Free The Anatomy of Deception by Lawrence Goldstone Page B

however, as almost every surgeon entering the field now followed the lead of the man who had invented mosquito clamps specifically to staunch blood flow during surgery—William Stewart Halsted.
    Ten assistants stood at the table dressed in hospital uniform instead of gowns, while Burleigh remained in street clothes. Corrigan, the bulldog, who was not trusted to do more than take notes in the Dead House, was to the surgeon’s immediate left, meaning that he was chief assistant. The Professor rolled his eyes at the sight.
    Burleigh signaled another assistant and the ether cone was placed over the patient’s face. As the drug was poured, Burleigh faced the gallery, which contained about twenty students in addition to ourselves, and announced, “Today, I will be treating a patient with acute diverticulitis, removing a suspected abscess from the sigmoid colon and then resecting the bowel.” He smiled, parting an extremely full beard. “Please watch carefully. I don’t wait for stragglers.”
    After the patient had been poked with a long needle to ensure that the ether had rendered him senseless, Burleighremoved a case in fine Turkish leather from his coat. I recognized it at once as the deluxe Tiemann & Company Patent Catch Pocket surgical set, advertised in their catalog at thirty-three dollars, the most expensive kit on the market. At eighteen surgeries per day, I surmised, Burleigh could well afford it. He opened the case, set it on a table behind him, and removed the large scalpel. Standing over the patient with what seemed almost malevolence, Burleigh lowered the scalpel to just above the abdomen, nodded to an assistant to note the time, and then cut.
    Flashing hands was no understatement. Burleigh made a swift paramedian incision on the left abdominal wall, about two inches from midline, beginning just under the rib cage and ending five inches below the umbilicus, cutting in one motion through the skin, subcutaneous fat—minimal due to the patient’s physique—and the anterior rectus sheath. As he spread these aside, four of his assistants dove in with pads. Burleigh then called for a retractor, cut the rectus muscle itself, and placed the retractor laterally, instructing a fifth assistant to hold it still. The entire process was completed in seconds.
    I glanced at the Professor, but he gave no sign anything was amiss. A paramedian incision was the correct choice—the rectus muscle is not divided, the incisions in the anterior and posterior rectus sheath are separated by muscle, and incisional hernia is less likely—but the length of Burleigh’s cut was far too long. It would be much harder to close, chance of secondary infection greatly increased, and control of the organs inside the peritoneum would be difficult.
    By the time I returned my gaze to the table, two assistants were frantically applying pressure to the larger vessels, while another sponged away fluids. Burleigh should here have switched to the small scalpel for a finer cut, but instead, in the interest of speed, he used the same large instrument to incise the posterior rectus sheath,
transversalis fascia
, andperitoneum. When he encountered the epigastric vessels, a geyser of blood shot out of the patient, spattering everyone on the right side of the table. Corrigan grabbed a hemostat and tried to clamp the artery, but with blood obscuring the cut end, it took him at least ten seconds to achieve the result. All the while, Burleigh was snarling, “Get that
closed
, damn you!”
    The rule in surgery, with so many crowded around the table, was “no talking except the big man.” Burleigh was particularly loud and abusive. As soon as Corrigan had placed the clamp, Burleigh screamed for another. The disorganization in the efforts of the team was palpable.
    When finally the bleeding was sufficiently controlled so that Burleigh could see, he began to incise the peritoneum to access the colon itself. Suddenly, the patient began to squirm on the table.