Thomas Jefferson University, Philadelphia, Pennsylvania, United States
Ay, but to die, and go we know not where,
To lie in cold obstruction and to rot,
This sensible warm motion to become
A kneaded clod…
William Shakespeare, Measure for Measure
Claudio: Act III, Sc. i
“Happy New Year!” a small voice squeaked out with soft exuberance. I looked up at the clock to see it was midnight, and my hands remained wrapped around the tortuous jejunum of a man I had never met. He was a large man, his belly cavernous and soaked with the same blood that once flushed a face I had never seen. His face, neck, and limbs were covered in the blue sterile paper drape of the operating room. Only his thorax—in which my hands were now immersed—met my gaze. John Doe was the “kneaded clod” Claudio feared he would become. Nothing more—and nothing less—than flesh.
And flesh is not something I am accustomed to knowing in isolation. In my previous life as an actor and teaching artist, it was the soul and mind that drove my work. If I were to heal a body or nourish the flesh, I would do it by first asking my students and my audience to explore questions of morality, motivation and movement. I would reach bodies through their minds and souls. The “sensible warm motion” of relationship—to characters through the script, to audience through blocking and staging, to time through costuming and make-up and language, and to life through motif and symbolism—had been my theater and my world.
Suddenly, I stood here, up to my elbows in bowel, with none of the “motion” and only the “clod.”
The first organ recovery I had ever experienced was an elegant, deliberate, almost plodding surgery in Pittsburgh on New Year’s Eve. Our medical team arrived 30 minutes after our Claudio had already been draped and the incisions made. His face, his immense still-intact body, and his humanity were left to my imagination; excepting the sparse information we had been given: African-American male, 34, DOB 03/XX/1975, BMI 46, creatinine 8. Our Claudio was born less than a month after I was, and there I stood, and there he lay. He died of asphyxiation. Secondary to…? “Dunno. You know as much as I do,” the answer came back cool, aloof, tired. Were it not for the slim possibility of giving life with his large, fatty liver and his immense, lava-rock-like kidneys, his death would have remained a non-event in my life.
O pardon me, thou bleeding piece of earth,
That I am meek and gentle with these butchers.
Thou art the ruins of the noblest man
That ever lived in the tide of times.
William Shakespeare, Julius Caesar
Marc Antony: Act III, Sc. i
Ripping me from my reverie, this morning's reality check is lightning-fast and brutal. We will hasten this woman’s death by removing life support—according to her and her family’s wishes, of course. And again, it is the organs we want. We have come for her kidneys, but I see her face, shaved head, shaved pubis, tattoos, short and plump stature, and lovely pink skin before seeing the tape of detached data: Caucasian female, 50, DOB 09/XX/1959. Two months younger than my husband.
My husband: an actor also, but like me, an individual torn between two worlds. His division is mathematics and acting: he forged a career as a computer programmer and a “mostly out-of-work actor,” as he is fond of saying. My divisions are science, theater and music. As a child, animal behavior and primatology studies by Jane Goodall enraptured me, while I explored Bartok and Beethoven and Shakespeare and Shepard in my free time. I remained divided in college, finally double-majoring in biopsychology and music. Even now, ten years of acting led me to … medical school. To the outsider, these are incongruous, a non sequitur. To me, one is simply an extension of the other—all an effort to explore and elevate the “ruins” of man, which pass all too quickly in our fleeting “tide of times.”
But spiritual exploration is ill-afforded here. Or is it?
We were ushered out of the operating room to wait. Wait. Wait. Wait. Casual conversation between me and the surgeons. But in the background (because I force the thought back there) is, "Shouldn't there be silence? What if I want to pray? Would that be weird? And now my head itches. Can’t scratch. Sterile. Stay sterile. A woman in the next room is dying."
Whoosh! Doors open: "Five minutes," says the nurse, as if we were waiting for the microwave or something.
More itching and waiting and not praying, and then, "Time." We hop up, and with a clipped pace we walk into the room. Scalpels rise: Slash, slash. Peel back. Crank open. Sternal saw. The high-pitched sound of metal on bone. Cannula. Shove. Perfuse. Cannula. Shove. Perfuse. Ice! Ahhhhhhhh.
And now we have time for elegance and methodical delicacy, because it is the kidneys we care about. Find the ureter, for God’s sake. Where is the Balfour retractor? Retract, retract, retract the skin and muscle and fat to open her abdomen wide. And now I notice that she is dusky. Pink skin fades to smoky cream. But I focus. And, honestly, it is fun. My God, the liver is beautiful. Nobody is going to use it???!! Oy, the waste. The anatomy is beautiful. Her anatomy is beautiful. Her body is beautiful. She is beautiful. Elizabeth is beautiful. Was she a Liz? A Beth? A Betty? How did she get here?
Suction. Right, yes. Harvest the lymph nodes to test for any disease of the organs. And then it is time to close. Me?! Really?! I get to close?! I'm sewing Elizabeth's skin. And I feel privileged. Sutures slip: Oops! Hold the forceps like a pencil. Yes, sir. But Elizabeth is oblivious to the gift she has given me: to touch, to learn, to know. Crappers, her umbilicus doesn't line up. I did not think about lining up her skin exactly, precisely, and just so, to give her back her belly button. Three stitches out, and I re-stitch to make her right, which seems absurd under the circumstances.
Drapes come off. Her lips are gray now. Her skin is gray. So fast. Off comes my gown and gloves, but I wait, staring at Elizabeth. "Tripped over her dog, fell down the stairs, hit her head, and in a coma," says one nurse. "Just like that."
Just like that.
KANANI TITCHEN, originally from Hawaii, now lives with her husband in Philadelphia, Pennsylvania, where she is a 3rd year medical student at Jefferson Medical College. Mahalo (thank you) to Hektoen Institute of Medicine for encouraging creative expression of the medical art sciences.