you are basing your surgery on a biopsy, be sure to look at the slides with the pathologist. Particularly if the result isn't what you expect. Don't go by the report.”
I felt terrible for Mr. Walters. I could have spared him this operation, spared him Popsy In retrospect, Mr. Walters s liver function tests were marginally off, and that should have been a clue.
Deepak repaired the hole in the bowel. Fortunately, there was just one. He oversewed the bleeding ulcer in the stomach; it would in time bleed again. We washed out the abdominal cavity with several liters of saline, pouring it in, then suctioning it out.
“Okay, come to this side, Marion. I want you to close.”
I worked steadily under his eagle eye.
“Stop,” Deepak said. He cut away the knot I had tied. “I know you have probably done a lot of surgery in Africa. But practice doesn't make perfect if you repeat a bad practice. Let me ask you something, Marion … Do you want to be a good surgeon?”
I nodded.
“The answer isn't an automatic yes. Ask Sister Ruth. In my time here, I've asked that question of a few others.” I could feel my ears turning red. “They say yes, but some should have said no. They didn't know themselves. You see, you can be a bad surgeon, and as a rule you will make more money. Marion, I must ask you again, do you really want to be a good surgeon?”
I looked up.
“I guess I should ask what does it involve?”
“Good. You should ask. To be a good surgeon, you need to commit to being a good surgeon. It's as simple as that. You need to be meticulous in the small things, not just in the operating room, but outside. A good surgeon would want to redo this knot. You're going to tie thousands of knots in your lifetime. If you tie each one as well as humanly possible, you'll experience fewer complications. I want to see even tension on both limbs. The last thing you want is for Mr. Walters to have a burst abdomen when he gets post-op bloating. That knot, done well, may allow him to go home and get things in order. Done poorly it could keep him in hospital with one complication after another till he dies. The big things in surgery depend on the little things.”
That afternoon we sat in the cramped office of Dr. Ramuna, the pathologist. She found cancer in the edge of one of the six biopsies I had taken days ago. A stern lady, Dr. Ramuna had a way of pursing her lips that reminded me of Hema. She was unfazed about having missed the cancer the first time. She pointed to the teetering stack of cardboard slide trays by her microscope—biopsies waiting to be read. “I'm doing the work of four pathologists, but I'm only here half-time. Our Lady can't afford more that that. But they don't give me half the work. I can't spend enough time with each specimen. Of course I missed it! No one comes down here to go over slides with me, other than you, Deepak. They call. ‘Have you read this specimen yet? Have you read that specimen?’ If it matters to you, come down, I say. Give me good clinical information and I can do a better job of interpreting what I see.”
I KEPT VIGIL over Mr. Walters. We had passed a tube through his nose into his stomach and connected it to wall suction, to keep his gut empty for the next few days. He was miserable with the tube and hardly spoke.
On the third post-op day I took out the nasogastric tube. He sat up, smiled for the first time, taking a deep breath through his nose.
“That tube is the Devil's own instrument. If you gave me all of Haile Selassie's riches, I'd still say no to that tube.”
I took my own deep breath. I sat on the edge of his bed. I held his hand. “Mr. Walters, I'm afraid I have