Turbulence

The heart lies still in the open chest. The surgeon looms over it, suture in his right hand, forceps in the left. He shifts his weight from one foot to the other, his calves and thighs taut. He peers over his surgical mask at the paralyzed organ, that fist of muscle designed to deliver the ingredients of life. Right now, cardiopulmonary bypass supplies the oxygen, and he understands the ultimate goal: restore the vital organ, a hummingbird that knows only how to beat its wings ceaselessly. But today, he stands as frozen as the heart. His eyes glance up to meet those of his surgical assistant on the other side of the table. The assistant’s eyebrows furrow beneath his blue surgical cap and his head tilts slightly, questioning the pause. The surgeon stares back and gently shakes his head, the tiniest gesture a massive admission of defeat.

The surgery is approaching its 11th hour; he agreed to attempt a re-do valve repair, and it’s the most difficult operation of the surgeon’s career to date. He mentally rifles through everything he has absorbed over the years of training, desperate for a hand to grasp onto that can pull him towards the light. The thick stack of index cards he carried in college, each sheet featuring a single organic chemistry formula. The tomes he toted throughout medical school, chronic back pain blossoming from their weight. The long call nights of residency, the nurses never allowing him to sleep more than 15 minutes. All the missed birthdays and bachelor parties and baby namings. His cardiothoracic fellowship a complete blur, the last few miles of the marathon. He had barely staggered across the finish line, limp-limbed and drunk with exhaustion.

Nothing sticks this time. Surgery is usually like flying a plane: rise to cruising altitude, progress through routine maneuvers, and land smoothly, all involved parties arriving safely at their destination. Of course, pilots can encounter unexpected conditions, external forces that generate turbulence and put the passengers in peril, but one always hopes for blue skies and mild winds. In this case, the takeoff had been rocky, a re-do sternotomy, or opening of the chest cavity. Forests of fibrosis first needed to be cleared past the breastbone in order to expose the heart, and this had taken several hours. He then needed to dissect out the diseased valve, the doorway that connected one room of the heart to another. Sick valves aren’t smoothed and sanded, but are instead warped and scarred, more difficult to remove.

When it was finally time to install the new valve, his hands were fatigued, and his mind was clouded with exhaustion. He had just flown through a most treacherous storm, no light in sight. He suddenly questions why he had agreed to perform this operation in the first place. Was it his pride? Or maybe it was his ego, that ballooned confidence, that had convinced him that he could take on this difficult case. When he saw the patient in the office before surgery, and talked to them and their family, he had felt invincible, confident in his capabilities, ready for the challenge. Now he felt deflated, lost in himself and shaky in his skills, and for the first time in his career wonders whether he can actually land smoothly and lead the soul below him towards health.

He imagines himself tearing off his gown and gloves and simply walking away from the operating table, leaving the patient completely incomplete, with a literal broken heart. He wonders what he would tell the family in that little consult room, the one with no windows and weak lighting, a tissue box always sitting lonely on the side table. How could he face them and tell them that he failed? That he couldn’t continue, so he simply stopped? Would he be able to live with himself, knowing he destroyed not just his patient’s life, but the lives of his family as well? Could he simply get into his car and drive away, abandoning his role, his duty, his oath?

He then recalls a moment in intern year, when he was assigned to assist a surgeon nearing retirement. He usually saw the surgeon shuffling the halls alone, hunched into himself, his bald head gleaming under the fluorescent hospital lights. He always wondered how the hospital allowed him to continue to operate, a dinosaur in a world of young doctors, still using outdated techniques and obsolete equipment. The case had started in a fairly straightforward manner, and they got started without a hitch. Eventually, though, the surgery went sideways, and they found themselves in trouble. The patient was not doing well, and they needed to get him off the table. “Guess we’ll close,” the old man said gruffly, his eyes focused on the open surgical field, hands busy reassembling what they had broken. The surgeon had stopped operating then, confused. He directed his gaze to the old man and insisted, “But we’re not there yet.” The old man then suddenly looked up, eyes shining over his surgical mask. “This patient might die if we stop now,” he said evenly, “but he will certainly die if we keep going.” At that, he asked for the closing suture, and neither of them said another word until the case was complete.

That patient did eventually pass away, and the surgeon was mercifully spared the job of informing the family. The old man had gone alone to break the news to the patient’s wife and children. But the case had haunted the surgeon for weeks afterwards. He had failed the patient, and the patient’s family, unable to finish what he started. He vowed then to never make the same decision.

Now, the clouds part and bright skies materialize on the horizon: “The only way out is through,” he whispers to himself. He imagines an airport, sunlight streaming through floor-to-ceiling windows, so many people moving in a million directions. He watches his former patients leave the gates, luggage on their shoulders, suitcases dragging. They’ll reunite with loved ones and head home, grateful for the smooth travels. He sees his future patients sitting in the terminal, reading their books, scrolling through their phones, about to take flight. They will trust their fellow human to shepherd them safely on their journey. And he asks for the healthy valve, and gently begins to sew it into place.