Atrium

“At this point in the surgery, Jared, you will take your scissors and snip open the right atrium.” The second-year resident’s eyes widened, briefly letting slip the mask I had come to expect from surgical trainees. That short moment of vulnerability finally hammered home what I should have known all along – I was going to see something incredible.

I was in the third week of my surgery clerkship and halfway through my time on the Abdominal Transplant service and, honestly, surgery wasn’t really agreeing with me. Going into the clerkship, I didn’t think I wanted to be a surgeon, and I sure hadn’t seen anything to make me change my mind. Nevertheless, I tried to be a good student – keeping my presentations short, knowing more than I said, frantically reminding myself of the muscles, vasculature, and innervations that so vexed me in anatomy two years ago.

But Abdominal Transplant was thoroughly draining me. It didn’t help that I never felt comfortable in the operating room. I was too hot. My eyewear was always foggy. I had a tremor. My incompetence at tying knots conjured memories of humiliation from my Boy Scout days. There’s so little you’re allowed to do as a medical student in the operating room, and yet you’re expected to be there, hour after endless hour, watching. And what do you watch in a transplant? Vessels being tied off. Over, and over, and over, endlessly. I explained it to my wife once as “standing, for five hours, watching you knit, and occasionally handing you scissors.”

And so it was that I found myself at 3pm one day, willing the clock or the surgeon to move faster, when the OR phone rang. There was a donor in Fayetteville; we were going to go get his liver and kidneys – and I was reluctantly along for the ride.

Having napped fitfully on the trip down, I was still groggy as I pulled on Cape Fear Valley Medical Center’s scrubs and struggled with the large surgical boots. After I caught up with my team, the surgeon began to discuss the procedure, matter-of-factly delivering the instructions that shocked me awake: “You will take your scissors and snip open the right atrium.” Suddenly, I felt the full impact of what we were called to Fayetteville to do. This patient, our patient, had a dead brain but an alive body, a body kept alive by the best our science could muster, until we killed it so someone else’s brain and body could both live. To be sure, it was only medical intervention that was keeping him in this state, but “snip open the right atrium?” It doesn’t get more dramatic!

As it turned out, the patient’s body wasn’t just alive – it was perfect. Needing to visualize his entire abdomen and most of his thorax, I saw a view of the human body that I had not seen since anatomy lab, and even that failed to prepare me for the glory of this young, fit man’s living cadaver body, unobscured by fat and bloat and decay, with the pulse of its arteries, peristalsis of its ureters and the beating, beating of that heart in its chest. When the time came to inject the preserving fluid, the blood had to come out. After the resident cut open the heart, it slowly fibrillated and finally stopped altogether. I pondered the cycle of life, death, and renewed life that I was a part of that night, the wonder of the patient’s body, the awe I felt before it and all that we were doing, and I thought, “If I felt like this every time I was in the operating room, there’d be nothing for me but to be a surgeon!”

I’d never understood before – people who want to be surgeons seem like those who have a different favorite color, or who inexplicably hate the combination of chocolate and peanut butter; bizarre, alien, incomprehensible. But that all changed that night in Fayetteville. It didn’t make me into a surgeon, but it gave me a glimpse, a taste, of how surgery must feel to those who choose that path. Surgery would never again seem like a crazy thing to want.