Cutting for Stone - Abraham Verghese [232]
One night, Dr. Braithwaite, Senior Consultant Surgeon and Chief Examiner for the Royal College of Surgeons, came in to see a patient with a high stab wound to the abdomen. Braithwaite was a legend for having pioneered a new operation for esophageal cancer, a notoriously difficult condition to cure. The patient, already inebriated, was terrified, abusive, and combative. Braithwaite, a compact man with silver hair, wore a blue three-piece suit that was the same shade as his blue eyes; he dismissed the porters restraining the patient and he put his hand gently on the man's shoulder and said, “Don't worry. It is going to be all right.” He kept his hand there, and the patient, staring at the elegant doctor, quieted down and stayed that way during the brief interview. Then Braithwaite examined him quickly and efficiently. When he was done, Braithwaite addressed his patient as if he were a peer, someone he might see later in the day at his club. “I'm glad to tell you that the knife spared your big blood vessels. I am confident you are going to do very well, so I want you not to worry. I'll operate, to repair whatever is cut or torn. We are going to take you to the operating theater now. Everything is going to be fine.” The docile patient extended a grubby hand of thanks.
When they were out of earshot of the patient, Braithwaite asked the entourage of registrars and house-officers, “What treatment is offered by ear in an emergency?”
This was an old saw, particularly in Edinburgh. Still, the old saws were not well known anymore, a matter that distressed Braithwaite greatly. He saw it as emblematic of a slackness in the new generation of trainees, and it was sad that only one person knew the answer. And that too a medical student, of all people.
“Words of comfort, sir.”
“Very good. You can come and assist me in surgery if you like, Mr. …”
“Stone, sir. Thomas Stone.”
During the surgery Braithwaite found Thomas knew how to stay out of the way. When Braithwaite asked him to cut a ligature, Stone slid his scissors down to the knot and then turned the scissors at a forty-five-degree angle and cut, so there was no danger to the knot. Indeed, Stone so clearly understood his role that when the senior registrar showed up to assist, Braithwaite waved him off.
Braithwaite pointed to a vein coursing over the pylorus. He asked Thomas what it was.
“The pyloric vein of Mayo, sir …,” Thomas said, and appeared about to add something. Braithwaite waited, but Thomas was done.
“Yes, that's what it's called, though I think that vein was there long before Mayo spotted it, don't you think? Why do you think he took the trouble to name it?”
“I believe it was as a useful landmark to identify the prepyloric from the pyloric area when operating on an infant with pyloric stenosis.”
“That's right,” Braithwaite said. “They should really call it the pre -pyloric vein.”
“That would be better, sir. Because the right gastric vein is also referred to in some books as the ‘pyloric vein.’ Which is very confusing.”
“Indeed, it is, Stone,” Braithwaite said, surprised that this student had picked up on something that even surgeons with a special interest in the stomach might not know. “If we have to give it an eponym, maybe call it the vein of Mayo if we must, or even the vein of Laterjet, which seems to me much the same thing. Just don't call it pyloric.”
Braithwaite's questions became more difficult, but he found the young man's knowledge of surgical anatomy to be shockingly good.
He let Thomas close the skin, and he was gratified to see him use both hands and take his time. There was room for improvement, but this was clearly a student who'd spent many waking hours tying knots one-handed and two-handed. Stone had the good sense to stick to a two-handed knot, tied well and with care, rather than showing off to Braithwaite with one-handed knots.
The next morning, when Braithwaite returned, he found Stone asleep