The Anatomy of Deception - Lawrence Goldstone [26]
Flashing hands was no understatement. Burleigh made a swift paramedian incision on the left abdominal wall, about two inches from midline, beginning just under the rib cage and ending five inches below the umbilicus, cutting in one motion through the skin, subcutaneous fat—minimal due to the patient’s physique—and the anterior rectus sheath. As he spread these aside, four of his assistants dove in with pads. Burleigh then called for a retractor, cut the rectus muscle itself, and placed the retractor laterally, instructing a fifth assistant to hold it still. The entire process was completed in seconds.
I glanced at the Professor, but he gave no sign anything was amiss. A paramedian incision was the correct choice—the rectus muscle is not divided, the incisions in the anterior and posterior rectus sheath are separated by muscle, and incisional hernia is less likely—but the length of Burleigh’s cut was far too long. It would be much harder to close, chance of secondary infection greatly increased, and control of the organs inside the peritoneum would be difficult.
By the time I returned my gaze to the table, two assistants were frantically applying pressure to the larger vessels, while another sponged away fluids. Burleigh should here have switched to the small scalpel for a finer cut, but instead, in the interest of speed, he used the same large instrument to incise the posterior rectus sheath, transversalis fascia, and peritoneum. When he encountered the epigastric vessels, a geyser of blood shot out of the patient, spattering everyone on the right side of the table. Corrigan grabbed a hemostat and tried to clamp the artery, but with blood obscuring the cut end, it took him at least ten seconds to achieve the result. All the while, Burleigh was snarling, “Get that closed, damn you!”
The rule in surgery, with so many crowded around the table, was “no talking except the big man.” Burleigh was particularly loud and abusive. As soon as Corrigan had placed the clamp, Burleigh screamed for another. The disorganization in the efforts of the team was palpable.
When finally the bleeding was sufficiently controlled so that Burleigh could see, he began to incise the peritoneum to access the colon itself. Suddenly, the patient began to squirm on the table. Burleigh screamed once more, this time to increase the ether. If the patient’s diaphragm began to move, the bowel could bubble and, especially with this huge an incision, it might force sections of intestine out through the opening and into Burleigh’s face.
The patient once more lay still as the additional ether began to take. Burleigh proceeded to the target. Still furious, he yelled, “Hold that still, you fool!” The eyes on the assistant holding the right angle retractor went wide, and he struggled to remain perfectly motionless. Burleigh began his inspection of the colon, performing the task as rapidly as possible. He found the diverticular abscess that he expected almost immediately, but there was no way of knowing what, if anything, he missed.
He clamped the colon on either side of the abscess and then, still using the scalpel with which he had cut through the outer skin, he excised the section. After reaching into his case for a length of silk suture and a needle, he stitched up the anastomosis. From there, Burleigh closed the incision in layers, sealing the giant opening with stitches far too large, in each case using the same needle and suture.
When he was near the end, Burleigh asked for the time. The entire operation had taken under forty minutes. He seemed disappointed and glared at Corrigan and the other assistants. When he had tied off the last external suture and the ether cone was removed, Burleigh nodded at the assistant keeping time and stepped back. Blood was everywhere, on the table, the floor, and soaking everyone’s clothing.