The_Invention_of_Surgery

contract to propel blood to the entire body. Dissecting further, we isolate
the left anterior descending artery (the LAD, or “widow-maker” artery),
and cutting it free, take the two-inch-long, spaghetti-thick vessel and dunk
it in formalin. It felt rigid and crunchy, and Dr. Anderson’s thoughtful and
pensive gaze at me remedies an investigator’s vehement skepticism about
the cause of death for this man. I think he knows we have found the killer—
a dislodged cholesterol and fatty clot that blocked this most important, if
not proportionally sized vessel—and his sensitivity for this man and his
family overcomes scientific dogma and pathology.
After “fixing” the small bits of tissues overnight in their formalin cups,
the samples are further dissected and we place the critical samples into
small blue plastic cassettes for microscopic preparation. These little
cassettes are about the size of Tic Tac containers, and are loaded into a
machine that exposes the contents to increasing concentrations of alcohol,
half an hour at a time, and then xylene, with the aim of halting all cellular
degeneration or bacterial growth while removing all the water and fluid in
the original tissue samples. The apparatus then dunks the plastic cassettes
into paraffin, creating a microscopic time machine where the tissue
samples have been frozen in time in a chunk of white wax.
I hand the stack of waxy blocks to our lab tech, who loads them onto the
Leica microtome, a machine that creates extremely thin wafers of wax that
come reeling off the blocks in a little chain, like paper Christmas
ornaments. She mounts the wax sections on glass slides, which are then
taken to the staining station. Until the dark purple and red stains of
hematoxylin and eosin (H&E) are applied, the tissue slice on the glass
slide is nearly invisible, but in time, the tissue section will pop with clarity
and differentiation. The tech picks up the slide and begins dunking it into
small metal cups of chemicals and dyes. Sometimes for thirty seconds and
sometimes for less, she works her way down the row of cups, and after
drying, the slides are ready for viewing.
I can’t resist the urge to look at the slide of the widow-maker coronary
artery first. I position the slide on the microscope stage—the little
platform on my Zeiss microscope with a hole in the middle—that allows
for the light to pass from underneath. Lowering my head over the
eyepieces, I rotate the focus ring until the cells come into clear view. The
artery, cut in cross section, is completely occluded with thrombus and
atherosclerosis, and I am staring at my patient’s killer, the very real