The_Invention_of_Surgery

Even before transporting the patient to the OR suites we gave Mr. Louis
a large dose of penicillin, but necrotizing fasciitis is notorious for not
responding to antibiotics in the emergency setting. Penicillin helps, but
surgical magnificence is demanded if the patient is to live another hour.
Once we urgently transfer the patient to the operating room and the
anesthesia team intubates him, we rapidly position him on the surgical
table. Racing to save his life, he is propped on his side and his entire left
side and arm are swathed with greenish-blue surgical drapes. Dr. Reid
works very quickly, making a dramatic, football shaped incision around
the shoulder blade and chest. Under nonemergency situations, this
dissection would likely take ninety minutes, but under the circumstances,
the dissection is done at lightning speed, in barely a dozen minutes. The
collar bone, the shoulder blade, the entire arm, and all the muscles
attached to those bones are rapidly cut away. The nerves emanating from
the neck and the large blood vessels emerging from the chest cavity must
all be tied off and cut.
As a resident at the beginning of my training, I know I would kill this
patient if I attempted to do the operation. I just don’t have the skills yet.
Dr. Reid is a superb surgeon, a master craftsman with unique
understanding, adept hands, supernormal concentration and stamina, and
most important right now, heroic courage. Moments like this will kindle all
these attributes in me for the rest of my life, and Dr. Reid’s greatest gift to
me will be the gift of confidence, the ability to take on impossible shoulder
and elbow cases in the future. Surgeons are criticized for arrogance and
brashness; this critique is probably fair, but at this moment, a fearlessness
nurtured from deep self-assurance is mandatory.
A surgeon can perceive if he has outflanked a flesh-eating bacterial
infection—there is no crackly air in the layers of soft tissue that he is
cutting through. A cocktail of life-supporting medicines continues to be
injected into Mr. Louis’s IVs as our team completes the final steps of the
forequarter amputation. Cutting edge antibiotics, in addition to penicillin,
are being pumped into his body even as the team races to detach the limb.
The moment of liberation of the putrefied appendage finally occurs,
leaving a gaping wound over the rib cage. There is a simultaneous sense of
triumph over the bacterial horde and an acquiescence to the power of
microorganisms as the limb is separated from the thorax and dropped into
a hazardous waste trash bag. Aggressive irrigation with antibiotic-laden