When Breath Becomes Air(31)

I spent the night prior poring through surgical textbooks, reviewing the anatomy and steps of the operation. I slept restlessly, seeing the angle of the head, the saw against the skull, the way the light reflects off the pia once the temporal lobe is removed. I got out of bed and put on a shirt and tie. (I had returned all my scrubs months ago, assuming I’d never need them again.) I arrived at the hospital and changed into the familiar blue garb for the first time in eighteen weeks. I chatted with the patient to make sure there were no last-minute questions, then began the process of setting up the OR. The patient was intubated, the attending and I were scrubbed and ready to begin. I picked up the scalpel and incised the skin just above the ear, proceeding slowly, trying to make sure I forgot nothing and made no mistakes. With the electrocautery, I deepened the incision to the bone, then elevated the skin flap with hooks. Everything felt familiar, muscle memory kicking in. I took the drill and made three holes in the skull. The attending squirted water to keep the drill cool as I worked. Switching to the craniotome, a sideways-cutting drill bit, I connected the holes, freeing up a large piece of bone. With a crack, I pried it off. There lay the silvery dura. Happily, I hadn’t damaged it with the drill, a common beginner’s mistake. I used a sharp knife to open the dura without injuring the brain. Success again. I began to relax. I tacked back the dura with small stitches to keep it out of the way of the main surgery. The brain gently pulsed and glistened. The huge Sylvian veins ran across the top of the temporal lobe, pristine. The familiar peach convolutions of the brain beckoned.



Suddenly, the edges of my vision dimmed. I put down my instruments and stepped back from the table. The blackness encroached farther as a feeling of lightness overcame me.

“Sorry, sir,” I told the attending, “I’m feeling a little faint. I think I need to lie down. Jack, my junior resident, will finish the case.”

Jack arrived quickly, and I excused myself. I sipped some orange juice in the lounge, lying on the couch. After twenty minutes, I began to feel better. “Neurocardiogenic syncope,” I whispered to myself. The autonomic nervous system briefly shutting down the heart. Or, as it’s more commonly known, a case of the nerves. A rookie problem. This was not how I’d envisioned my return to the OR. I went to the locker room, threw my dirty scrubs in the laundry, and put on my civilian clothes. On the way out, I grabbed a stack of clean scrubs. Tomorrow, I told myself, would be a better day.

It was. Every day, each case felt familiar but moved a little more slowly. On day three, I was removing a degenerated disc from a patient’s spine. I stared at the bulging disc, not remembering my exact move. The fellow supervising me suggested taking small bites with a rongeur.



“Yeah, I know that’s how it’s usually done,” I mumbled, “but there’s another way…”

I nibbled away for twenty minutes, my brain searching for the more elegant way I had learned to do this. At the next spinal level, it came back to me in a flash.

“Cobb instrument!” I called out. “Mallet. Kerrison.”

I had the whole disc removed in thirty seconds. “That’s how I do this,” I said.

Over the next couple of weeks, my strength continued to improve, as did my fluency and technique. My hands relearned how to manipulate submillimeter blood vessels without injury, my fingers conjuring up the old tricks they’d once known. After a month, I was operating a nearly full load.

I kept myself limited to operating, leaving the administration, patient care, and night and weekend calls to Victoria and the other senior residents. I had already mastered those skills, anyway, and needed to learn only the nuances of complex operations to feel complete. I ended my days exhausted beyond measure, muscles on fire, slowly improving. But the truth was, it was joyless. The visceral pleasure I’d once found in operating was gone, replaced by an iron focus on overcoming the nausea, the pain, the fatigue. Coming home each night, I would scarf down a handful of pain pills, then crawl into bed next to Lucy, who had returned to a full work schedule as well. She was now in the first trimester of pregnancy, with the baby due in June, when I would complete residency. We had a photo of our child as a blastocyst, taken just before implantation. (“She has your cell membrane,” I remarked to Lucy.) Still, I was determined to restore my life to its prior trajectory.



Another stable scan six months after diagnosis passed, and I reopened my job search. With my cancer under control, I might have several years left. It seemed the career I had worked for years to attain, which had disappeared amid disease, was now back in reach. I could almost hear trumpets sounding a victory fanfare.

—



During my next visit with Emma, we talked about life and where it was taking me. I recalled Henry Adams trying to compare the scientific force of the combustion engine and the existential force of the Virgin Mary. The scientific questions were settled for now, allowing the existential ones full play, yet both were in the doctor’s purview. I had recently learned that the surgeon-scientist position at Stanford—the job for which I had been heir apparent—had been filled while I was out sick. I was crushed, and told her so.

“Well,” she said, “this doctor-professor thing can be a real grind. But you know that already. I’m sorry.”

“Yeah, I guess the science that excited me was about twenty-year projects. Without that kind of time frame, I’m not sure I’m all that interested in being a scientist.” I tried to console myself. “You can’t get much done in a couple of years.”