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ter seems to run in a continuous loop on one — one talking hairdo
provides a World Series recap I’ll hear four times during the day
— while two other screens show a semi-static grid of scheduled
surgeries. Williams doesn’t pay attention to it; he has a piece of paper
with his lineup, not that he ever looks at that, either. Despite the
hectic pace and possibility for change at any time, he just seems to
know what’s next. Today is a light day: Williams has “just” the five
surgeries scheduled, with the possibility of an “add-on.” The previous Thursday he did nine. He’s done as many as a dozen. A doctor
overhearing our conversation tells me that I’ve unwittingly signed
on for “Russellmania.”
11 a.m.
We’re in OR 7, where Williams will patch a hole in the abdominal
wall of an older man. He’s done thousands of these operations. If he
had to own up to a specific specialty as a general surgeon, Williams
says it’d be hernia operations, particularly groin hernias. “That’s what
keeps me in business,” he says.
It’s a relatively simple procedure to correct a common problem:
Part of the lining in the belly has pushed through a hole in the abdominal wall and formed a “hernia sac.” Williams removes the sac
and patches the hole. If all goes as expected, the man on the table
will go home tonight.
To patch the hole, the surgeon uses a thin mesh that looks like
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LOUISVILLE MEDICINE
something you might fold over the gutters on your house to keep
the leaves out. He Saran-wraps it over a long, thin wand of an instrument, pierces it through a small incision in the man’s stomach
and, after the mesh spreads over the hole, Williams secures it with
titanium tacks so small you’d lose them in a thick carpet. Watching
him turn the tool, a visual cousin to the Harmonic, to secure the
mesh reminds of, well, a kid with a Bedazzler.
The procedure doesn’t take long. By 11:20, Williams has turned
to the resident across from him to stitch up the incision. “OK, time
to shine,” he says to Dr. Alexandra Martin, 24, a third-year from
Louisville. Martin is one of three residents who rotate onto Williams’ team every month. It’s near the end of October, so Williams
has grown comfortable with Martin, though he thinks one month
isn’t long enough for a quality rotation. When he was a resident,
surgical rotations were three months at a time. “Now, by the time
you get to know them,” he says, “they’ve moved on.”
Martin, who later tells me she’s not sure exactly what she might
want to specialize in, focuses on the suture. Unlike some surgeons,
Williams prefers stitching by hand to stapling, which is faster. “I trust
myself more than the guy who made the stapler,” he explains. So the
residents learn a valuable old-fashioned skill on his watch — not
unlike learning to drive a stick shift in an automatic-transmission
world. You never know when you might need it.
“A little too wide,” Williams advises as Martin sews, reaching above
their heads to adjust the umbrella-like lights that hover over the table.