a stop. A timeout. Ryan goes over the basics — name of patient,
age, allergies, medicines, procedure scheduled. Like a copy editor
scanning the headlines for typos one last time, you don’t want to
screw up the big things.
Then we’re off. Williams makes an incision with “one of the greatest
inventions of the last century” — the Harmonic scalpel, which looks
like a glue gun with an extra-long snout. Invented in 1991, about the
time Williams was getting started, the Harmonic cuts and coagulates
tissue at the same time, so there’s no blood to speak of. (A relief.)
Dr. Sarah Walker, 31, a fourth-year resident from Pensacola,
Fla., has scrubbed in to assist. She wants to be a pediatric surgeon.
She’ll be 33 years old by that time. “The lifestyle of a surgeon is not
predictable,” Walker says. “It’s not nine-to-five, generally. For the
amount of training and stress, you have to really like it.”
“You’ve got to be a little nuts,” Costabell adds.
Williams smiles under his mask. You can tell by the narrowing of
his eyes behind his glasses. He wears readers, not the fancy “surgical
loops” you might see on an episode of Grey’s Anatomy or ER. Williams works independently as a general surgeon in Louisville, keeping
three offices (Jewish, Jewish East and South End Medical Clinic) and
operating at several venues across the city, including a heavy load
at Jewish. Thursdays are his big surgery days, and I’m tagging along
in what began as participation in the Greater Louisville Medical
Society’s Wear the White Coat program (which allows civvies like
me to shadow a doctor) but quickly turned into an obsession. Not
just with the affable Williams, board chair of GLMS, but the world
in which he, literally, operates.
“How about a little music,” Williams says. “It got too quiet in
here.” Smither cues up some Alan Jackson. Just over an hour into
surgery, Williams and Walker are tying off blood vessels to the
colon. “Tie them down tight,” he says to Walker. “I don’t want to
be back here tonight.”
It’s 64 degrees in OR 6, cold for anybody not under the lights of
the operating table. Williams is teaching as he works. “All the colon
does is absorb water,” he says. “We’re going to leave about a foot of it.”
How long is a colon?
“About eight feet.”
Why do we have so much if we don’t need it?
“Because that’s the way God did it.”
At 6-foot-3, Williams towers above his patient, refusing to slump
his shoulders because that way, he says, it keeps his legs from getting
tired. His wristwatch is tied to the drawstring of his scrubs. From
time to time, he shifts the weight from one foot to the other, like a
racehorse in the paddock conserving energy. A few years ago, he
developed plantar fasciitis, so he discovered molded sole inserts
and a New Balance running shoe that fit like a charm. He buys the
same brand, four pairs at a time, every four months. That’s how fast
he goes through them.
Smither asks Ryan for an instrument, speaking the foreign language of medicalese. “No problem-o,” Ryan says. She’s been at Jewish
for 48 years, almost half as long as the hospital has been around. (It
opened in 1905.) And she moves with the professional confidence
that comes with wisdom and experience. There’s likely nothing she
hasn’t seen in an OR. (Ryan will retire in less than a month, sent
off with a going away party from Williams and the gang at Jack’s
Lounge, and on this day she’s jokingly counting down the hours. She
has also made the little lost journalist her pet project — the better
to keep him out of the way.)
“He asked what it would take to keep me here,” Ryan says, nodding
toward Williams. For the past few years, she’s worked part-time on
Thursdays and Fridays, making sure to keep those Thursday surgery
dates with Williams and his team.
“And you were a candy striper at the Battle of Gettysburg, right,
Judy?” Costabell says.
“I was.”
“Don’t mess with my nurse!” Williams says, mock-growling.
“I’m trying to make her angry and maybe she’ll stay,” Costabell
says.
“Because your way ain’t working.”
Here’s the shock of watching surgery: You get used to it. Soon
enough, the act of surgery fascinates more than what’s being done
to the body, which, truth be told, all kind of looks the same from
the inside out. (At one point, I tell Williams that it all looks like raw
chicken. “Pretty much,” he says.)
This laparoscopic-assisted surgery is much like watching a surgery
on the Discovery Channel. It’s on TV. Williams and Walker operate
by watching a screen that shows what’s happening inside a small
incision in the bell K