Hunting for Hippocrates. Warren J. Stucki

dipstick except the ketones were high and the glucose was four plus. He had Diane draw a blood sugar which came back 457. Dr. LaRowe, the internist in the office next to his, had initially tried pills, oral hypoglycemics, but they just did not control the blood sugar level. Unfortunately, that left only insulin as a treatment.

      Well, so far the diabetes really hadn’t bothered him that much and hopefully if he kept his blood sugars under control, it never would. He knew a lot of diabetic men became impotent, but if that happened there was always Viagra or implants. It was just the nuisance of the insulin shots and the diet and always having to be on a schedule. Running on a tight schedule was not his nature.

      Moe tore off the cellophane wrapper, stared at his piece of processed chicken, then lost his appetite. But there was that damn schedule again. If he didn’t eat, then he would have to adjust his evening dose of insulin, and that would be just a guess. Then in the morning his sugars would undoubtedly be high or low, then he would have to adjust his morning dose of insulin, and so it would go on and on. The dreaded yo-yo effect. It would be far simpler just to eat the goddamn chicken.

       FIVE

      As Moe entered Howard’s room while making early morning rounds, he noted that his pre-op orders were being carried out. An intravenous of D5LR had been inserted in Howard’s right arm and two grams of Ancef were already being piggybacked into the line. Poised with a razor, an attractive middle-aged nurse was bent over preparing to shave him for surgery. Howard feigned dismay as the nurse informed him that she had to shave all his abdominal hair, including pubic hair.

      “Goddamn it Doc, you didn’t say anything about that,” Howard whined, then winked at Moe.

      “Sorry bout that,” Moe grinned. “But that’s nothing, wait till she puts in the Foley catheter.”

      “The what!” Howard exclaimed.

      “Just seeing if you’re awake,” Moe chuckled.

      “I hope you’ll at least wait till I leave the room,” Connie laughed.

      “Didn’t see you there in the corner.” Moe turned to Connie. “Yeah, we’ll wait on the catheter until you’re in the operating room, Howard, and asleep.”

      “I trust you slept well and are feeling sharp,” Connie said, flashing a smile.

      “I slept as well as I ever do and what you see is what you get,” Moe said with a smile, then turned again to Howard. “Sorry about that bowel prep last night Howard. You probably didn’t get any sleep either?”

      “That’s okay, Doc, but I suspect my colon would pass a drill sergeant’s white-glove inspection today. Anyhow, I’ll get plenty of sleep pretty soon.”

      Moe glanced at Connie again. She was wearing wash-faded Levis and a tight, red-knit sweater. She looked good, even at 6:30 in the morning. “Do either one of you have any questions about the procedure, or did we pretty much cover everything in the office?”

      Connie reached for her father’s hand. “How long will the surgery take? Where shall I wait?” she asked.

      “The surgery will take from one-and-a-half to two hours, not counting anesthesia time,” Moe said, arching his back, trying to relieve the chronic muscle knot. “There’s a waiting room just outside the surgery suite. If you want to wait there, I’ll talk to you as soon as the surgery is over.”

      “Uhmm,” the white uniformed nurse still razor in hand, cleared her throat and looked at her watch. “Dr. Mathis, if I’m going to have the patient prepared for a seven-thirty start, I better get going.”

      “Oh, I’m sorry. See you in a few minutes, Howard. Connie, it’ll be two and one half hours before I’ll see you again, so don’t start watching the clock in an hour and wonder what’s taking so long.”

      “I’m sure if the surgery runs long, it’ll be because you’re telling one of your famous stories,” Connie chuckled.

      The surgery suite was located on the third floor of the hospital. It had six brightly lit operating room pods, each extending from a supply hub that formed the central core and each operating room had a window. At the time of construction, ten years ago, windows in the operating room were considered fairly controversial. When the hospital was built, the size of the operating rooms was considered more than adequate. However, with the unprecedented burgeoning of medical technology, each room rapidly filled with bio-technical machines. Now the operating rooms looked cluttered, messy and small.

      For example, the new anesthesia machines monitored the partial pressure of each gas that flowed through them. Hence, they were much larger and required twice as much space. Then there was the obligatory pulse oxymeter to monitor what percent of hemoglobin was bound to oxygen in the patient’s blood and the anti-thrombic pump device that delivered alternating mechanical compression to the calves of the patient, trying to prevent blood clots and the more ominous pulmonary emboli. The old, dependable electro-cautery machine was still present, but now it was augmented by an even larger machine, the argon-beam photocoagulator, also used to stop surgical bleeding. The newest addition was another large machine to deal with bleeding, the harmonic scalpel, that vibrated with such high frequency that it cut and sealed blood vessels at the same time. To add to the confusion, each room had a large storage rack on wheels that contained the equipment necessary for the increasingly popular percutaneous and endoscopic procedures.

      Added to all this was the storage space required for daily expendable items such as sponges, dressings, sutures, syringes, needles and scalpel blades. Finally, allowing space for small tools that were used on an almost daily basis, there was hardly enough room for the manual laborers, the surgeon, the anesthesiologist, a circulating nurse and a scrub nurse. And the patient—the patient looked almost inconsequential in this high tech arena.

      After scrubbing his hands at the stainless steel sink, Moe entered this electronic maze promptly at 7:30 a.m. He was never late. Moe’s mood immediately improved when he noticed Judy would be his scrub nurse today, then it plummeted when he saw Judy and Rusty engaged in what appeared to be a private conversation. The two of them were sequestered in the corner of the operating room behind the harmonic scalpel, just out of earshot.

      “Morning Moe.” Dr. David Dalby, the anesthesiologist said smiling broadly. “He’s asleep. I think I’m finally getting the knack of this anesthesia stuff.”

      “I’m pretty sure Medicare would allow you to charge a higher fee if you could only learn to wake them up,” Moe jested, but felt his mood sour.

      He waited a minute with his hands held upright and dripping water, then he barked, “Judy, if you have a minute, you could give me a towel and put on my gloves. Rusty, you might just as well start draping.”

      “Certainly, Dr. Mathis,” Judy said just a little too formally, as she broke from her huddle with Rusty.

      “Didn’t hear you come in,” Rusty said sheepishly. “Are you going suprapubically or perineally?”

      “When’s the last time you’ve seen me use the perineal approach? You know I like to get the lymph nodes.”

      Rusty shrugged, and started placing the sterile paper drapes on Howard, leaving the abdomen exposed. Moe walked to the left sided of the operating table.

      Without looking at Judy he held out his hand. “Knife,” he commanded, then turned to Dr. Dalby. “Okay for me to start, David?”

      “As far as I know,” Dr. Dalby grinned.

      Moe made an incision with one uniform motion in the midline from two centimeters below the umbilicus to just above the pubis. The electro-cautery was used to stop the sub-cutaneous bleeding, then Moe used the scalpel to incise the midline fascia and enter the Space of Retzius. The peritoneum and abdominal contents were retracted superiorly and medially to expose the pelvis. Following this, the lymph nodes were harvested from the external iliac, internal iliac and obturator chains, then sent for frozen section. In fifteen minutes they would get