Michelle Paff 
Philadelphia, Pennsylvania, United States

The transformation of a medical student into a physician is depicted in the short story, The Steel Windpipe (1925), by the Russian physician and author, Mikhail Bulgakov. A young practitioner is stationed alone at a rural hospital, and one snowy evening he is approached by a woman with her dying infant. The child is suffering with diptheria, and he knows that to save her life he will need to perform a tracheotomy, a procedure that he has seen done only once.

When I read this story, it reminded me of an experience I had during my third year of medical school, when I observed my intern perform a tracheotomy for the first time. The nurse anesthetist extubated the patient and handed the ventilator tube to the surgeon so that the patient could be ventilated. Suddenly, the nurse anesthetist announced there was no air entering the patient’s lungs. The intern frantically dug into the bloody wound in a desperate attempt to locate the tracheal lumen. After what felt like an hour, the nurse anesthetist finally announced that there was air flow, and we all immediately felt a rush of relief. It inspired me to paint The Tracheotomy, which depicts the suspense of an intern dissecting the tissues and inserting the tracheotomy tube, experiencing the pressure of having a patient’s life in her hands for the first time.