My attending figure-skates an instrument through the feathery fascia of the anterior neck. Smooth surgical steel slides easily through wisps of transparent tissue the color of soap bubbles, like blades on ice. He finds purchase and with almost imperceptible movement opens the instrument; it is a wordless command for the chief resident to cut.
And a millisecond later—snip.
A window opens and with it the path forward. The right-angle clamp, and the skilled hand wielding it, catches its scent, following the tissue’s contour with the innate magnetism of a bloodhound on the hunt. Another small cut. Snip. Soap bubbles burst. Discrete structures appear and demand attention. All are respectfully acknowledged; some (nerves) are spared, while others (vessels) are tied and cut or clipped and cut or buzzed away. The surgeons are fluid and meticulous and silent as their hands waltz beneath the hot operating room lights. It is a practiced and precise synchrony of steel, tissue, and gloved hands on a sterile-blue field. In the background, their metronome ticks steadily at seventy-five beats per minute.
Oh, and I’m there too, tightly gripping two tiny retractors with hands that are little more than sacks of lactic acid suspended over the surgical field. This is my first thyroidectomy; it is just over a week into my surgery clerkship and I am over-tired, under-prepared, and increasingly rattled by my fascination with the operating room. My operative responsibility is commensurate with my expertise—which is none—so I commit myself to retracting with all the strength I can muster. By nature of my task, I am angled away from the field, exposing the canvas to the artists at work, at this moment having more in common with the pair of scissors than the surgeon wielding them. I crane my neck to catch a glimpse of the elegant dissection anyway. When this proves difficult, my gaze turns upwards, trying to crack the operative code of what instrument is that and what vessel is that and is that even a vessel and how do they know to do that and where will they go next.
My hands itch to hold instruments. I want to dance but I can only wait in the wings, micro-adjusting my grip on the retractor as my intrinsic hand muscles scream, praying I do not interrupt the ballet.
An hour or two later the patient is sewn up with deft layers of suture and I watch as my chief resident snaps his gloves off, outer, then inner, into the trash. What began as pearly white neoprene is now a cloudy red, covered in blood dried in streaks and whorls. Battle scars, proof of engagement. I do the same. My gloves are perfect, unsullied, pearly white neoprene. My gloves are pristine.
Over several more weeks of surgery, my count of perfectly clean gloves rose steadily but so did, in measured doses, my responsibility in the operating room. I first graduated to scissors, learning a Pavlovian reflex to pounce earnestly on that telltale sign—two ends of suture held taut, the command implicit—often embodying the classic paradox of cutting at once too long and too short. I closed incisions, slowly and meticulously, clumsy fingers slipping through the holes of the needle driver. Abstract concepts like tension and traction became real as I threw careful knots that were so much easier practiced at home. Here and there, I held a Bovie. By the end of my rotation, I had become a minor recurring role in the highly choreographed surgical theater, able to do only the most basic tasks in the operating room. Meanwhile, my fascination with surgery had only grown.
Although I was often a bystander during cases, those opportunities to wield a pick-up or a driver brought with them a new constellation of feelings. I started to look at my every move with an omnipresent self-criticism. I was harsh on myself, harsher than anyone else was, a manifestation of my discomfort at being unskilled. Hungry for improvement, I threw knots over and over again on the drawstrings of my scrubs and on my water bottles and on the straps of my backpack. I ripped my suture kit to shreds with careful stitches. I jumped at any chance to sew, to staple, or even to glue, and I did so fiercely. The chance to participate in surgery, even in the most minor of ways, brought with it a duty to perform. I realized this was the price to pay for getting my hands dirty.
I finished my core rotation on surgery conflicted. I knew that learning to run a nice-looking subcuticular stitch does not a surgeon make, and that, despite my best intentions, I could never approximate the reality of surgery as a medical student. I knew the training path was intense, the hours long, and the consequences serious. And yet, I could not (and still struggle to today) capture in words the feeling in my chest when the surgeon says, “knife, please,” and then, “incision,” followed by a cut and stream of red. I approached the rest of my clinical rotations with an open mind but unconsciously stacked each one against the operating room. And while I loved my time on the medicine floors and in the emergency room, nothing pushed me to be the best version of myself like surgery.
Several months later, I assume my familiar position as second assistant, gripping my tiny retractors and watching as two pairs of skilled, gloved hands raise flaps in the anterior neck, divide the platysma, and begin to expose the superior pole of the right thyroid. It is almost a year to the day since I saw my first thyroidectomy as a clerkship student; I am a sub-intern now, a little more confident in the OR and a little better at surgical mind-reading. In the year since seeing my first thyroidectomy, I have decided to become a surgeon. On my endocrine surgery rotation, I will watch this dissection many more times but it will never quite lose its magic. Gloved hands perform on their sterile-blue stage.
My hands still itch to hold instruments but I am content to wait in the wings and savor the fleeting privilege of existing in this room without any of its responsibility. I watch the surgeons’ hands create and destroy, acknowledging the years of training that have earned them this opportunity to dance.
At the end of the case, I snap my gloves, outer than inner, into the trash. They are pearly white and still pristine. But not for much longer
Julia Gasior is an MS4 at the Perelman School of Medicine.
Art by Adina Singer, an MS2 at the Perelman School of Medicine.
