Cutting for Stone - Abraham Verghese [75]
Over the hum of the receiver, Ghosh could hear the blood rushing into his ear with every heartbeat.
Hema's brusque “Hello” told him she was scowling. “It's me,” he said. “Do you know who I have here tonight?” He told her the story. She interrupted before he could finish: “Why are you telling me this?”
“Hema, did you hear what I just said? We have to operate. It's our duty.”
She wasn't impressed.
He added, “They're desperate. They have nowhere else to go. They have guns.”
“If they are so desperate, they can open the belly themselves. I am an obstetrician-gynecologist. Tell them I just had twins and I'm in no condition to operate.”
“Hema!” He was so mad that words would not come out. At least in the business of patient care, she was supposed to be on his side.
“Are you minimizing what I have on my hands?” she said. “What I've gone through just yesterday? You weren't there, Ghosh. So now these children's every breath is my responsibility.”
“Hema, I'm not saying …”
“You operate, man. You've assisted him with volvulus, haven't you? I've never operated on volvulus.” By “him” she meant Stone.
The silence was punctuated only by the sound of her breathing. Does she not care if I get shot? Why take this attitude with me? As if I'm the enemy. As if I caused the disaster she walked into when she returned. Did I invite the Colonel here?
“What if I have to resect and anastomose large bowel, Hema? Or do a colostomy? …”
“I'm postpartum. Indisposed. Out of station. Not here today!”
“Hema, we have an obligation, to the patient … the Hippocratic oath—”
She laughed, a bitter, cutting sound. “The Hippocratic oath is if you are sitting in London and drinking tea. No such oaths here in the jungle. I know my obligations. The patient is lucky to have you, that's all I can say. It's better than nothing.” She hung up.
GHOSH WAS an internal medicine specialist through and through. Heart failure, pneumonia, bizarre neurological illness, strange fevers, rashes, unexplained symptoms—those were his métier. He could diagnose common surgical conditions, but he wasn't trained to fix them in the operating theater.
In Missing's better days, whenever Ghosh popped his head into the theater, Stone would have him scrub and assist. It allowed Sister Mary Joseph Praise to relax, and for Ghosh, being the first assistant to Stone was a fun change from his routine. Ghosh's presence transformed the cathedral hush of Theater 3 to a carnival racket, and somehow Stone didn't seem to mind. Ghosh asked questions left and right, cajoling Stone into talking, instructing, even reminiscing. At night, Ghosh sometimes assisted Hema when she did an emergency C-section. Rarely, Hema sent for him when she performed an extensive resection for an ovarian or uterine cancer.
But now he found himself alone, standing in Stone's place, on the patient's right, scalpel in hand. It was a spot he hadn't occupied for many years. The last time he stood on the right was during his internship when, as a reward for good service, they let him operate on a hydrocele while the staff surgeon stood across and took him through each step.
On his instruction the circulating nurse passed a rectal tube into the anus, guiding it up as high as it would go.
“We better start,” he said to the probationer who was scrubbed, gowned, and gloved on the other side of the table, ready to assist him. Her faint pockmarks were hidden by cap and gown. Even though her lids were puffy, she had beautiful eyes. “We can't finish if we don't start so we better start if we're to finish, yes?”
A very large incision should be made
—of small ones in such cases be afraid—
The coil brought out, untwisted by a turn
—a clockwise turn as you will quite soon learn—
And then a rectal tube is upward passed—
Thereon there issues forth a gaseous blast …
With the colon swollen to Hindenburg proportions it would be all too easy to nick the bowel and spill feces into the abdominal cavity. He made a midline