Of Scrubs And Screws

You put on the light and illuminate the view-box. The transparent plastic-like-paper film displays some radio-opaque and radio-lucent shadows. You observe the film very meticulously fathoming the urgency of the case. You press the electronic-buzzer immediately that lies underneath your desk and call the on-duty medical officer, in order to prepare the patient for surgery.

An elder man, in his mid-fifties, hailing from a remote village of Kailali, presents to the emergency ward with an open distal tibia fracture on his left foot, with a history of diabetes mellitus and hypertension for the past ten years without any specific sustained-injuries. 

You scan the patient’s particulars prudently and take note of each and every detail that is penned down on a plain, white history-sheet. Having completed your post-graduate study on orthopedic surgery from John’s Hopkins, you always knew your life would take you on a roller-coaster ride, with scores of patients charging you with their agony and undying pain. You still remember how you never missed a single episode of ‘Bob the Builder’ that aired when you were a spring chicken. On your tenth birthday, you asked your mother to buy a Lego-set of the same show, so that you could build your own variety of equipment and tools. You always fancied Bob’s toolbox that accommodated an eerie-looking jigsaw, a bulky drill, and a light-weighted monkey wrench. But little did you know at the time how soon your proclivity towards those tools you’d make assembling Duplo-bricks would turn into a reality.  

Today you’re going to perform your two-hundredth (200^th) surgery. You put on a long, greenish surgical-gown and a loose, nylon trouser, free of lint and any other desquamated fabric bits. You head towards the washbasin, situated alongside the main OT room, and scrub your bare, unsterilized hands with antimicrobial soaps and liquids. This isn’t the first time you inhale the characteristic pungent hospital smell…this isn’t the first time you catch a glimpse of strange-looking retractors, and hand-holders arranged systematically on top of the theatre-table. This is the first time you realize how your hard work has finally paid off as a feeling of contentment brings roses to your cheeks.

As soon as you push the metallic door with your sturdy shoulder joint, you start mulling over the management protocol silently. You see the patient lying serenely on the hydraulic theatre-bed, sedated with the right proportion of anesthesia. As you position yourself next to the operating table, you take a close look at your patient’s injured foot and start the surgery, stabilizing the vitals throughout the hour-long venturesome process.

The surgery finally comes to a halt. You gaze at the wall clock and notice the time to be precisely 9:00 am. You want to go out and have a cup of morning tea, with succulent cookies and cupcakes. But you hold back your breakfast craving and instead cram down a couple of sodium chips along with a sweetened glucose drink to energize yourself for the countless number of impending surgeries to come. As soon as you finish your morning delight, a new case of medical emergency befalls you. You ask the attending nurse to enlighten you about the case without any delay.

A young man, in his mid-twenties, hailing from Pokhara municipality, presents to the emergency ward with a right femoral neck fracture and soft tissue injury, with no significant history of diabetes mellitus, hypertension or any other specific past illnesses.

You check the particulars for one last time before you head to the washbasin to scrub your hands again. You take out your used-gown; dispose it into the enormous litter bin placed beside the water-tap and adorn yourself with a fresh piece of scrub suit. 

After a short break, you gear yourself up for your two-hundred-and-first (201^st) surgery. A case of femur fracture, you speak indistinctly and warm up your fingers as if you’re kneading bread dough. You stand beside the injured patient, inspect him, caress his haunch area gently and proceed with the surgery diligently.

“Can you pass the scalpel, please?” you request.

As soon as the head nurse hands you the equipment, you run your skillful fingers over the pelvic-skin making a superficial incision of six centimetres. You make your way through the underlying subcutaneous tissue, the fascia, the bulky quadriceps, and finally reach the injured bone (i.e., femoral neck). You perform the surgery by open reduction, preserving the most vital blood supply of that area (which is the medial circumflex femoral artery) while fixing the fracture with three stainless cancellous screws. The whole procedure takes about four hours to complete, where you finally stabilize the patient with minimum blood loss and soft tissue repair.  

You take a look at the clock again. You notice the time to be exactly 1:30 pm. Your body is half-starved now, and you want to put your hunger to rest by gulping a heavy delicious brunch. But as you get tied up by another case, your emerging hunger pangs go unobserved, leaving you dead on your feet. 

“Sir, it’s a case of RTA (road traffic accident) with multiple fractures on the right humerus and a flail chest.” says one of the interns.

“Please give me the details about the patient’s medical conditions, if present.” you ask hastily as you change your blood-spattered gown.

“The patient is thirty years old and is asthmatic. He is on corticosteroids for the last ten years and is non-diabetic and non-hypertensive.”

“Okay! Quickly put the patient on the ventilator and maintain his vitals. Don’t administer general anesthesia; the airway may get constricted obstructing the patient’s airflow.”

You instruct the medical officers to manage the airway, breathing, and circulation of the patient. As soon as the oblong monitor indicates normal vital readings, you take the scalpel, cut through the wounded chest, and with the help of metallic screws, you start fixating the broken ribs. You also manage to fix the fractures of humeral shaft with intramedullary rods and numerous minuscule plates. After an unceasing tiresome procedure lasting for four hours, your body becomes very pale and numb. You ask for a glass of water and quaff the liquid within seconds, quenching your thirst. You lay flat on the ground with your head facing the ceiling. You take a big sigh and notice the time to be precisely 6:15 pm.

What a hectic day!  You mumble and applaud yourself silently for successfully performing your two-hundred-and-second (202^nd) surgery.

At the end of the day, you come to realize the essence of the Hippocrates oath you took when you laid your foundation in this humanitarian field. You create a selfless version of yourself today. You reincarnate your being into an avatar that always comes to the aid of others and unfold your empathetic demeanor who saves countless lives every dawn and dusk.

But you don’t find yourself bedecked with lavish costumes and bright-colored cape, characterizing you as some sort of superhero with a superpower. Despite the fact that your weary body is festooned with a raw, bloodstained suit, you consider yourself a superhero, a hero for others, as you gradually muse over your inner voice that shouts, “Not all superheroes wear capes, some wear scrub suits!”

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