The_Invention_of_Surgery

were being invented. Every great surgeon requires an innate sense of
three-dimensional space buttressed by years of anatomic learning. The
location of every muscle and minute blood vessel and nerve is surprisingly
predictable; a gifted surgeon comprehends these laminations with rapid,
precise dissection. An aging joint, like an ancient tree tentacled onto a
rocky cliff face, develops thickened stratums of bony spurs, loose cartilage
bodies, and overgrown, inelastic ligaments. As I delve deeper toward the
diseased shoulder joint, I have to abandon the scalpel for stouter
instruments.
Other specialists deal with soft tissues like brains and bowels.
Orthopedic surgeons deal with bones, ligaments, muscles, and joints. Our
tool kit includes hardware: metal saws, chisels, drills, and hammers. After
dissecting deeply through the soft tissue layers around the humeral head, I
expose the arthritic joint, cut off the top of the bone with a metal battery-
powered saw, and place successively larger metal stems down the hollow
humeral canal. Once prepared, I can insert the final total shoulder
implants. At some stages, every operation is like a project, and requires
the use of brute force to pound, shape, smooth, and extract tissues and
body parts.
After implanting the new shoulder replacement components, I reverse
course and backtrack my way out of the shoulder joint. The last step is
always skin closure. Back in the days before antibiotics, early surgical
pioneers used silk or catgut sutures to bring tissue edges together. Those
materials were dissolvable, which created an immune reaction that opened
the door to infection, and commonly death. We now use “inert” or low-
inflammatory suture materials or metal staples that hold skin together.
As my surgical team applies the final dressings, Dr. Cohen also reverses
his steps. He stops the short-acting inhalant anesthetics that were
vaporized into the breathing tube and discontinues the intravenous drugs
that kept Lisa sedated. Gone are the days where drugs, such as ether, took
days to wear off: today’s designer molecules wear off in minutes. Lisa
begins to move her body and fight against the tube in her mouth. When it is
safe, we remove the breathing tube and shuttle her back onto the gurney.
Our little contingent rolls Lisa down the hallway, now progressing
toward the recovery room. Patients often fear saying something stupid or
embarrassing in the operating room. Most do not. There tends to be only
incomprehensible mumbling in the moments surrounding the induction and