ID: 53 year old man with no past medical history presents with
large scalp basal cell carcinoma.
Lives alone in apartment. Works as custodian.
My cat’s ginger paw caresses my cheek to rouse me for her breakfast. The red digits of my bedside clock read 4:53.
I reach to the clock, tap a button curtailing the alarm, heave the duvet from my body, swing my legs on the ground, chuck off my nightshirt and put on my running outfit. Sabine squeaks, purrs and makes figure eights between my fleet as I stumble into the bathroom. My eyes close as I brush my teeth, hoping to imbibe more sleep.
I wander into the kitchen, open a cupboard door to find the red bag of kibbles. I fill Sabine’s bowl full of her niblets, put the bag back in the cupboard, walk down the stairs, and out the door, setting out into the darkness.
The clop of running shoes hitting sidewalk pavement echoes through suburban streets lined with lightless houses.A half hour later, at the end of my nervous jaunt , I pause at the threshold and catch a peek of sunrise, the highlight of my day.
I unlock the door, step inside, take off my running gear, jump in and out of the shower, dress, grab my knapsack and head out, as Sabine darts outdoors before I close the door. I walk among the gold, mauve and pink streaks of the dawn sky, enjoying my post-jog state. Ten sweet minutes.
I arrive at the Plastic Surgery ward, swinging my white lab coat around me, as I join the flock of white coats gathered next to the counter. I glimpse at the clock on the grey wall behind us: 26 minutes to 7.
The residents are huddled over the trolley of white binders. We medical students are satellites, awaiting the cue to proceed down the hall, at the tail of the parade.
Haziz looks up from the huddle. “Okay. Let’s go,” he pushes the cart of charts, sparking the procession. I hide at the back, chatting with Jorge, a surgeon completing his fellowship. “Why do they have to round so early? It’s mean waking everyone up. Doesn’t make sense.”
“Have to see everyone before the first OR, at eight.”
“Why don’t they just see the person scheduled for eight and then see the rest after that?” I ask.
“Have to see everyone,” he repeats. During his Plastics residency in the States, he had once told me, the residents arrived at 5 am so they could round, write and then present case summaries to their preceptors at general rounds at 6:30 am.
“Was it useful?” I ask.
“That wasn’t the point,” he replies.
We follow Hazziz and Dave from bed to bed. I cringe as we wake each person lying in the dark by switching on the bed’s flourescent lamp above each head. I lean over Hazziz’s shoulder as he peels back bandages on her belly concealing pink flesh and yellow puss. “Does it hurt?”, I ask the woman under the gauze.
Hazziz turns his head to me, “No wonder you want to be a psychiatrist.” Why did he say that? He turns back the bandage, leaving it lying on her skin, awaiting a nurse to remove it and apply a fresh one.
We turn to the next bed. The man’s ear is patched. Hazziz and Dave grumble. “We’ll be starting the reconstruction today,” says Dave,and turns back to the entourage, shaking his head. “Waste,” he whispers.
“What does he mean?” I ask Jorge.
“He shot himself. Tried to commit suicide and botched it,” he replies. “So now we have to fix it.” I try to catch his eye, smiling meekly as we walk out of his room.
We wander into a private room. Dave ignites the light. A startled round man awakes with a little white stocking on his head. A few seconds after the light is switched on, a couple of white-coated grey-haired, balding men arrive. They approach the bedside, as Dave, Hazziz and we, their white-coated ducklings, step aside.
“It’s pretty big,” says Dr. Tupper as he rolls the stocking off the scalp underneath.
“It’s huge,” Dave exclaims as Dr. Tupper pulls off the white gauze, revealing a giant scab resembling a purple crusted pancake-shaped hat. “It’s like a plate.” The puzzled eyes under this grotesque beret look up at him.
“It’s okay, Mr. McKenzie,” Dr. Tupper puts his hand on the man’s shoulder. Mr. McKenzie’s face softens. “We’ll take care of it.”
The other white-coated man, Dr. Calham steps out of the circle to the periphery. He points toward the bed, then leans toward Jorge and me. “He’s a janitor at Parksville School. He’s probably been walking around with this thing growing on his head for years. Went the emergency room a few days ago and took of his cap.”
“Why did he come in now?” I ask.
“He said it was starting to bleed. That worried him.”
7:52am.
We file out of Mr. McKenzie’s suite as Dave and Hazziz rush up the stairs and the rest of us scatter.
I emerge out of MGH, off to the refuge of the Children’s Hospital. I look forward to hanging out in the surgeons’ lounge with Cal, a general surgery resident and my preceptor who just returned from Africa where he had fixed cleft palates for a week.
I appreciate the morning light pouring through the lounge windows, sunny disposition of my preceptors and simplicity of our work.
We do a lot of “ear tucking”. I am allowed to practice my stitching, well-hidden behind auricular cartilage. My handiwork brings it closer to the child’s head. “No more Dumbo jokes,” for this boy, notes Cal as I hook my needle into this young scalp.
1:02pm
After lunch, I head back to the dingy red brick hospital for adults. The glass doors open as I step on the black rubber at its entrance, beaconing me down the fluorescent-lit corridor, up the dim grey elevator and onto the top floor. I walk to the women’s change room, full of lockers of a few dozen nurses and a handful of physicians, put my coat and knapsack in an empty locker marked “STUDENT” and change into green cotton pajamas: “scrubs”.
I exit the locker room, pairs of green-clad women and men pass by me. Hips graze hips. Hands roam along backs. Everyone is giggling. I am bewildered.
Cal meets me at the nurses station and we head to the OR. Together, we approach the stainless steel sinks. After stretching the handles of a mask over our ears, covering mouth and nose, we each reach for a plastic yellow packet from a pile, next to the sink, and rip off the plastic skin to reveal a soft pink block . I turn the tap handles with my elbows, unleashing a stream of water, and enjoy the warm foam bubbling from the pink sponge, as I rub my palms, fingers, wrists and forearms. Three minutes. Minimum, I am told. My elbows tap the long chrome faucet handles to shut off the flow of water. Our elbows bent, keeping damp hands in mid-air, we turn our backs to the swinging doors and push through, into the operating theater
Inside, we are greeted by a masked, green-clad nurse. Her ungloved hand pinches the wire at the top of my mask, molding it to the bridge of my nose. She holds up a wrinkled green cotton gown in front of Cal, as he places each hand through the holes presented to him. Another nurse has a gown ready for me. I follow Cal’s lead. Once his hands are through the cuffs, he spins one hundred eighty degrees. My nurse taps my shoulder, triggering my turn. I watch Cal’s nurse’s (now latex-covered) hands create three bows from the ties along his back, as the woman behind me does the same. She grabs an extra strip along his side, he twirls and then I twirl. The final bow is tied along each of our waists.
“Thank you.”
I follow Cal to the silver trays where paper rectangles, atop a green towel, await us. I pick up the package, rip off the top edge and open it, exposing two flat, hollow, latex hands. I tuck my finger inside one glove, reach my other hand inside and pull the latex over the green gown’s cuff. Cringing in my effort to not touch my skin with my rubber digit, I reach inside the other glove and pull it over my hand, wrist and cuff. My finger grazes the cotton sleeve. Damn. Recalling last OR, when I wasted four pairs of gloves, I decide to let it go.
Our sterile fatigues in place, we join the troops assembled around a hill of cotton fabric the same color as our outfits.
It encompasses a familiar round purple disc, surrounded by a bed of hoses, and illuminated by a spotlight. Mr. McKenzie’s tumor is the afternoon’s center of attention.
I shift to the second row, behind Hazziz and next to Katherine, my classmate. Dave stands across from us, with a woman and man on his side. Together, we form a circle around
Mr. McKenzie’s head. Cal stands somewhere among the other half dozen in the room.
“We’ve been at this for three hours,” says a tall figure. “Could take another three or four. We’ll need a lot of blood.” I recall the voice from this morning’s rounds. Dr. Tupper?
Dave asks for a scalpel. The woman at his side passes him a stainless steel blade. “It’s a big job. I’ll be ready for a beer at the end of this one.” He cuts into the mass before him. Blood seeps around the knife. The nurse sops it up with white gauze at the end of scissor-like stainless steel forceps.
“Are you going to the party tonight?” she asks.
“What party?” asks the man next to her. I recognize his eyes. It’s Dr. Calham.
“The one for the closing of the OR’s at the Civic Hospital,” she replies. “This is the last OR day here.”
“Should be lots of booze,” mumbles Hazziz as he tugs with his forceps.
“Sounds good, where is it?” Dave keeps his eyes on the task at hand.
“On the eighth floor,” she says.
“Sure, I’ll go over when we’re done,” Dave turns to her. “You going?”
“Just doctors are invited.”
“You can be my date.”
“I’ll go, too,” says Dr, Calham. “You can be my date.”
“I can’t be both of your dates,” she giggles.
“Sure you can,” assures Dr. Calham.
“Yeah,” Dave looks up. “You can be the Plastics concubine.”
The nurse turns to Dave,” What’s a concubine?”
I turn, wriggle through this green crowd and head out the swinging doors, gasping for air.
