The operation has lasted three hours and is perhaps at its halfway point. The scrub technicians can rotate in and out as they tire. I watch a scrub tech named Josh arrive to take the place of Cathy. Cathy possesses a quiet competence, a pleasant smile – and has laughed at all my jokes. As far as I’m concerned, Josh can only be a poor substitute.
Dr. Boveri bends over the patient, continuing the precise work of cutting and dissecting. As first assistant, I provide exposure, lifting and pulling aside muscles, ligaments and other structures so Dr. Boveri can see what he is doing. I work as Dr. Boveri’s assistant for the pure pleasure of learning. As an impatient resident under his training at Emory University, I once found the intensity of this Harvard-trained surgeon annoying. Ten years later, I pass my sickest patients into his skilled hands and regard his intensity as a miracle, and a gift to my patients.
Josh, the new scrub tech, seems to think his job includes keeping up the chatter in the O.R., especially, it appears to me, during critical moments of the operation, when a slip of the knife could unleash a life-threatening gusher of blood.
Did you see the game last night? You know, Dr. Snow always prefers the other kind of clamp. Whoa! Can you believe how many worms they ate on Fear Factor?
Dr. Boveri ignores the chatter. A surgeon’s preferred language is one of action. His eyes carefully trace the fingers of cancer that have groped their way through my patient’s intestines. Working together we pry away the malignant flesh, piece by piece, reaching deeper and deeper into the body until we penetrate the abdomen to the cancer’s very source. We are deep inside the pelvis.
Dr. Boveri leans forward almost imperceptibly, as the surgery reaches the zenith of its difficulty. He places a sponge over a portion of bleeding tumor and pauses in his dissection.
Cancer is cellular growth gone amok, a raging fire that spreads through the body, burning nutrients and consuming flesh in its path. The cancer before us has obscured the boundaries between uterus, ovary, and rectum, binding them together in an unnatural mass of biological concrete. Dr. Boveri uncovers a chunk of tumor that seals the space between appendix and external iliac vein. He gently probes the vein. Its thin walls channel the surge of blood returning from leg to heart. Methodically, relentlessly, Dr. Boveri works to liberate the vessel, separating healthy from unhealthy tissue, cutting flesh to save a life. After forty minutes, the tumor is gone, and the vein is free. It is a master performance.
Josh, however, is not to be outdone. As he receives the piece of malignant flesh from Dr. Boveri, he notches up his monologue, in a self-appointed role as court jester. For much of the operation, words have run from his mouth like water from an overflowing toilet. Now he reaches for his finest moments. Who do you think is the hottest on Desperate Housewives? Hey, what is this? Is it tumor? What do I do with it?
“It’s cancer. Put it in the basin,” Dr. Boveri says.
Two minutes later: What is this? Wow, this is something. Same thing? Put this in the basin too?
Dr. Boveri gestures toward the basin.
Five minutes later, Josh launches into a reprisal. Is this cancer too, he begins.
Dr. Boveri explodes. “What do you THINK it is, Josh?!!” He struggles visibly for self mastery, and can be heard to mutter, tuna fish sandwich?
He takes a deep breath, the furrows in his brow subsiding as he regains his equilibrium. A surgeon reveres self-control above almost every other virtue, and I suspect his outburst bothers him more than it does anyone else. But at least it has the desired effect – Josh keeps his mouth shut.
As the operation nears its sixth and probably final hour, a quiet, smiling Cathy returns to the operating room. Dr. Boveri interrupts his work to thank Josh as he leaves the table, but it is not until Josh is completely gone, having scrubbed out and exited the room, that the surgeon finally allows himself the luxury of full expression.
“Cathy,” he grimaces, “we are SO glad you’re back.”
Dr. Boveri is a surgical oncologist affiliated with Cherokee Women’s Health. He and Dr. Litrel work in an integrated group with nutritionists, geneticists, molecular biologists, chiropractors, naturopathic doctors and others, including patients, to develop better models for health, and to help prevent cancer from occurring.
-Dr. Mike Litrel
