The Anatomy of Deception (8 page)

“Thank you.” The Professor seemed genuinely touched at my enthusiasm. “The offer was supposed to have remained private, but, doctors, I fear, are more uncontrollable gossips than spinsters. News of my visit has reached the board at the hospital here.”

“Has your position in Philadelphia been compromised?”

“I suppose not,” he replied, “although it did result in this dinner. Old Benedict—he’s head of the trustees—has asked for an opportunity to persuade me to remain in Philadelphia.” The Professor reached up and tugged at the dip of flesh under his chin. “It is all quite flattering, actually.” Then he smiled and clapped his hands together. “But that brings us to you. If I accept the offer, I would like you to come with me to Baltimore as Assistant Head of Clinical Medicine. The position would apply not just to the hospital, but eventually to the medical school as well. Initially, you will receive two thousand dollars per annum, although I’m certain that you can at least double that with private patients.”

I stared at the Professor, feeling my lower jaw moving but with no sound emerging. Finally, I managed, “Dr. Osler … I … am …” No more words came.

The Professor laughed, one loud cannon shot. “Well, Carroll, I believe I have for once struck you dumb. You look quite exceptional. Well, you’ve earned it. I knew you were a special sort the first day I saw you at rounds two years ago, and nothing has since persuaded me otherwise. You are professional, thorough, curious, and a fine doctor. As to your age, I suppose you know that for my first teaching assignment, I was younger than you are now.”

I did know. At McGill University in Canada, Dr. Osler had
been granted a teaching position at twenty-three. His students dubbed him “The Baby Professor.”

“And besides,” he went on, “children of the backwoods such as ourselves need to stick together, eh?”

Although the Professor enjoyed stressing the bond of our rural upbringings, he was hardly a rustic. The Osler family had eventually settled in a wilderness town in northern Canada, it was true, but the Professor’s father, Featherstone Lake Osler, had been the original choice to sail on the
Beagle
as ship’s naturalist, a post that went to Charles Darwin only when the elder Osler declined. Though the Professor’s father had then entered the ministry and been posted to Bond Head, Ontario, William Osler had been surrounded by books and learning during his entire childhood.

My boyhood, by contrast, had been dominated by a decidedly different set of stimuli. The fetid smell of our farmhouse still lingered in my nostrils, unwashed bodies mixed with the waft of cheap stew and even cheaper liquor. Yelling, tears, and the soft moans of my mother were never far away. I would continue to send money home so long as I was able, but I had not and would not return to Marietta. With four thousand dollars per year, I could finally make certain that no one in my family could have further cause to accuse me of ingratitude.

“Still,” he continued somberly, “it will be difficult to leave … I have made so many friends.” Then he brightened once more. “But as much as I prize my colleagues here, the Hopkins staff will be truly extraordinary. Welch, as you may know, will be running the show … brilliant pathologist. Lafleur, whom I taught in Canada, will arrive shortly. Halsted is already there.”

“Halsted?” I asked.

The Professor’s face turned dark, an instantaneous eclipse. “And why not Halsted?” he bristled. “He is the finest surgeon in America, probably the world.”

I was stunned by the Professor’s change in demeanor at
my query. “Why, yes, Dr. Osler,” I sputtered, “I’m sure you are correct, but I thought that he …”

“Yes, I know what you thought,” the Professor replied. “‘Drug addict.’ You and everyone else.”

“I didn’t mean—”

“Of course you didn’t,” he snapped, though his irritation seemed directed no longer at me, but to an audience not present. “Halsted has been unfairly maligned for the better part of a decade. To think that a man of his genius has been reduced to … Well, it’s not important now. Do you know that at this moment, he is perfecting a new surgical suture that will be largely subcutaneous and cause almost no tissue trauma and minimal scarring?”

Before I could respond, the Professor continued, more willing to expound on the prejudices foisted on a colleague than those foisted on him. “Halsted has pioneered one brilliant surgical advance after another. Just months ago, he had aseptic gloves fabricated by the Goodyear Company. Rubberized gloves are a huge step, Carroll. They promise to all but eliminate surgical infection.”

“I had heard that surgeons in New York were beginning to use gloves,” I said, “but I didn’t know Halsted had pioneered them.”

“It was typical,” the Professor fulminated. “One of his nurses was experiencing sensitivity to the carbolic soap with which everyone—or at least almost everyone—now washes before surgery to try to achieve some level of asepsis. To eliminate the need for caustic material to touch the skin, he had the gloves fabricated. They can be rendered truly aseptic. Thousands of lives will be saved each year.”

Dr. Osler took a step forward and actually placed an index finger on my chest. I was stunned. I had never known him to make physical contact in anger.

“Doctor, I would protect William Halsted as I would protect a treasure,” he told me, almost in a growl. “The good he will do over what I hope will be a long life, the lives he will
save, the suffering he will prevent … do you really desire that medical science deny itself a man such as this?”

“No,” I replied, still not daring in my astonishment to move. “I suppose not.”

“No supposing about it,” he grunted. Then, like a kettle removed from a flame, he stepped back and emitted a deep sigh. “This is a simple issue that pits the prejudice of ignorance against the enlightenment of knowledge. Nothing could be clearer. I confess, Carroll, I cannot understand the way some people think.” Dr. Osler withdrew his watch. “We’ll just have time. Come with me, Doctor.”

The Professor turned on his heel and headed back the way we had come. He took the far staircase to the first floor and emerged across the hall from the operating theater. He opened the door and bade me to enter.

“Burleigh will be clearing an abscessed bowel,” he said with disgust. “You’ve never seen Burleigh at work before, have you? I believe you will find it enlightening.”

Wilberforce Burleigh was perhaps the Professor’s most impassioned critic on the staff. He was in his sixties, had been a surgeon for forty years, and thought that medicine was just fine as it was. Burleigh’s eyes narrowed at our arrival and he glared at us as we strode up to the gallery, muttering to himself. I could distinctly make out the words “spying on me.”

A moment after we had been seated, the patient was wheeled in, and Burleigh turned to the task at hand. An emaciated, sandy-haired man of about forty lay on the table, covered up to his chin with a sheet, his terrified eyes flitting about and his lower jaw quivering. The surgeon took no notice.

Burleigh was from the “flashing hands” school of surgery—everything the man did was based on speed. Quick work was not mere affectation. In traditional surgery, bleeding was only minimally controlled, usually with pads and pressure, and as a result more surgical patients died from shock than from their primary illness. What hemostasis did exist was achieved
by other flashing hands, often eight or nine sets of them, belonging to the army of assistants that most surgeons employed in the effort to have every task attended to immediately. I’d heard that a wag at Yale called this process “nine women trying to have a baby in one month.”

Recently, the development of mosquito clamps—small, scissor-shaped hemostats—allowed for more effective clamping of blood vessels. With bleeding controlled, the surgeon could work more slowly and carefully, but not every surgeon cared to slow his pace. Burleigh was notorious for continuing to place a premium on speed. He never tired of recounting that in 1846, during the first successful use of ether in surgery, Robert Liston had amputated a leg in mid-thigh in twenty-six seconds, or of bragging that he, Burleigh, had once performed eighteen operations in a single day. Fewer and fewer of that ilk were left, however, as almost every surgeon entering the field now followed the lead of the man who had invented mosquito clamps specifically to staunch blood flow during surgery—William Stewart Halsted.

Ten assistants stood at the table dressed in hospital uniform instead of gowns, while Burleigh remained in street clothes. Corrigan, the bulldog, who was not trusted to do more than take notes in the Dead House, was to the surgeon’s immediate left, meaning that he was chief assistant. The Professor rolled his eyes at the sight.

Burleigh signaled another assistant and the ether cone was placed over the patient’s face. As the drug was poured, Burleigh faced the gallery, which contained about twenty students in addition to ourselves, and announced, “Today, I will be treating a patient with acute diverticulitis, removing a suspected abscess from the sigmoid colon and then resecting the bowel.” He smiled, parting an extremely full beard. “Please watch carefully. I don’t wait for stragglers.”

After the patient had been poked with a long needle to ensure that the ether had rendered him senseless, Burleigh
removed a case in fine Turkish leather from his coat. I recognized it at once as the deluxe Tiemann & Company Patent Catch Pocket surgical set, advertised in their catalog at thirty-three dollars, the most expensive kit on the market. At eighteen surgeries per day, I surmised, Burleigh could well afford it. He opened the case, set it on a table behind him, and removed the large scalpel. Standing over the patient with what seemed almost malevolence, Burleigh lowered the scalpel to just above the abdomen, nodded to an assistant to note the time, and then cut.

Flashing hands was no understatement. Burleigh made a swift paramedian incision on the left abdominal wall, about two inches from midline, beginning just under the rib cage and ending five inches below the umbilicus, cutting in one motion through the skin, subcutaneous fat—minimal due to the patient’s physique—and the anterior rectus sheath. As he spread these aside, four of his assistants dove in with pads. Burleigh then called for a retractor, cut the rectus muscle itself, and placed the retractor laterally, instructing a fifth assistant to hold it still. The entire process was completed in seconds.

I glanced at the Professor, but he gave no sign anything was amiss. A paramedian incision was the correct choice—the rectus muscle is not divided, the incisions in the anterior and posterior rectus sheath are separated by muscle, and incisional hernia is less likely—but the length of Burleigh’s cut was far too long. It would be much harder to close, chance of secondary infection greatly increased, and control of the organs inside the peritoneum would be difficult.

By the time I returned my gaze to the table, two assistants were frantically applying pressure to the larger vessels, while another sponged away fluids. Burleigh should here have switched to the small scalpel for a finer cut, but instead, in the interest of speed, he used the same large instrument to incise the posterior rectus sheath,
transversalis fascia
, and
peritoneum. When he encountered the epigastric vessels, a geyser of blood shot out of the patient, spattering everyone on the right side of the table. Corrigan grabbed a hemostat and tried to clamp the artery, but with blood obscuring the cut end, it took him at least ten seconds to achieve the result. All the while, Burleigh was snarling, “Get that
closed
, damn you!”

The rule in surgery, with so many crowded around the table, was “no talking except the big man.” Burleigh was particularly loud and abusive. As soon as Corrigan had placed the clamp, Burleigh screamed for another. The disorganization in the efforts of the team was palpable.

When finally the bleeding was sufficiently controlled so that Burleigh could see, he began to incise the peritoneum to access the colon itself. Suddenly, the patient began to squirm on the table. Burleigh screamed once more, this time to increase the ether. If the patient’s diaphragm began to move, the bowel could bubble and, especially with this huge an incision, it might force sections of intestine out through the opening and into Burleigh’s face.

The patient once more lay still as the additional ether began to take. Burleigh proceeded to the target. Still furious, he yelled, “Hold that still, you fool!” The eyes on the assistant holding the right angle retractor went wide, and he struggled to remain perfectly motionless. Burleigh began his inspection of the colon, performing the task as rapidly as possible. He found the diverticular abscess that he expected almost immediately, but there was no way of knowing what, if anything, he missed.

He clamped the colon on either side of the abscess and then, still using the scalpel with which he had cut through the outer skin, he excised the section. After reaching into his case for a length of silk suture and a needle, he stitched up the anastomosis. From there, Burleigh closed the incision in layers, sealing the giant opening with stitches far too large, in each case using the same needle and suture.

When he was near the end, Burleigh asked for the time.
The entire operation had taken under forty minutes. He seemed disappointed and glared at Corrigan and the other assistants. When he had tied off the last external suture and the ether cone was removed, Burleigh nodded at the assistant keeping time and stepped back. Blood was everywhere, on the table, the floor, and soaking everyone’s clothing.

Burleigh turned and faced the gallery. “As you can see,” he exclaimed proudly, “the operation was a success.”

Even before the last syllable was out, the Professor was on his feet. “We can go now,” he said to me softly. As we left, I could feel Burleigh’s eyes on my back.

Once we were out in the hall, the Professor asked, “So, Doctor, what did you think?”

“Ghastly. The entire process was highly septic, he used the wrong instruments, tissue trauma was severe, he did not examine the affected area for additional damage, and the stitching was worse than could have been achieved by an inebriated seamstress.” I might have added that my indignation at watching Burleigh at work had shocked the last aftereffects of drink right out of my system.