The_Invention_of_Surgery

decedent’s face, studying his contorted, bluish visage flattened on the right
side from lying prone in the snow as he was dying. He was alive a few
hours ago, but his rigid and motionless corpse looks counterfeit; only
cutting into his barrel chest will convince me he’s a man.
The knife blade is placed at the sternal notch, the divot at the top of the
chest bone where a thin layer of skin covers the windpipe. Cutting into the
flesh, Dr. Anderson draws the knife in a straight line, down the front of the
chest and along the abdomen, toward the belly button—and then taking a
curved detour around it—and ending at the pubic bone.
Instruments are used to spread the skin edges apart, and I ready the
bone saw to open up the sternum. I have learned how to use the saw, and
Dr. Anderson allows me to operate the tool to cut the chest bone down the
middle. This is the same device that heart surgeons use, and as a medical
student, I’m thrilled to get to use real surgical tools years before I
normally would. A rib spreader is placed between the bone edges, and
winding a simple crank on the spreader forces the rib cage to gape wide
open.
The heart and lungs announce themselves as the sternum is spread. The
crimson-colored muscular heart is partially shrouded by the billowy
lungs; gray, diaphanous, and boggy. The heart and lungs are bound
together, yin-and-yang, different in color, structure, function, and
heaviness. The thoracic cavity, demarcated as a cage of bony ribs and
floored by the muscular diaphragm, encases the heart and fragile lungs.
The diaphragm is a thickened, powerful membrane that partitions the
thoracic and abdominal cavities. The diaphragm has three large, inch-
wide holes that allow passage of the esophagus, aorta, and vena cava. By
carefully cutting through the fleshy diaphragm, we can preserve the
integrity of the vessels and esophagus, not causing leakage of blood or
food contents.
Once in the abdominal cavity, we encounter the liver, the size of a small
football, the kidneys, the intestines (stomach, small intestine, and large
intestine), the spleen, bladder, and pancreas. Because the walls of the
intestines have not been carelessly cut, there is no spillage of partially
digested food, or further along the tract, in the large intestine, feces.
As medical investigators, we have several choices in how we examine
these organs. The most old-fashioned method would be to simply poke