Cutting for Stone - Abraham Verghese [215]
He adjusted the overhead lights. When I lifted the liver, the bleeding was much less than before, and what's more, the torn edges of the vein were visible on the backdrop of the tube. Deepak grabbed one edge of the tear with long forceps and passed the curved needle through and then grabbed the other edge, passed the needle through that and out, and tied a knot. I let the liver back down. It was a laborious process: lift, grab, pass needle, mop, pass needle to other side, mop, tie, relax the pull on liver.
At some point, just as were nearing completion, I sensed someone at my shoulder. Deepak glanced up but did not say anything.
“Is that a Shrock shunt, son?” a voice behind me said. It was a male voice, polite enough, conscious that it was a delicate moment to intrude, but with the authority of one who is entitled to ask.
Deepak looked up again, then back to his work. “Yes, sir,” he said.
“How big was the tear?”
Deepak pulled up the liver and adjusted the overhead light so the visitor could see. “It was three-quarters of the way around the cava.” The tube hed pushed down from the heart made a lovely internal splint for the vein, and running across it like a crease was the first part of Deepak's neat repair. It was a beautiful sight, order restored from chaos.
“Very impressive,” the voice said. There was no sarcasm, just genuine admiration. I stepped back so the visitor could have a better look, and when I did, he leaned in. “Very, very nice. Id put some gel foam around the raw area of the liver. Were you planning to leave some drains?”
“Yes, sir.”
“I'm assuming you are the attending physician?” the voice said.
“No, I'm the Chief Resident. My name is Deepak.”
“Where is your attending?”
Deepak met the speaker's eyes, and said nothing.
“I see. Not one to get out bed for this sort of thing. Do you ever see him?”
As if in reply, Ronaldo snorted and turned to his dials, feigning disinterest. The visitor looked to Ronaldo and seemed about to bite his head off, but then remembering this wasn't his theater, he didn't.
“And how many Shrock shunts have you done before, Deepak?”
“This is my sixth.”
“Really? In what period of time.”
“In two years here … Unfortunately we see a lot of trauma.”
“Unfortunate, yes. But fortunate for us. We are not ungrateful … Still, six Shrocks, did you say? Remarkable. How have they done?”
“One died, but a week after the surgery. He was walking, eating. Probably a pulmonary embolus.”
“Did you get an autopsy?”
“Partial. The family allowed us to reopen the belly. The repair to the cava looked good. We took photographs.”
“And the others?”
“Second, third, and fifth are alive and well, six months after the operation. Fourth died on the table before I got this far. I had just opened the heart.”
“Do you count that one?”
“I should. ‘Intention to treat’ … that counts.”
“Good man. You should count it. Most surgeons wouldn't. And your sixth?”
“This is him,” Deepak said.
“Right. Well, that's better than my experience. I've done four. That's over six years. They all died. Two on the table, two so close after surgery that it was as good as dying on the table. They weren't all trauma like this. Two were tears from someone trying to remove an adherent cancerous mass. You ought to write up your experience.”
Deepak cleared his throat. “With all due respect, sir. I have. No one will publish a report from Our Lady—”
“Nonsense. What is your full name?”
“Deepak Jesudass, sir. This is my intern—”
“I tell you what, write up this case and add him to your series, and then let me take a look at your paper. If it's good, I'll see that it gets published. I'll send it to the editor of the American Journal of Surgery. I'll check with you to see how this patient does. Good luck. By the way, my name is—”
“I know who you are, sir. Thank you.”
The visitor must have been walking away when Deepak said, “Sir? … If you were to … never mind.”
“What is it, man? I have a cadaver organ