It’s 5am. I peer through fast-revolving doors and eye the light skim of snowfall. I’m aware of a deep shiver. It’s the breeze flapping my skimpy white coat, right? Don’t kid yourself, rank fear is what this is.
This is my first 24-hour stint as a surgical dresser. This allegedly thrilling moment of emergence from a mind-numbing four-year rote of lectures and exams out into clinical medicine’s maelstrom of learning by doing. My own practice? With my own patients assigned to practice on? Surely a vision too magical to conjure. Too magical, indeed. The reality of this first night, this snatching up of a callow student initiate into mean city streets, is purest terror.
I chose this of my own will?Pictured myself, did I, some WWII hero battling death and disease? The A&E Department,1 commonly known to us med students as “The Box,” opens into Giltspur Street, right across from Smithfield Central Meat Market, national distribution point for a thousand years for every species of animal carcass from Europe’s breadth and length.
The market being a 24-hour operation, its sundry adjoining pubs are all-nighters too. From The Box’s doorway, I take in the sight of a gang of meat porters across the way. Now freed from six-hour stints of shoulder-humping half-cows and whole-pigs up lengthy carcass aisles and hoisting them onto massive meat hooks to sway on the blustering breeze, the men jostle their way into The Dog and Duck pub.
They’ll be downing pints of bitter like the fonts are running dry. Chasing them with tots of cheap Scotch. Heaven forbid any find their way in here.
But heaven is deaf. Minutes later, a member of the Worshipful Company of Butchers staggers through the door. Short, thickset, all muscle and timber, he is cloaked neck to ankle in a once Royal-blue smock, now caked in blood. His right hand clutches at a dark crimson rag wound clumsily about his left. He’s also much the worse for drink.
The staff nurse taps me on the shoulder. “You’re up. Space four.”
I draw back the curtain. A junior nurse and hospital porter are struggling to hump the chap onto the gurney. He rolls his head at me: I must look to his giddy gaze like an unlicked babe. The nurse is yelling as “Smithfield Market” half-stretches himself across the bed. “Mr. Palmer, calm down. Calm down, will you? Here’s the doctor now. He’s going to fix you right up.”
As I approach, Mr. Palmer collapses of a sudden into stertorous slumber, granting me the chance to ease his rag loose. But it’s stuck firm. I tug harder, galvanizing Mr. P. He grabs his wounded hand back, sets off a bloody ooze, which looks all set to gush. I press the wrap back fast, wait several long moments, take several long breaths, and let him settle back.
I lift the edges once more, more gingerly this time. And take in the full spectacle: his right thumb is dangling like a lifeless twig from a branch. His hand looks the size of a leg of lamb. Must have sliced his cleaver almost through. I flash on recent visions of animal carcasses, then on corpses in my late-vacated anatomy lab. Now, what exactly do I recall of the intimate structural relationships of the human thumb?
Raw student I may be, but I know the mantra: You can always tell a Barts man, but you can’t tell him much! Which, being interpreted, equals: Stand on your own two feet’ til in dire emergency. Nothing for it but to commence operations. I look about for the nurse.
But she’s into the fray ahead of me: without a word of prompting, she dons efficient rubber gloves, opens up this massive operating pack onto an already draped cart, wheels it toward me. I survey the wads of bandages, dressings, and surgical instruments she has displayed.
“Scrub up next door,” she prompts me tersely. “Glove size?”
“Er, 7. Um, and a half.” Something like that, far as I recall.
By the time I’m back, she has a gown and gloves stretched out for me to don. She swabs copious quantities of iodine over the wound and smoothly drapes towels about my whole operating field. Mr. P. stirs, but settles once more to slumber. I offer mute thanks for the respite allowed me to inspect my surgical tray: scalpel, forceps, needles, suture material, dressings. I force back burgeoning dread and plunge in.
Forty long minutes later, I have succeeded—heaven be praised—in tacking Mr. P.’s vital organ back upon its foundations in his pulped-up palm. I know it, though: my fledgling efforts are largely a botch. Thank God the booze is still at work in him.
I hear they’ve got this store of watered-down beer,and theysip at it right through their shift. Though he likely wouldn’t show pain even if cold sober.
I stop, stretch, and review my handiwork. At least no blood has been spilled for a bit. I’ll grant you that suture line is awfully ragged—but that thumb of his is pretty pink. Pinkish, anyway. Mind you it’s sticking up at a pretty weird angle.
The staff nurse, all starched white pinafore over ice-blue dress, pokes her head round the curtain. She nods at the probationer,2 who makes her retreat, then casts a long eye over my operating field. Finally: “How about giving Ken a call?”
The notorious Dr. Kenneth T., on-call house surgeon. My heart sinks.
Dr. T.’s notoriety stems from his fund of caustic commentary on med students’ bungling forays into any kind of surgery. He’s also infamous with the nursing profession for the conquests he’s notched up among probationers. Which is perhaps why she hasn’t suggested I summon him sooner.
But I cannot let Mr. P. out of here without clearance from the powers-that-be. This I know. I lift the phone at the nurses’ station, finally rouse him, and press him to journey from his cozy berth to my makeshift operating theatre. Once arrived, he flicks a scornful look over the site of my surgery—swollen, purple, misshapen, though at least attached, even partly mobile member—and pronounces for all of Giltspur Street to hear: “Whatever you do, man, don’t take up surgery.”
Having uttered this sparkler of witticism, he retires back to his nest while I overcome my shame.
Next Monday in the A&E clinic, I greet Mr. P., back for his first check-up. The bandage about his hand is grubby but still intact. And the tip of his thumb is visibly pink above it. He gives it a cheerful wiggle as he seats himself. “Nice job, guvnor. Not that I ’member too much abaht it, like. Bit worse for wear, I were.”
“A bit, yes, Mr. Palmer. But you were most cooperative. A model patient, in fact. Perhaps we might see how things are coming along.”
As I draw back the final piece of lint from his wound, I am stunned to see his once disfigured thumb is resuming something close to its native shape. He grins, wiggling it at me once more. Astounding the human body’s power to heal—with minimal help from me.
“Not too sore, I hope? Did you take all those pills we gave you?”
“Those ones for the infection, yus. Not them pain killers, though. Can’t have me mates labeling me ‘sissy.’”
By his final visit, only a florid scar running from wrist to thumb tip recalls my first stint in The Box. Mr. Palmer announces, “Me an’ me mates wants you to join us, like, for a pint or two nex’ week. Nex’ time you’re on duty, like.”
I’m sorely tempted. Until the full significance dawns: my drinking habits do not extend to a skinful of Guinness before breakfast.
Emergency Department (ED)
JOHN GRAHAM-POLE, MD, MRCP is a 1966 graduate from St. Bartholomew’s Hospital (“Barts”) at London University and an emeritus professor of pediatric oncology & palliative care from the University of Florida. Now retired in Nova Scotia, he has written and/or edited six books (three academic, three poetic), as well as many articles and book chapters. He writes poetry and short stories based primarily on his 40 years of medical practice. His first young-adult novel is being considered for publication, and he is working on a memoir about his journey to becoming a doctor.