by Steve Szilagyi
After eight years writing publicity for a cable television network, I was let go. Just in time. I was hankering to get out of Manhattan, go back to my hometown, and marry a girl I knew in high school. Once I’d gotten all that out of the way, I found myself in need of a job. The rust belt city of my birth offered nothing as glamorous as the position I’d left. So I took a job at the local hospital – which happened to be a top-ranked academic medical center. They needed someone to write their employee newspaper. I thought I’d do that humble task for a few years, then retire and lead the literary life. You see, I’d written a novel, and I was pretty sure it was going to be a hit. And it was.
Somehow, the tumblers of fate fell into place and unlocked the doors to an agent, publisher, good reviews, and, finally, interest from Hollywood. In between writing for the hospital, I was doing interviews, book signings, TV, and radio. On my lunch hour, I stuffed coins into a hospital pay phone, calling Los Angeles and London, while producers bid for the right to film my book.
The movie starred an Academy Award-winning Best Actor, and I got a standing ovation at the North American premiere. The money was good, but it didn’t last forever. And I never missed a day at the hospital if I could help it. Week after week, I plugged away at the employee newspaper. My second novel didn’t come so easily, living as I was in a small house with a child.
That was okay. I was being drawn into the world of medicine. An essentially silly man, myself, I was in awe of these serious people. They didn’t know or didn’t care about the book or the movie. I worked hard to prove myself, and eventually became a kind of writer-at-large for the physician leadership. One year I was writing promo copy for Rodney Dangerfield; the next year, I was writing speeches for brain surgeons.
Working on articles, papers, books, and speeches for top doctors, I had the run of this huge hospital, its research labs, and operating rooms. The physician leadership took to me. My duties came to include being a tour guide for distinguished visitors. I called myself the official greeter, and medical counterpart of Joe Louis in Las Vegas. No one got the joke. But that was okay. I got to see surgery.
Fear of swooning. For a long time, I avoided the operating rooms. Fear kept me away. I was afraid I’d see a drop of blood and faint. Doctors I was writing for would say, “Listen, I could describe this procedure. But it would be better if you saw it yourself. I’m doing one tomorrow. Why don’t you scrub in and watch?”
No way, I thought. I’m not going to risk waking up on the floor to see a whole room full of surgeons and nurses laughing and tossing balls of gauze at my head.
The day came, however, when I could no longer say “no”. A famous photographer wanted to shoot a surgery. The top boss at the hospital ordered me to scrub in with the photographer and keep him out of trouble. I asked around and found a surgeon who was amenable to our presence. He was doing an operation the next day. It turned out to be a doozy.
I walked into the OR to find myself face to face with a full-color illustration from an anatomy text. The patient’s abdomen was exposed from breastbone to groin. I could see all the familiar organs: lungs, stomach, liver, intestines. Pink, brown, purple, fuchsia. Each in its proper place. I could even see the lungs tensing and relaxing with shallow breaths.
Cocky guy. I’d been holding my own breath, preparing for the worst. But this was nothing like I expected. Back in the 19th century, they used to talk about “seeing the elephant.” Meaning, you’d seen the thing everyone was talking about: the Duke of Wellington, the Crystal Palace, Niagara Falls. Now I knew what they meant. I was seeing the elephant. The churning, pulsing compartments of the body where the real work of life was carried out.
The procedure was an aortic aneurysm repair with a few add-ons. With so many organs exposed, there was an air of risk in the room. Nurses, assistants, anesthesiologists, and technicians performed their essential tasks. But you could tell who was ultimately responsible: the surgeon himself.
I knew this surgeon as a short, cocky guy. Now I could see why he seemed to think so highly of himself. That body on the table was his to kill or save. He worked quickly, surely, with calm confidence. The busiest person in that crowded room.
A wholesome interest. Once my fears were overcome, I became something of a surgical voyeur, in the most wholesome sense of the word, if there is one. I never turned down an invitation to surgery, and became something of an expert at getting the necessary permissions to take special visitors into operations.
I worked at the hospital for 30 years and remained lay observer. You never lose the thrill of seeing a human heart beating away in an open chest. Though I saw plenty of cadavers, they failed to interest me. There’s a big difference between living organs – plump, pink, and perfused – and the flat grey flesh of a cadaver being picked at by medical students.
One way or another, I observed all or part of organ transplants, joint replacements, spine straightening, eye operations, liver surgery, urological procedures. Some operating rooms were tense. Some were full of energy, with music blasting away. Some surgeons liked visitors, unless some kind of destabilization took place – then it was a terse, “Clear the room” and you high-tailed it.
Brain surgery was something of a disappointment. They don’t take the top of the head off and expose the cerebellum, as you’d expect from cartoons. Brain tissue is so vulnerable that the surgeon operates through the smallest possible hole in the skull. The one kidney surgery I saw also took place through a disappointingly small incision – though the surgeon was kind enough to show me the soft, dark tumor when he got it out, flourishing it in my face at the end of his forceps.
Out of the shambles. For sheer bloody spectacle, nothing compares to orthopedic surgery. Bare bones poke from slabs of meat. Garish spines and ribs are exposed, with scarlet bits of flesh, like half-finished barbecue.
As a lifelong vegetarian, I noted that the prevailing odor in many operating rooms was the tang of burning flesh. To keep the operative field free from blood, small veins and arteries need to be burned closed as soon as they appear. This is accomplished with a spark from a tiny electrical wire. The smell brought back memories of family cookouts with szallona, a Hungarian treat made by melting fatback over an open flame.
Ballooning belly. Minimally invasive surgery, also known as laparoscopic surgery, was taking off during my years at the hospital. These operations take place in dark rooms. The real action is magnified on a video screen. Looking up, you see tiny shears chomping away at pink tissue like leaf-eating insects.
In some laparoscopies, the patient’s abdomen is painted with amber disinfectant and inflated with carbon dioxide. It doesn’t look like a balloon. It is a balloon. The swollen hemisphere glows dramatically under focused light. Hollow rods poke out at angles, like darts on the bull in a corrida. (The patient’s outcome is usually better than the bull’s.)
Bound to fall. Over the years, I saw more and more female surgeons entering the field. Some people still consider this news. But twelve years ago or more, I was accompanying a famous basketball executive on a tour of the hospital. I got permission to take him into a procedure that happened to be a liver transplant, a long, gory operation. Gowned up like mummies, we entered the room. The basketball star took one look at the gaping incision and said, “I feel dizzy”. The surgeon looked up, mentally measured the distance from the top of the seven-footer’s head and the edge of her sterile field and said “Please take him out” – and I did. It was only afterward that it struck me that the transplant surgeon, the assistant, the anesthesiologist and everyone else in the room but me and the basketball guy was a woman. So there.
No bad ops. When I get together with old friends from work, they laugh at my naïve take on surgery. They tell me I never saw any bad ops. No smelly tumors. No temper tantrums. No gross maxillofacial deconstruction violating the brain’s deeply coded expectation of facial regularity. There are few things that I would like to unsee (prostate surgery). Most was fascinating. Much provoked pity and anguish.
Cutting In. One day, I had an assignment that took me to the hybrid rooms, high-tech spaces that combine a catheterization lab with a conventional OR. As I passed one of these rooms, the sliding doors opened, and I glanced inside. A patient was lying on the table. He or she was morbidly obese and open from chest to abdomen. Organs showed in the deep slash. Thick slabs of unruly yellow fat curled away from both sides of the incision, barely restrained by industrial-sized retractors. It was like seeing a futon being ripped apart by an iron robot.
A life was surely being saved or prolonged in that room. The skilled personnel who worked there would do their utmost to give that patient the best possible outcome. Nonetheless, it shook me.
Give and take. I retired from the hospital not long after seeing that tableau. Everything I did as an observer and guide over the years was done with strict adherence to the hospital’s rules of patient safety, privacy and consent. And now, here is my point: Nothing I saw in all my time at the hospital made me cynical about healthcare. Doctors, nurses and others involved in direct patient care give far, far more than they take from the profession. No one is forced to care for your or my often deeply unpleasant physical disorders. These people have taken it upon themselves – so let us honor and thank them, and make sure our lifestyles never land us on the table. As for me, I came away my time in healthcare with a plaque, a pension, and a headful of impressions I’m still trying to make sense of.