Chelsea Green E-Galley. Not for copying or distribution. Quotation with permission only. UNCORRECTED PROOF.

Chelsea Green E-Galley. Not for copying or distribution. Quotation with permission only. UNCORRECTED PROOF.
four

T he Hea r t of t he M at t er

I will always remember the third year of medical school as the year
I fell in love. I don’t mean with Randy, who indeed remained my
partner well beyond our Physical Diagnosis course—that love story
took a little longer to unfold. No, what I fell head-over-heels in love
with, to have and to hold from that day forward, was the beauti-
ful mystery of the human body, and the exquisite art of healing
it. It is hard to name what it is that makes a good doctor, just as it
is to define a good teacher, or a good mother, even though we all
know one when we see her. I believe the defining factor is this: At
one point or another, they fell in love with their work. Back then, I
assumed it was till-death-do-us-part love, and I was going to let noth-
ing get in the way of my pursuit.

In our third year at Georgetown, we began working in the hospitals

full-time. We were assigned to a team that worked with an “attend-
ing physician”—the specialist in charge—and directly supervised by
the most senior doctor-in-training on the team, the chief resident.
The short white jackets that medical students were required to wear
made us stand out among the real doctors like dislocated thumbs.
My first assignment was with the surgery service, my first attend-
ing physician was Dr. Conrad, a famous but intimidating cardiotho-
racic surgeon, and my first day was spent in the operating room.
Mrs. Babson, a woman I had met briefly the night before, was having
the mitral valve in her heart replaced.
It was barely dawn when I passed through the automatic doors
marked or personnel only and into an inner sanctum where no
initiate felt welcome. Every green-clad person bustling around in
there was busy. The woman I first asked directions of didn’t even
stop as she pointed me to the nurses’ locker room. The rest of my

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Chelsea Green E-Galley. Not for copying or distribution. Quotation with permission only. UNCORRECTED PROOF.

team, all male, were changing on the other side of the hall, just off
the doctors’ lounge, so I was on my own as I surveyed the tall stacks
of folded green scrubs next to the lockers. It was like being at the
Gap, but with only one style and color to choose from. I changed
quickly, found the door that led into the “clean” side of the OR suite,
and took a few steps inside.
A huge board covered the wall behind the nurses’ desk, like the
arrival/departure board at a train station, listing what patient/
surgeon/procedure was in what operating room. My train was leav-
ing from OR 10. Leery of asking for any more help, I wandered
down the hall past big picture windows that looked into each room.
It was hard to recognize people in their surgical garb.
“Are you lost?” asked another masked face.
“I’m looking for room ten,” I said.
“C’mon.” She sighed, as if I was the twelfth lost med student she’d
had to rescue that morning. “This is really the chief resident’s job.”
We stopped at a room that looked identical to all the rest, and
she stuck her head through a crack in the door. “I’ve got one of
yours,” she directed to the chief. “You might want to keep track of
your students.” I was causing trouble already. “Scrub up,” she said to
me in parting, and I turned to face the deep sinks against the wall.
The spray of water from the long, curved faucets completely
doused me, and by the time I pushed my way through swinging
doors into the OR, hands held up, elbows dripping, the front of my
scrubs was soaked. The scrub nurse, already passing out instruments
to the team, was delighted to interrupt what she was doing to hand
me sterile towels. In a world inhabited by masked people, I was learn-
ing eye language very quickly. I methodically dried each finger, each
hand, each arm, just as I had seen in the instructional video the day
before, and then held out my arms to receive my sterile gown. For a
moment, I was like Cinderella being gowned for the ball by a swirl of
birds, as a team of anonymous hands pulled the gown back against
my shoulders, wrapped it around me, tied it at my neck. My fingers
waited, outstretched, as the scrub nurse took another break from her
life-sustaining tasks to snap sterile gloves on my hands.
Except my ungloved hand brushed against her sterile arm.

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Chelsea Green E-Galley. Not for copying or distribution. Quotation with permission only. UNCORRECTED PROOF.
“I’m contaminated,” she announced to the room, and called for a
clean gown. Dr. Conrad sighed deeply, and the chief resident shook
his head. The anesthesiologist peeked out over his curtain at me,
then went back to maintaining his patient in deep sedation while
we made wardrobe changes. Once the scrub nurse regowned, she
returned to the instrument table and the surgeons continued their
work. I stood there gloveless, holding my inept hands up in the air
where they couldn’t get into trouble. An eternity later, a second
nurse came around with a fresh package of gloves.
By the time I stepped up to the table, directly across from the
newly decontaminated nurse, I was dehydrated from sweating and
light-headed from hyperventilating. Dr. Conrad was the first to
acknowledge me: “You’re late.” And then to the chief resident, “Does
your medical student know the causes of mitral valve insufficiency?”
“I’m sure she does,” he returned in the same third-person style.
“Dr. Keavey, tell me three causes of mitral valve insufficiency in an
adult, starting with the most common.”
We were off and running. “Mitral valve prolapse, myocardial
infarction, rheumatic heart disease.” My gloved hands lay uselessly
on the sterile field as I parried the questions they thrust at me while
they worked. Classical music played in the background, softening
the steady pulse of electronic beeps. Finally, an hour or so into the
procedure, the team having worked their way through the chest
cavity and down to the pulsing red heart lying pillowed in the lungs,
I was handed a retractor—a small rake-like structure that holds
back tissue so the surgeon can better visualize the field. My hand
cramped as I doggedly kept the instrument in place, and my mouth
parched as I answered the endless questions.
Gradually, I was given a little more to do. Dr. Conrad handed
me the suction catheter. “Keep the tip there!” he instructed. My
job was to keep the site from filling up with blood but, despite my
best efforts, a small pool formed just where Dr. Conrad was about
to make an incision. He grabbed the catheter away in disgust and
handed it to the chief.
Finally, the patient was ready to go on cardiopulmonary bypass.
Her blood flow would be redirected so that it was pumped out of

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Chelsea Green E-Galley. Not for copying or distribution. Quotation with permission only. UNCORRECTED PROOF.

her body, oxygenated in a machine, and pumped back in, bypass-

ing the heart so that it could be stopped and operated on. While
the surgeons busied themselves with the bypass apparatus, I stood
mesmerized by the steady pumping of the fist-sized heart, blood still
surging through its chambers. I gingerly laid my fingers across the
heaving muscle. Everything else in the room slipped away as I felt it
pulsating to an ancient rhythm under my touch, connecting me to
the power and beauty of life itself.
I knew I would go through anything for this. I could handle the
old-boy, survival-of-the-fittest teaching style, the humiliation of feel-
ing like the most ignorant one in the room, the long hours, the
inevitable failures and criticisms. It would all be worth it. I really
was in love.
The pace of events shifted rapidly as the heart was stopped and
bypass was established: Tubes were inserted into spurting vessels,
bleeding was controlled, rapid-fire commands passed back and
forth. My main role was to stay out of the way.
Things went poorly over the next several hours. The surgeons
struggled in vain to attach the artificial valve to the weakened heart
chamber, but everywhere they went, the tissue gave way, and the
bleeding eventually was unstoppable. Six hours after I had dripped
my way into that room, Mrs. Babson was pronounced dead. Her
defeated heart lay still and useless in its bed.
A calm came over the room as Dr. Conrad left to talk to the
family. A fresh shift of nurses came on duty, and the anesthesiolo-
gist began disconnecting all the tubes and lines that just moments
before had been so necessary. The chief resident and I remained at
the table to close up the remains of Mrs. Babson. He handed me
tweezer-like forceps and suturing thread connected to a crescent-
shaped needle. There was a lot of space that needed closing, and I
worked slowly with the unfamiliar instruments. The chief seemed
in no rush. There were no more interrogations, just quiet instruc-
tion as I reunited layer after layer of tissue. I had to pee really badly,
and my muscles were sore, but I was totally engrossed in the task,
as detached from my own human needs as I was from the human
drama of a passing life.

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Chelsea Green E-Galley. Not for copying or distribution. Quotation with permission only. UNCORRECTED PROOF.
Still feeling the electricity that had surged through me at the
touch of a beating heart, it seemed like I had stepped into a sacred
circle, no longer an initiate. By the time I was running nylon thread
through the skin, my wrist was carving smoothly through the air,
laying down stitches in neat little slants.

There I am, a tireless and idealistic twenty-three-year-old, my gloved

hand for the first time holding a surgical instrument aloft, my head
swirling with obscure anatomical facts, lists of differential diagnoses
on the tip of my tongue, and the wonders of modern medicine quite
literally open before me. While I try to put aside, for that moment,
the humbling fact of Mrs. Babson’s passing, my twenty-three-year-
old self is trying to concentrate on what can still be accomplished
as I master the art of suturing. At this glorious if tragic moment,
modern medicine and health care are one and the same for me.
What I can learn, I can do. It will be many years and several practice
models later, in a career that takes me through a variety of mili-
tary and civilian settings, before I realize how disconnected medical
science can get from health care delivery. For now, at least, I am on
the right path. I will be the good doctor.

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