Hektoen International

A Journal of Medical Humanities

The surgeon

John Graham-Pole
Antigonish, Canada


Eli had once overheard an ENT nurse describe the sound of his artificial voice box voice as a cross between that of a toad and a crow—a voice any woman would hang up on fast. But right now a frail caw-croak is all he can summon. Jamming the phone’s receiver close to his face, he tries to speak. His legs dangle over the bedside, and he can hear the clinic’s standard operating chaos: phones ringing off the hook, typists at computers bashing out whatever-whatever, nurses hollering and scurrying in all directions. No wonder the receptionist cannot catch his rasp; he can hardly hear her voice—just enough to know it for Janine’s.

She’ll figure out fast I’m a patient from her years working ENT. All of us with our voice boxes chopped sound the same—none of us can handle the phone.


Eli cannot remember a time before the warts, a time before they first plugged his airway and screwed with his breathing. Papillomas, Dr. Knoblauch, his surgeon, called them. He remembers his mom’s first big talk with him when he was 13. He had kept quiet, taking it all in.

I had this virus, Eli, when I was pregnant with you, made these warts down inside me. Guess I passed them on when you were getting born. They said you must’ve sucked the virus down in your throat—started up making warts too. Only not like on your hands or feet from someone else’s towel. They grow in your voice box, then work on down into your bronchials. The docs haven’t come up with good treatments, though they keep trying new stuff.

At 20, Eli still has only hazy ideas about female organs; he does not want more details. His mom is the only woman he has ever been alone with. He cannot remember her ever going on a date, though she is cute enough to. She had him home-schooled when she realized the bugs he was catching in school were putting him in hospital with pneumonia each winter. She never leaves him alone after work, which he knows must cramp her style. She does not talk much about his father. He only knows snippets from occasional conversations with his mom:

Your dad and I never married, Eli. A good guy, he was, but once I got pregnant he wanted me to get an abortion. I said no way. I must have been six months along when he took off—never saw hide nor hair of him again. You could track him down if you wanted—I keep in touch with his sister in Buffalo.

He does not care that they never got married or that he has never known his dad. They manage fine, though he feels bad about her social life. As a kid he had made friends in the hospital, getting the same experimental medicine for warts: interferon shots three times a week, a bunch of check-ups. After a while he did not see those kids anymore; they kept his shots going for a year before the docs acknowledged they were not doing diddly-squat. Then they sent them to this surgeon in New York, an expert for papillomas for the whole country. The guy took one look and said he had nothing new, so his surgeons back in Gainesville took to scraping them out of his throat every month like clockwork. Lately it had to be every two weeks to keep his breathing right.

Dr. Knoblauch chopped out his voice box, and Eli’s had this hole in his windpipe to get air to his lungs ever since. A tracheotomy—trach for short. The speech therapist taught him to talk through his gullet, and now he utters short sentences people can figure out, but his voice is still whispery, so they have to decipher it.

He knows he is stuck with these suckers forever, popping up like cucumbers in a good harvest. Every few hours Eli sticks his suction pump in his trach to clear it. In cold weather—like now—a bug can muck things up big time.

Most patients he meets in the clinic nowadays are old guys with throat cancer on their last legs. But Eli has stayed short for his age, does not shave, and the staff in the children’s ward have known him forever, so they still put him in there for his clean-outs.

Guess they’ll have to switch me over to an adult ward sometime, he has told his mom, but I’m in no hurry. Those little tykes like asking questions, and they think my trach is cool.

Eli gets a kick out of giving his “lecture” to medical students in clinic; he knows a bunch more than them about papillomas. He considers visiting his nurses and doctors as an outing from his usual solitude, even though he hates the surgeries in the worst way—they leave his throat raw as butcher meat, sucking up bloody spit for days.

His mom put a bit aside from her paycheck and bought him a computer with Internet hook-up. Eli has read up on his illness—even doctor stuff—and has built up a whole vocabulary of medical words. He jokes with his nurses: Bet I could pass the doctor exams without going to school for it.

He has stumbled on chat rooms like Teen Chat, Late Nighters, and a few related to health topics, so he makes new friends and gets flirty with girls who post their pictures. After all, they’ll never hear my weirdo voice. He stops short of posting his own mug shot; he knows things cannot come to anything more than online flirting.


With a final rasp, Eli hangs up—he was getting nowhere on the phone with Janine. He struggles to take in enough air to stay conscious, knowing if he cannot get enough oxygen he will not last long. He is not about to call his mom at Subway; he hates the fuss she will make, and she is the one putting bread on the table. When she checked in before heading out for her early shift, he muttered that he was fine. The truth is he felt rough when he had gone to bed, and this morning breathing had become a major production. He knows he has picked up a bug—his snot is green and tastes yucky.

The bedroom clock reads 12:04 when he unplugs his pump and hauls himself, and his set-up, into the bathroom. He likes to look his best, even though the only people he sees most days are his mom and his own reflection. Peering at the mirror, he spots something weird at his trach opening. He leans in close; no doubt about it, two warts are sticking out through the hole.

In 20 years he has never had this head-on view—though he has pictured them plenty. They have even showed up in his dreams as gristly serpents snaking down into his lungs. But the sight of them jutting out into the open air quickens Eli’s breathing.

No point suctioning—only meant for yuck you can hawk up.

Shuffling back to the bedroom phone, he dials the restaurant. The waitress knows him right off.

“Your mom’s on her lunch break, Eli, then going grocery shopping. I’ll be sure to let her know you called, soon as she’s back.”

Eli is quickly losing his strength as he tries to make sense on the phone. His oxygen supply is running low. Then he gets an idea. The more he thinks about it, the more he knows the answer. He has been on the wrong end of a scalpel 200 times in the past 15 years, and, now that he is older and the surgeries are becoming more difficult, they have taken to discussing the details of their procedures with him.

Seems like I’ve picked up enough to do my own surgery—at least in an emergency. Just because I’ve got a hole in my throat doesn’t mean I’m stupid. Don’t have my own OR, but I can lay my hands on everything I’ll need.

Eli considers the knives in the kitchen, but decides the bathroom scissors will be safer. He knows to sterilize them and to find a bunch of stuff for mopping. Scouring the kitchen and then the bathroom, taking longer and longer breaks to rest, he settles on two toilet rolls and a bowl of hot water.

Perched on a stool close to the mirror, he starts the operation. His mouth above the hole is now dry as cotton. Thankful that his eyesight is good, he clenches a wad of toilet paper in his left hand, hooks his suction up close by his right, and starts snipping bits off the first swollen snake poking its head through the trach opening.

He has not planned on the swamp he is quickly into. As the first scalp drops to the counter, blood spurts forth on top. After a frantic struggle, he gets a grasp on what is left of the stem and staunches the gush. He is breathing fast, but at least he can catch his breath. Guiding his suction around his operating field, he waits, holding on for his life to the stalk. He feels his throat tighten and sucks in a final gasp of air.

After an hour, or a minute, he gingerly eases the pressure and sees the flow has slowed to a seep. Time to snip some more. He leans closer to the mirror, poking his scissors down beneath the top of the second monster. The hole is only an inch across, so it is hard to get a grip on its neck once the head is sliced off. Clutching fresh toilet paper, he makes tiny snips round the edges. A little blood, nothing he cannot handle. His breath is labored; he stops to rest. Now or never to top that, baby. He closes the blades and squeezes down.

At once a deluge of blood spurts onto his shirt, sluices down his arms, and makes his fingers stick together. But struggling to wedge tissues over the main bleeding cuts his air supply altogether.

What’s better—croak from bleeding or no oxygen?

Sensing darkness closing in on him, he leans in once more. With a sharp forward tilt on the stool, he goes down with a crash amid a cascade of toilet paper, dragging his suction set-up with him. His final awareness is of a door slamming downstairs.


Eli snaps his eyes open and knows at once where he is: Intensive Care. They always put him here after his surgeries until they can take him off the machine. He hears the low hiss-thud close by, telling him the respirator is doing his breathing.

“Eli, you’re in there!” His mother chokes back a sob. “Oh God, thought I’d lost you for sure.”

He turns his head as far as the tubing strapped on his face allows. His mother is stooping over him, forcing a tearful smile, but he can sense her anger.

“What were you thinking, Eli? Operating on your own throat, for Lordy’s sake! I just knew something bad had happened when you called the restaurant. You weren’t right this morning, were you? I had the ambulance meet me at the house—and there you were, flat out on the bathroom floor, blood all over!”

Her vexation melts as she grasps his hand, summoning another teary grin.

“Next time you want to take a turn at do-it-yourself surgery, boy, just make sure you’ve got me there for your nursing back-up.”

Eli suddenly realizes how hungry he is. What couldn’t I do to a plateful of bacon and eggs, and a side of home fries?



JOHN GRAHAM-POLE, MD, MRCP is a 1966 graduate from 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 academic 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 under consideration for publication, and he is working on a memoir about his journey to becoming a doctor.


Highlighted in Frontispiece Winter 2012 – Volume 4, Issue 1
Winter 2012   |  Sections  |  Surgery

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