When our team meets, we realize that we are short-staffed for the day.
Room 8, the simple procedure room, is available this afternoon. While
most of my Plastics cohorts are committed to the outpatient ORs for
aesthetic surgery, our chief, Dr. Bonamassa, will be finishing a skin flap
operation for a breast cancer patient in the main OR. It is decided: we will
do the case in Room 8, overlapping the more complex skin flap operation,
and the team has tapped me to do the simple act of incising the skin and
extracting the fungal assemblages. Not only is it convenient for the team, it
is safer to do an HIV case with only one surgeon, lessening the chances of
accidentally lacerating a team member during the case. And for me, the
intern, this is a huge leap forward: my first case where I am the only
surgeon in the room. A mixture of exhilaration, intimidation, courage, and
fear builds as the afternoon case approaches.
Once the patient has undergone induction of anesthesia and placement
of the breathing tube, I prepare his arms and right leg for surgery. A
couple technicians and a nurse help me prep the skin surfaces with yellow-
orange betadine soap, and carefully placing the blue surgical cloth drapes
around the limbs, I cover Rick’s face and torso, only exposing three limbs.
A few minutes of surgical choreography result in overhead lights
illuminating Rick’s right arm, with Christi, my scrub tech, and I sitting on
opposite sides of the limb. A stillness descends upon the room after a
flurry of activity, and the moment that I have dreamed about my entire life
is poised to happen.
“Knife,” I ask of the scrub tech. Holding the scalpel, I glance around
the room. There at the windowed door, I see Dr. Bonamassa monitoring my
progress. Every surgeon has this moment, the first independent cutting of
skin, and our eyes lock for a beat. My boss gives me a subtle nod, which I
reflexively reciprocate, and turn my attention back to the arm.
I draw the knife edge across the skin overlying the blob of fungus. The
thin flesh edges gape open, revealing the doughy cream-colored
homogenous fungus. There is no pus, and although I was prepared for a
putrescent stench, the globule is odor-free. Immediately, I notice punctate
bleeding along the freshly sliced skin boundaries, and the grave
consequences of that HIV-tainted ichor demand a solemnity in my task.
Grasping a blunt stainless-steel elevator instrument, I tease the
encapsulated fungus out of its saccule. The human body has a knack for
materializing a pouch-like home for low-virulence invaders and foreign
marcin
(Marcin)
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