Full Circle

The operating room is very cool and smells very sterile. It is a potent smell - a little like vicks vapour rub, but with less peppermint. The patient, a little boy, lies on the operating table. A group surrounds the table - 3 physicians, two assistants, one nurse observing and myself (observing as well, although I must admit I wanted to get my hands in there too!). The surgery was a release surgery of the left hip and right foot. The little boy sustained extensive burns to the front of his body (face, torso, right arm and hand and both legs on the front) about 4 years ago. The scar grewing into a thick mass. As the wound closed after the burn, the scar that formed began to pull the edges together, causing contracturing at the hip, the left hand, and both feet such that the toes on both feet and fingers on the left hand were literally pulled backwards of the top of the hand and feet. On the ears and the left mandible, the wounds developed into massive keloid scars. This was the second surgery - a release surgery which is done to release the scar and the joints can be moved back into proper position.

Back to the operating room...I walked in towards the end of the hip release part of the surgery. The doctors where preparing to cut through the solid mass of scar tissue on the foot. First, discussion about the incisions - direction, depth, how many to make along the longitudinal lines. The boys head and torso is covered. Only the leg is exposed. They move the leg about in all directions, examining, considering. There is no resistance from the boy...I'm intrigued as I've never worked with such a limp body - I'm used the body responding, moving, resisting, releasing or contracting in response to what I do to it. Here, there is not resistance or response - it seems much more maluable....there is not personality to that leg, no sensation to guide you...only the pure anatomy dictates what must be done.

The discussion ends, the scalpel is passed from one set of hands to another and the first incision is made. At first I feel my pusle rise as the scalpel enters the flesh, but that quickly passes and I lean in a little closer. I'm surprised at how little blood there is...one of the medical students is ready with a bloody gauze to clean up and absorb up the blood that does bubble up to the surface. The skin splits and gives away quickly from the tension of the scar. The white of the underlying fascia and tendons becomes visible. The doctor releases the adhered scar from the underlying tissue with an insturment he inserts under the scar and pulls up, tearing it away from the underlying tissues. I'm amazed that no muscle was cut, no tendons nicked or damaged. The incisions are made in a Z-pattern along the dorsal surface of the foot and quick, efficient movements sew the opening up. Large needles are inserted into the toes to stablize the toe joints...how quickly and easily they go in. I wonder what type of resistance the tissue gives to the needles? What the doctor senses as he pushes deeper to guide him and ensure the needle is not damaging any bones or blood vessels...? The toes are so small and his hands so large. I'm amazed at how steady his hand is.

In the recovery room the boy starts to wake up. He throws up. The next morning there is significant bleeding in the left hip region. In the dressing room, the nurse starts to take off the bandages while the boy screams bloody murder in pain...I realized he probably was not given any pain killers. The surgeon comes and it's decided that the grafting will be touched up under anasthesia because it is too painful otherwise. The parents are quite, somber, helpless.

In the afternoon, the boy starts to wake up again. He's holding down fluids. He smiles at a picture I show I took of him the other day kicking a ball.

In surgery you literally open the body up and look inside; I spend my days "looking inside" with my hands. It was amazing. I feel like I've gone full circle: in the surgery room I saw the layers, the colour, the thickness of the scar. When I look and touch now, there is a whole new dimension to my understanding of what I am palpating...now it's more tangible for my mind to capture what my hands sense...