Direct Red: A Surgeon's View of Her Life-or-Death Profession

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9780061725418: Direct Red: A Surgeon's View of Her Life-or-Death Profession
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Surgeons have long been known for their allergy to doubt, an unsurprising trait in professionals who must play God, routinely risking someone else's life to do their job. But in this illuminating memoir, Gabriel Weston reveals the emotions, passions, and doubts normally hidden behind a surgeon's mask.

Interweaving her own story with those of her patients, old and young, Weston evokes both the humor and the heartbreak that come from medicine's daily confrontation with the ultimate unknowability of the human body. With prose that does not flinch from the raw, graphic realities of a surgeon's day, Weston confronts life, death, and the unique difficulties of being a female surgeon in a heavily male-dominated profession.

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About the Author:

Educated in the United Kingdom and the United States, Gabriel Weston studied English literature at Edinburgh University before attending medical school in London. She went on to become a member of the Royal College of Surgeons and is a part-time ear, nose, and throat surgical specialist. She lives in London with her husband and two children.

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SEX
To be a good doctor, you have to master a paradoxical art. You need to get close to a patient so that they will tell you things and you will understand what they mean. But you also have to keep distant enough not to get too affected. This distance keeps both parties safe. A doctor can’t afford to faint at the sight of blood or retch on smelling faeces. And the last thing a person wants when they have been told awful news is for their doctor to start crying. But sometimes, you feel the likeness between you and your patient more than the difference. Sometimes, your own body declares its fallibility as if in sympathy for the person you are consulting, or your heart defies you by responding just when you least want it to. One of the most difficult things is learning how to manage sexual matters in hospital life. It’s like going through adolescence all over again.

The first time I ever touched a stranger’s penis, I was lucky enough that it was a patient under general anaesthetic. The old man, who had been wheeled unconscious into the operating theatre from the anaesthetic room, was due for a left hemicolectomy for cancer, a long operation which requires a urinary catheter for monitoring.

I was a house officer. I knew I loved being in theatre but as yet had no useful place in it. I was standing awkwardly in one of the corners when my handsome registrar invited me to initiate myself. I accepted enthusiastically, admitting my ignorance of the procedure, and was grateful when he agreed to show me what to do. A nurse arranged a trolley with all the bits we would need, and Adonis and I approached the patient’s naked groin.

I put on a pair of sterile gloves. ‘Now,’ Adonis instructed, ‘one hand is clean. One hand is dirty. With your dirty hand, swab the penis.’ Struggling to prevent the words ‘dirty’ and ‘penis’ from conjuring certain private fantasies about myself with this surgeon, I began to blush. I washed the man’s glans.

A small coterie of theatre staff were enjoying my clear discomfort, as my registrar continued. ‘Now, with that hand, hold the penis still. And with your clean hand’ — a breeze of relief at not having to keep hearing the word ‘dirty’ lightened my blush here — ‘take the lignocaine jelly and introduce it into the meatus.’ What I now saw as my useless, trembling and woefully clean, never-to-be-meaningfully-dirty hand fumbled with the man’s limp organ and the vial of jelly which I hoped would disappear into his penis poured out all over his groin. Adonis, from his lofty position of experience and romantic obliviousness, began to find my incompetence amusing. ‘Pull back the foreskin and introduce the catheter.’ No penis, all foreskin, the task seemed impossible. The slippery prepuce appeared to have no underlying structure to be retracted on so that the end of the foot-long catheter kept popping out of the baggy eye of the man’s penis, flicking jelly around with every jaunty boing. Nurses and theatre underlings tittered. Adonis woundingly quipped, ‘I thought you might have been better at this. Not your first penis, surely?’ ‘My first floppy one, yes!’ was all I could hotly reply.

Adonis eventually finished the job for me, but for weeks afterwards I was greeted in operating theatres the hospital over with sniggers from senior surgeons, identifying me as the one who had declared herself used to handling firmer members.

Another awkward encounter, which made me feel like I had been cast back to peripuberty, occurred during an on-call. I was asked to see a post-operative orthopaedic patient suffering from what is known as phimosis. This is a painful condition which occurs if the foreskin is pulled back over the head of the penis for any length of time. The band of retracted skin acts like a tourniquet, impeding drainage of blood from the penis and causing it to balloon painfully. In hospital, it may happen when a nurse or doctor has forgotten to pull a foreskin back into position after inserting a catheter.

It was the middle of the night when I arrived on the orthopaedic ward and I was immediately able to make out a low groaning, separate from the ward’s collective groan. Steve, the burly chief nurse, led me to Mr Ashton’s bed, drew the curtain around me and the patient and, with an encouraging wink, left us to it. Leg and cast on a pillow, Mr Ashton’s head was thrown back in disquiet. His swollen, discoloured penis lay like a dark lighthouse against the horizon of the sheet’s edge.

He was a young man. We were contemporaries. I tried to chase from my mind the idea that, in other circumstances, I might have met him at a party. I found myself perversely grateful that his pain left no room for embarrassment between us. He looked wildly at me and whimpered a little. I began to talk to him in a quiet voice, not because it was night-time but because I wanted him to look at me and think me quiet and therefore gentle, since what I began to explain to him was that I was going to put his sore penis into my hand and squeeze it. As soon as I said ‘squeeze’, I added ‘very very gently’, but what I didn’t detail was that I would then start to squeeze it harder and harder until I chased all that pooled blood back up more proximally so I could get the foreskin noose loose and put things back where they belonged.

I took his next whimper for assent and, like someone on slow spool, finger by finger, enclosed as much of the head of his penis as I could in my hand. It felt as if the two of us were hardly touching. Mr Ashton drew breath at this point, his worst fears of vengeful womanhood perhaps allayed. Then, gradually, I began to apply more pressure, first just enough for the small muscles of my hand to relax their still semi-extended position, then more. In a curious inversion of other similar contacts, I felt rewarded as the contents of my grip began to shrink. I carried on applying pressure bit by bit. After about five minutes, I was clenching Mr Ashton’s penis with all my might. As all the remaining trapped blood migrated northwards from the end of his organ, the young man’s discomfort eased and what had previously looked like agony gave way now to nude shame. In the artificial dusk of the ward, we were suddenly just two young strangers, one holding the other’s penis.

Mr Ashton said thanks and clearly couldn’t wait for me to leave. I felt satisfied with a job well done but also wanted to make myself scarce. Steve made some obvious joke or other on my way off the ward and another task called me elsewhere.

The penis also makes its presence felt more subtly in the medical workplace. Before I had even thought of becoming a doctor, while studying English up north, one of my tutors sought the help of his surgeon brother to refurbish his kitchen. The evening this constructive individual arrived in town, I was at a small student dinner party at this tutor’s house. We were eating meat and his brother ate a lot of it. We were telling young person’s stories about our gap years, about the only adventures we had ever had, postcard-sized. His tales of cutting and thrusting in the operating room made ours seem small and silly. This Mr Silk had a few photo albums in his car, which he showed us over coffee. They were full of before-and-after pictures of tumours followed by smooth expanses of flesh; compound fractures followed by straightened limbs with neatly stitched skin. At the end of the meal, Mr Silk peeled an apple in front of us all, and we watched as a regular ribbon of skin eased its way from the fruit in a perfect, unbroken coil.

At twenty-two, I was amazed, so when a full evening of my attention was rewarded with a singular invitation to visit my tutor’s brother in his operating theatre whenever I might next be in London, I accepted without hesitation.

Less than a month later, I took the train south one weekend to stay with an aunt. On the Saturday, I arose at dawn and caught the first tube to Mr Silk’s private operating suite. I felt a great sense of excitement as I was shown to the women’s changing room and handed my first ever surgical scrubs and cap. I remember as new the oddly industrial smell of the fabric, like hard dusty tarmac. And the feeling of being almost undressed, with only the starchy top and bottoms to brush against skin and underwear.

When he saw me, Mr Silk hugged me to his chest, then welcomed me into his theatre with exquisite grace. I was introduced to his urbane anaesthetist and his various helpers. He showed me what everything was. I mistook this for courteous surgical convention. It would take me fifteen years from this point to reacquire the feeling of being ‘someone’ in theatre, for more authentic reasons.

He then performed an athletic and dramatic hip replacement. I don’t recall much of the procedural detail, complete neophyte as I then was. What has remained is a more sensate memory. The music of the anaesthetic equipment, heard for the first time with its hums and peeps and sighs. The mixed aroma of clean hard surfaces and the loam of the body’s upturned soils. The migrainous glare of the theatre lights. The pared-down gestural language between the players.

When the operation was over, the patient wheeled out, the orderlies gone, Mr Silk produced a bottle of champagne from the anaesthetic fridge, and he and I and the anaesthetist stood in theatre and drank it all from those small slush-white beakers that have corrugated sides and usually hold children’s squash. Knowing nothing of the mores of private medicine, I took this for surgical commonplace, a kind of post-sacrificial bonding.

Afterwards, my tutor’s brother took me out for lunch, and a sense of wonder and excitement and exhilaration at what I had seen poured from me limitlessly throughout the meal, so that all potentially awkward moments were smoothed by its unction; so that any opportunity to realise that it was a little odd to be sitting with this strange man in this restaurant in this way was lost in the sparkle of a surgical world newly seen, compared to which the normal world appeared foxed like an old photograph.

As we left the restaurant, he ushered me with his large all-doing hand upon my elbow, a hand which still gave off a faint scent of Betadine, between the two heavy wooden doors leading out of the restaurant to London and its usual traffic. He stopped me. He stood very close and said, ‘It was a wonderful morning.’ And then, ‘My wife doesn’t know about this.’ Which seemed an odd preamble to a sudden sense I had that he might be about to put his large 55-year-old mouth on mine. I took a step back, and quickly opened the door leading to the street. After a stilted thanksgiving, I was walking to the Tube, and thence to my aunt’s house. I was never given such special treatment again.

All workplaces are full of this. But in a career where the body is the common currency, it feels odd to have one’s own body be at all the issue. However, if this kind of experience makes one self-conscious, far more disturbing is the situation where one’s own romantic feelings about a patient get in the way.

As I was shaking out a new white coat from its flatpack, to do my first on-call as a qualified doctor, on the other side of London, a perfect young bricklayer was accelerating his 750 cc motorbike to 60 mph on a seemingly empty city road. As the first hours of my on-call disappeared in little tasks and chats, he saw too late the van which pulled out from a side street and knocked him off his bike. While I wondered if the night had any excitement in store for me, Mark hit the ground, bounced several times onto all sorts of different bones, which broke, and then skated noisily across the gravelly surface of the road. He covered a hundred metres of this surface in ten seconds. He then lay silently in a heap for five minutes while the ambulance called by the man in the van came to fetch him. Soon afterwards, he reached A&E, where a trauma team was waiting. The primary survey of airway, breathing and circulation pronounced him alive; the secondary survey, where a quick run-through of every part of the body is performed, concluded that this man would be admitted to hospital as an orthopaedic patient, and that all other injuries would have to wait until the life-threatening bone ones were sorted out.

Mark had thirty-six fractures. Some of these were large single breaks, others accounted for by a single bone having shattered in several places. Amazingly, his skull and face had not been squashed and his internal organs had received no major injuries. His crash helmet and bones had served their purpose.

Two consultant orthopaedic surgeons, each with a registrar, took him to theatre and began to put things back in place. One I didn’t know. The other was called Santa for his gut and facial hair and ho-hoing manner. He always called himself a carpenter and he certainly had his work cut out here. A big man, he began to straighten crooked limbs in order to stem the bleeding in and outside the bones that was threatening the young man’s life.

I was summoned as the underling whose job it was to remove as much as I could of the gravel that had got stuck to Mark’s grazed body and face when he came off his bike. For this, I was given a large plastic bowl of soapy water and several scrubbing brushes, the ones we use to clean our hands before operating. They have hard, densely packed plastic bristles and I felt quite sick as I was encouraged by Santa to rub ever harder, until several brushes had to be replaced by new ones, until the already so damaged man bled in response to my personal assault. Santa reassured me that I was doing my patient a favour, reducing his risk of infection and of the skin scarring that gravel causes, known as tattooing. So as I scrubbed, he bled and it seemed as if, within this room, we were exchanging deformity for deformity. The twisted limbs were straightening to calm the eye but the whole body was now looking veiled with the blood that my work had drawn from it. After a few hours, I left. I had worn four scrubbing brushes flat and my night on call was over.

The next time I saw Mark was on the intensive care unit the following day. His extremities were covered in plaster. External fixators stuck from various aspects of these casts like outsize Meccano scaffolds. Only stripes of skin were visible against the white and these looked swollen, their surface scuffed by my efforts. The young man’s head was round with oedema. Round like a child’s picture of a head. Not round like a head really is.

I was feeling a bit queasy. It was my first time on an ITU. I was still getting used to my white coat, which I wore awkwardly like someone trying to suit the wrong fashion. I was thinking I couldn’t believe I was a doctor now and that I really didn’t know what I was meant to be doing. I had a clipboard with all my consultant’s patient names on the front piece of paper. There was a stout box next to each name in which I was meant to write the jobs that would need doing that day for each patient. I held my pen above Mark’s box, waiting for instruction or inspiration, and I peered at the man’s face with what I hoped would pass for clinical scrutiny. His black, heavy-lidded eyes were open a little, like a turtle’s, and I saw the globes within them turn in my direction. The half-dead man ...

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9780099520696: Direct Red: A Surgeon's Story

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