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“Dr. Exacto”
is the pen name of a leading surgeon at a
major metropolitan hospital in the
Midwest. He is a graduate of the Tufts
Medical School, a Fellow of the American
College of Surgeons, and has been
practicing his art for over thirty years.
The following are selected excerpts from
his forthcoming autobiography,
A Sawbones Speaks.
I imagine every
surgeon has a vivid memory of his first
incision. I know I remember mine. I was an
intern, wet behind the cars but cocky as
all get-out, and the operation was a
routine appendectomy. As I was scrubbing
up, the senior resident—a fish-eyed coot
with Sen Sen breath—came over to me and
put his arm around my shoulder. Was I
nervous? Did I think that I could handle
it? Well, I just sneered at him, spit on
my hands, and went to work. I’d show the
patronizing bastard! Gingerly I palmed the
scalpel. Where to start? I held my breath,
took one huge swipe, and I was through
into the abdomen...but where was the
appendix? Here? No. There? No. Christ, the
patient’s insides looked like fifty
pounds of unstuffed sausage meat. I needed
help, but you can bet I wasn’t going to
ask the smirking resident to bail me out.
So in I went. I laid about me like
Mac-Duff. A slice of this, a piece of
that... could this be it? I worked for
hours like a man possessed, until at last
I pulled a six-inch tube of gray-green
slime up through the wound and the
attending nurse—who didn’t like old
fish eyes any more than I did—muttered,
“Good job, doctor.” That was it, then.
Hell, I felt so good I almost bit the damn
thing off and spit it in the air. I’d
finally soloed. Finally “cracked one”
on my own.
*
* * *
You
hear a lot of talk these days about
unnecessary surgery, about unscrupulous
physicians slicing people open when some
less traumatic means of treatment would suffice. What utter crap. All operations are performed
because there simply is no other way to
find out what it is that ails you. X-rays,
for example, are a total waste of time. If
something went wrong with your car you
wouldn’t have it X-rayed, would you? No.
You’d open up the hood and shove your
arms down in the engine till you found the
part that wasn’t working right. And
that’s the way it is with surgery....
*
* * *
Let
me repeat. There’s no such thing as an
unnecessary operation. All surgery is per
se good for you. All surgery is
beneficial, and I’ll tell you why: it
airs you out. It ventilates your organs.
Surgery and surgery alone can clear the
stagnant, fetid air that clogs your
abdomen. You don’t believe me? That’s
your problem. An English surgeon named Sir
Richard Cooney understood the value of
aeration as far back as 1823, and if it
weren’t for all the mumbo jumbo Lister
made up about germs (whatever they are),
ventilation still would be the guiding
principle of surgical procedure.
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“Dr.
Exacto” favors fresh air when he
operates. Here he has removed a
patient’s vital organs and is giving
them a thorough ventilation on his
kitchen windowsill before replacing
them. One time, he remembers with a
chuckle, a stray German shepherd grabbed
a patient’s liver from the “airing
rack” outside his operating room,
and nurses had to chase the dog for
seven blocks before recovering it.
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Germs?
The hell with germs! What’s needed is
fresh air, and when you come to me you
literally get a bellyful. Weather
permitting, all my operations are
performed beneath an open window so that
gentle breezes can massage your
oxygen-starved organs. When it’s
indicated, I’ll pull organs out
completely so that they can get a really
thorough airing (see illustration). Once
replaced, these kidneys, livers, etc.,
invariably function better than they did
before. The evidence is overwhelming,
incontestable. Aeration is the cornerstone
of modern surgical technique, the key to a
successful operation, and the essence and
essential of a long and healthy life. You
mark my words, its time will come again,
goddamnit.
*
* * *
I’ve been a surgeon now for over
thirty years, and while I’ve seen some
great strides forward in the healing arts,
I've also seen a number of ridiculous
procedures added to our hospital
routines—procedures that waste time and
money, mollycoddle patients, and
accomplish absolutely nothing. Take
catheterization. Now, it's normal for a
patient to have trouble urinating for a
day or two after his operation, but if
he's still stuck on the third day,
hospitals immediately start jamming
catheters into him sixteen ways at once.
More tubes, more trauma, more malpractice
suits—all totally unnecessary! What do I
do about post op patients who have trouble
passing water? I do what we used to do in
med school thirty years ago. I give them
beer. If they can't take it orally, I pour
it in their IVs. And they love it. Two
Buds and they're peeing like they used to
in the parking lot behind the Hi-Ho
Tavern. Plus, it cheers them up. I tell
you not all change is progress. There's
some things, tried and true, that should
be left alone.
*
* * *
Speaking of patients...here's a tip
for any parent with a child who's got to
have an operation. I suppose that there
are kids out there who've got the guts to
look an operation in the eye and spit, but
trust me when I tell you that they're few
and far between. Most kids find out that a
strange old man is going to stick a dagger
in their bellies and they start to scream
like wounded banshees. Take my
advice—don't tell them. Lie. Just say
they're going to the movies or a birthday
party, then drop a half a dozen Miltowns
in their Kool-Aid, and you'll get them to
the old OR without a lot of totally
unnecessary wailing and hysterics. It's
easier on you, on them...and on the
surgeon.
*
* * *
Throughout my long career I've
found that pre-op patients are beset by
many dreads and terrors, almost all them
well-founded. Surgeons do drink heavily to
get their courage up before a tricky
operation, and they will permit the
orderly on duty to yank out your tonsils
or appendix. Then there's the fear, a
common one among my patients, that I'll
start to operate before the anesthetic has
completely taken hold. Now, any surgeon
who coughs up malpractice premiums will
swear to God that such a gross mistake
could never happen, but I'm here to tell
you that it can and does. A case in point:
three weeks ago I had a patient laid out
for a simple cholecystectomy. I got the
high sign from my anesthesiologist and
started slicing when the guy screamed
bloody murder and jumped ten feet in the
air. The crazy bastard went up like a
marlin that I hooked off Bimini at last
June's AMA convention. Jesus, what a
sight! We got him down eventually, but by
the time we did he'd lost about a hundred
pints of blood, and fifteen minutes later
he was gone. We lost him... just the way I
lost that goddamn fish.
*
* * *
Elsewhere in my book I've made
allusion to some "great strides
forward" in the healing arts. If
you'll forgive an old man blowing his own
horn for several moments, I'd like to
describe a revolutionary practice that
I've personally pioneered and that is
slowly overcoming the objections of a
bunch of yahoo morons at the AMA and
gaining general acceptance. I call it
simultaneous ambulation, or SA.
 SA
is an extension of early ambulation, a
technique whereby the patient, in order to
avoid blood clots and blood stagnation, is
encouraged to get up and walk around the
first or second day after his surgery. I
go this admirable technique one better.
Whenever possible, I insist my patients
stroll about the OR while their operation
is in progress. When only a local
anesthetic has been administered, they are
more than capable of locomoting under
their own steam; a general anesthetic
usually requires that they be helped (see
illustration). There are, of course, a few
malingerers and whiners who refuse to get
up of off the table, but the chances are
that later on they'll pay the price for
their dumb sloth in stagnant blood and
lethal embolisms. Tough luck. All I can do
is warn them; after that they're on their
own. The hell with 'em.
*
* * *
There's one old saw I hear a lot
that's always irritated me: a surgeon
buries his mistakes. Now, I suppose that's
true, up to a point, but did you ever stop
to think that we bury lots of our
successes, too? We do. I'd estimate that
half of the really first-rate jobs I've
done have gone unnoticed and uncelebrated
just because the weak-willed patient
didn't have the stamina to make it through
the rigors of the operation. Just last
month I did a textbook gastroenterostomy
on some old bat who couldn't stand the
wear and tear and croaked halfway between
the OR and Recovery. A
"failure"? A
"mistake"? Not on your life. I
opened up that broad the way a waiter in a
fancy New York restaurant debones a trout.
Hell, you could dig her up today and take
a picture of her insides and they'd put it
in the goddamn medical encyclopedia! Don't
talk to me about mistakes...
*
* * *
Let's end with a laugh. We tend to
think of surgery as a grim and grisly
business, filled with blood and pain and
death. It does, however, have its lighter
side, and here's a silly anecdote to prove
it.
Ten years ago, on the occasion of
our twentieth wedding anniversary, my wife
presented me with a beautiful engraved
gold pocket watch. It must have set her
back a thousand bucks, and frankly, I was
tickled pink. A few days later, however,
after successfully removing a pancreatic
cyst from a certain Mrs. Smith, I found
that I'd misplaced the watch, and though I
searched the hospital from top to bottom,
I'll be damned if I could find it
anywhere. When I told my wife, she blew
her stack, claimed that I'd lost the thing
deliberately, and said she'd never speak
to me again. Needless to say, I was upset
the next day as I made my rounds, and when
Mrs. Smith complained to me about intense
pains in her abdomen, I snapped at her to
stop her bellyaching; the operation had
gone perfectly and I had problems of my
own.
The next two weeks were hell. I
couldn't find the watch no matter where I
looked, and Blanche, my wife, moved out on
me and checked into a fancy-pants hotel.
The damn place cost a fortune. Meanwhile,
Mrs. Smith continued bitching about
stabbing pains and claimed that she heard
ticking noises coming from the area of her
incision. I told her she was nuts and
brushed aside her stupid, whimpering
complaints. One night, much to my
surprise, she died, and since I'd done the
operation on her I was asked to do the
autopsy. I did, and what do you suppose I
found wedged in between her liver and her
pancreas? My watch! Well, let me tell you,
I was thrilled. I gave a whoop and kissed
the nurse, the orderly—I even kissed old
stone-cold Mrs. Smith. When I told
Blanche, she laughed so hard I thought
she'd bust a gut, and to this day she'll
ask me for the time and then start to
cackle like a crazy woman.
Surgery...there's
more to it than misery and tears.
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