Operating on the Funny Bone: Poems from a Heart Surgeon
The culture of medicine, a world of intense pressures, intimate moments, glorious triumphs, and horrific failures, has always been leavened with laughter. Humor, often of the dark variety, acts as a defense mechanism, a pressure release valve, a teaching tool. In my thirty-four years as a heart surgeon, I have used laughter for all these reasons and observed my colleagues doing the same. As a rule, we conceal quips and comic remarks of sometimes questionable taste from our patients, their families, and others outside our circle lest we come across as disrespectful or uncaring. But employed with discretion among medical professionals, black humor can ameliorate interpersonal, cultural, and class differences. It can alleviate anxiety and manage grief. It can permit transmission of important information that is difficult to express by other means. Think of it as surgery of the absurd, an operation on the funny bone.
Writing about medicine in a darkly humorous way has enhanced my ability to cope with the stress of a demanding medical practice. In this, I follow in the footsteps of literary physicians such as Anton Chekhov (whose humorous writings I considered somewhat neglected), William Carlos Williams, Mikhail Bulgakov, Abraham Verghese, and Richard Selzer. The poems in this submission peel back the curtain to expose laughter as employed in the often bewildering, often conflicted, world of medicine.
Samuel L. Jackson Pulls a Shift in the Intensive Care Unit at the Height of the Pandemic
motherfucker in Room Eleven turning blue around the gills intubate the motherfucker ten more hours in my shift
turning blue around the edges week old donuts in doctors’ lounge nine more hours in my shift can Dunkin make a ventilator?
doctors’ donuts down disposal my home-made mask is one week old can anyone make a ventilator? I wonder if I can get the test
my home-made mask is one week old starting to grow a greenish coating I wonder if I fail the test I wonder if I can smash my pager
Room Eleven’s started coding left a list of next of kin gave them the number of my pager Jesus Christ I hope they lost it
don’t have time to call the kin motherfucker in Room Eighteen Jesus Christ he’s gonna lose it intubate the motherfucker
Surgery Interns Know the Rules
never let anyone see how scared you are
if anybody asks you if you’ve done one of these before you say yes I’ve done one because no one wants to take responsibility for helping you do your first but if you say you’ve done several you might not get the help you need
never say oops always say there
nobody grades you anymore on a scale from A to F henceforth those who judge your performance do so on a spectrum with Bugs Bunny at one end and Elmer Fudd at the other
there’s one bad thing about in house call every other night– you miss half the good stuff
some of your mentors operate at the speed of light others at the speed of dark you can do nothing about this
if you need help managing a sick patient calling someone more experienced– a senior resident, an attending– will always be regarded as a sign of weakness
the only clue the patient has about the quality of the surgery is how well you closed the skin
The Anatomy Lesson of Dr. Nicolaes Tulp
On an unseasonably warm day in January of 1632 Aris Kindt made his dramatic debut before a capacity crowd at the Waaggebouw in Amsterdam. Hanged only a few hours earlier for petty thievery Kindt’s youth and absence of obvious pathology made him perfect to be cast as the lead. Nobody else auditioned.
Directed by Dr. Nicolaes Tulp, doyen of Anatomy, whose cadaveric dissections had become an annual spectacle, Kindt offered a unique interpretation of the role. Instead of the traditional abdominal opening for extraction of the gastrointestinal system, Kindt’s dismemberment began with the limbs.
Tulp’s production proved a great success with both the Guild of Surgeons, members of which crowded closely to observe the anatomic minutiae, and with the paying customers, members of the aristocracy and the mercantile elite, proud of their city’s claim to world leadership in advancing from the Dark Ages into a new era of Light.
So pleased was Tulp by the performance and by the attentive sketches Rembrandt made during the show that he never noticed the old master’s mistake in the final painting, incorrectly portraying the dissected left hand as possessing the anatomy of the right.
Or did Rembrandt truly nod? Art historians speculate that this discrepancy may have been intentional, Rembrandt’s silent protest to show his abhorrence of the annihilation of Aris Kindt?
The banquet that followed was said to be most felicitous as well. History does not record who carved the roast.
When I give the order to start the pump, and the maimed heart muscle collapses like the rotten rubber of a busted out two-ply tire,
I face the possibility that my meager vein grafts won’t get this patient out of the room alive. He could die on the table, right in front of me.
Or he might succumb later tonight, following a brief struggle. Or linger a few days more, until my siege of drugs and machines
and consultant opinions prove futile. The answers must await the climax of the operation and the denouement.
When I think about this stage, these special effects, and the remote possibility of a happy ending,
I wonder why it took me so long to grasp the meaning of the words Operating Theater.
In this drama I play two roles, protagonist and spectator,
actor who does not know the ending,
audience member who cannot find the exit.
Doctors Are Passing from Our Lives After Phillip Levine
When the administrator threatens our group saying that our RVUs have fallen, I riff on possible meanings of the words Relative Value Unit.
Would it please him if I induced my cousin and closest Relative, to come here for care? His Medicaid wouldn’t pay us shit, but his complicated cirrhosis would generate a ton of RVUs.
As for Units, singularities, individual things, we got that aced. One-of-a-kinds in this practice– the unique, the sui generis, the once-in-a-lifetime– are common as pennies.
Which leaves us with Value. The regard we hold for something, its monetary worth, perhaps its comparative worth relative to . . . relative to . . . the price previously stated.
My colleagues start wadding their panties, taking the administrator’s implied threat more seriously than I. They propose remedies ranging from advertising to working longer hours to better parking
to merging with another group to working longer hours to shortening the time we spend with patients to working longer hours.
The administrator believes we’ll let him curl his claws into our nostrils, carry us on his hip like bowling balls, and send our heads spinning down the lane. No. Not this doc.
After today, one of my partners asks me, what are you going to do? He means, what am I going to do in retirement after 34 years, and I answer “Something worthwhile. Just for a change.” He laughs, but that’s a question for tomorrow.
Today, I consider how I got it wrong. I thought I spent all those years holding those hearts in my hands. But it was those hearts holding on to me.
Today, for the final time, I don blue-gray scrubs, sun-bright headlight, three-point-five power optical loupes, comfy sneakers consecrated by the blood of thousands of patients and permanently stained despite countless washings.
Today, I enter the operating room where my scrub tech has opened her trays and aligned my tools like knights on horseback ready to lay siege– scalpels and rongeurs, scissors and trochars, needles and lancets and osteotomes, instruments machined from nickel and steel and titanium, chrome and copper and lead–all the precious metals– each instrument imparting its unique gratification when I grasp it, when I touch it to the patient’s heart.
Today, I await the arrival of my last patient, who will lie on my operating table, this marvel of ergonomic perfection that adjusts smoothly, remains immobile, and resists vibration when someone bangs into it.
After today, if I show up in this room again, I will be the one lying on this table.