The_Invention_of_Surgery

of clothing. Job one in a trauma bay is hacking off the clothes.] As a nurse
is trying to take off the Timberland boots I can tell that his legs are a
jumble of bones. Hideously, she twists the leg 360 degrees, and as the
jeans get cut, it’s apparent that the leg is completely amputated, only
connected to the hip by the nerves, thick as a rope. Oh my god, I think
again.
Joe scrambles to press on the thigh to stem the gush of blood. I think I
am watching this beautiful young African American man die. He appears
lifeless, and although these dozen or so lifesavers are scrambling in
synchronized orchestrations, I can’t imagine they can halt his demise.
While Joe waits for a tech to procure a tourniquet, he glances up at me,
calmly asking, “What you got?”
I am mostly in shock, and not exactly sure what he is asking. Is he
asking about this young man clinging to life?
“Dave—what’s the deal with the knife wound ... are his hands injured?”
“Yes, both his thumbs are almost completely cut off. I rewrapped both of
his hands with sterile dressings.”
Joe places the tourniquet around the demolished leg, stemming the flow
of blood. He looks back at me and says, “Look, we’re getting crushed here.
I want you to numb up that guy’s hands and wash them out in that ER
room, and we’ll try and sew them back on later tonight.”
This is the reality of how a county hospital works (even today). There is
simply too much work for a limited number of workers, and because all
county and metropolitan hospitals are propped up by medical students and
residents, patients often are cared for by unqualified practitioners. It is
simply the truth.
I make my way back to Henry’s exam room and tell him that our team is
planning on reattaching his thumbs tonight, but because of the two
crashing trauma patients, we can’t go to the operating room now. My job is
to wash the wounds now in hopes of preventing a terrible infection from
the filthy machete. The problem is (although I don’t tell him), I don’t know
how to do a regional anesthetic block.
When William Halsted pioneered the use of cocaine as a local
anesthetic, he rapidly learned that targeting a specific nerve far away
from the intended target could result in the entire limb becoming numb.
However, this mandates extremely intricate knowledge of the three-
dimensional anatomy of the nerves, and I simply do not yet have that type