The_Invention_of_Surgery

The brain of this gentlemen is firm and pink, robustly characterized by
circuitous folds and wrinkles that shrink with age, but in this young man
are so plump it seems that his brain was too big for his skull, stuffed in by
the promethean life-giver. Inspecting the brain matter with duteous
fingers, pushing the gyri this way and that, peering into the sulci, and
investigating for ruptured vessels or evidence of tumors, we satisfy
ourselves that a gross examination of the organ reveals no immediate
abnormalities.
Standing opposite each other over a narrow table, Dr. Anderson and I
stabilize the brain with our hands. He grasps a twelve-inch-long knife that
looks suitable to carve a turkey, and begins slicing the brain like a loaf of
bread. Each slice of brain is about a third of an inch thick, and we lay out
the sections on a large pan. This results in a tray full of brain slices,
almost like a pan of large cookies, permitting thorough inspection of the
entire brain. This technique was developed decades before there were CT
or MRI scans, and was the only way of delving deeply into the brain
structure of deceased individuals.
Having harvested all the organs and intestines, we turn again to his
heart. Everything else normal, our suspicions center on acute myocardial
infarction, or a heart attack. With a massive heart attack that results in
immediate death, there are no grossly visible (to the human eye) changes
to the heart muscle. In someone who has battled cardiac ischemia for days
prior to death, the myocardium begins to turn pale—even yellow. In our
deliveryman, the heart looks normal, but now we focus on the coronary
vessels.
The heart is our body’s pump station, and even though all of our blood
comes pulsating through the cardiac chambers, it doesn’t perfuse the
pump’s muscle. The cardiac muscle demands its own vascular supply,
coming in the form of the coronary arteries that branch off the aorta as it
leaves the heart. These two main arteries, the right and the left, branch out
and send little arterioles deeply into the muscle to provide oxygen and
fatty acids (used as fuel). The coronary arteries are visible on the exterior
of the heart, and using surgical instruments, we dissect the arteries for
microscopic analysis.
In our hearts, the left coronary artery bifurcates into two main
branches, just an inch from the aorta, and these two branches feed the
most important part of the heart, the left side, which must powerfully