I stand in a small room of doctors all dressed in crisp white lab coats. It smells of latex gloves, antiseptic, of healing wounds. It’s my third week at Respublikine Vilniaus Universitetine Ligonine — Vilnius University Hospital, in my home country of Lithuania, where I’m shadowing for the summer. I’ve seen more than two-dozen head wounds so far, several burns, countless broken bones, sprains and cuts. I’m not afraid of the blood. I’m not even afraid of dislocated joints. But I am afraid of neurosurgery, which is where I’ve been put for the day.
I mean, what is neurosurgery really? How much do we actually know about the brain? The thought of cutting into the most complex and mysterious organ in the body — of a living body, for that matter — feels almost dehumanizing.
The head of surgery demands yesterday’s report. In the morning old cases are reviewed and new cases introduced. I squint intently at the PowerPoint from the back corner of the room, trying to understand the complicated medical terminology. It’s impossible. The surgeon I shadow is named Dr. Terbetas. He’s assigned a case coming in from a different hospital. Something about a spinal injury, I gather, and everyone disperses.
I step into the congested waiting room scanning for the patient. In the corner sits an older man and his son. Dressed neatly, flannel button-downs tucked into off-white slacks, they rise to shake my hand.
“They sent us here from Taurage,” the son says. He has kind eyes. “Nowhere else would take him.”
The father, Aleksandras, 84, says he has no history of surgeries, diseases or broken bones. May have broken his leg once at a high school dance. Or maybe it was a sprain.
“Old as the moon,” says a nurse.
I scribble these details on the chart. “How did the accident happen?” I ask.
“I had driven home from the grocery store all by myself. I stepped out of the car, took a few steps and all of a sudden, I got really dizzy. Before you knew it, the blocks of cement below me started spinning and I must have fallen.”
“We called the ambulance and they took him to the hospital,” says the son. “There wasn’t much they could do there.”
“They sent me here and gave me this thing for my neck,” says Aleksandras, pointing to the pathetic brace wrapped around his neck. “A week later, here we are.”
Aleksandras had fractured the dens of C2, the topmost vertebral point of the spinal cord, joining the skull and spine. Dr. Terbetas explains it all to me, pointing to the chipped bone floating on the X-ray. Even with my basic understanding of neuro-anatomy, I can tell this surgery is going to be difficult. Moving the broken bone a millimeter in the wrong direction would be fatal, and at his age, even a successful surgery would not guarantee that the bone would grow and reconnect with the spine.
Dr. Terbetas rushes off to see another patient, and I wheel Aleksandras and his son to a room to prepare for surgery.
“So are all doctors this young in America, Dr. Tamkus?” Aleksandras asks me in the elevator.
“You don’t have to call me doctor,” I say, smiling. “I’m just a student. Not even a medical student — yet. But I hope to be.”
“I was starting to think America had really gone overboard with the education thing if they were spewing out doctors as young as you,” Aleksandras says. I laugh. Talking to him and his son is refreshing. I spend the whole of my 20-minute break chatting with them. I offer to help Aleksandras unpack, but he declines.
“He’s very independent,” the son tells me. “His whole life he had worked on his farm tending to the cattle and horses, tending to the crops. I had never seen a man love what he does more than my father. Two years ago on his birthday we told him that he had worked enough, that it was time for him to settle down, because it would be better for his health. I think that’s when he started getting old.”
Aleksandras folds his striped pajamas and places them on the bed.
The OR is green — green scrubs, green sterile cloths, green walls. Two X-ray machines, a crash cart and an acute physiologic system tower over the gurney in the center of the room where an anesthetized body — Aleksandras — lies on a table. It is bright and cold. The mask traps my breath and warms my face. Only the steady beeping of the vitals machine interrupts the silence of the room. The surgeon asks for the scalpel.
It is a potent image — one human operating on another. One standing tall, tool in hand, the other lying scared on a table. Commands roll off the surgeon’s tongue: Clamp. Forceps. Scalpel. The life of the patient lies at his fingertips.
Only Aleksandras’ neck is visible. It’s almost as if he isn’t there. Sometimes, I forget that he is. The sterile clothes move up and down as he breathes. I hold Aleksandras’ hand.
Once the operation is complete, I step out of the OR and tear off my face mask. I breathe easier now. I squint at the clock at the end of the hallway. Two in the morning.
I head up to the break room with the thought of laying on one specific brown couch for a nap. The elevator opens and I see the son, holding his wearied head up by his palms, body slouched. He looks up to me with hopeful eyes.
“Saule, how was the surgery?”
I tell him we had to call in another surgeon for help. I tell him they tried for hours. I tell him Dr. Terbetas could not reach the spine. With every sentence his face falls. “It’s not over,” I add hastily. “They are going to try to get to the bone from the back. He just has to recover.”
We sit in silence. For 10 minutes, for an hour. Time is not absolute, especially in this place. After all, it was just a few hours ago that I had befriended these people.
They say emotional distance is a sign of a good surgeon. But that seems like a pipe dream. We get satisfaction from helping people, from knowing people, through relationships, conversations. I’m not sure I can do it, not yet.
I look up at Aleksandras’ son. He is asleep now, hunched over with his face in his hands. I lean back in my chair, and close my eyes too.
Saule Tamkus is an LSA Junior.