Surgery is something most people try to avoid at all costs. Yet we cannot resist watching someone else go under the knife. TV shows like Nip/Tuck have banked on this perverse fascination for years, happily satisfying our penchant for blood and guts. So when a friend and I were invited to see a live colorectal surgery, we couldn’t resist. It’s not every day you get to watch a man’s excretory system get entirely re-routed.
Upon entering the hospital, a nurse points us towards a narrow corridor, where we fish disposable scrubs out of a cardboard box. We walk into a sterile white hall called the “aseptic core,” swathed in teal J-cloth from head to Keds—or in my friend’s case, three-inch heels, which the nurse frowns upon.
Dr. Cohen, the surgeon leading the procedure, greets us warmly and quickly briefs us on the proceedings. Our patient, an elderly man suffering from rectal cancer, needs his sigmoid colon and rectum removed.
A heavy set of doors reveal the operating room painted cool lavender, buzzing with activity. Generic pop hits hum from the radio. We are greeted by a pair of legs spread wide and supported by stirrups, a blue sheet dangling between them.
In the centre of the room, three figures clad in surgical green lean over the patient. Between the hairnets and face masks, we make out their eyes by the white lights overhead, and they smile in acknowledgement. I am secretly thrilled to catch my first glimpse of blood on their gloves.
We spend the next hour by the patient’s head, craning our necks over his covered face to peer into his abdomen. An opening in the blue cloth pinned to the body frames a rectangle of loose yellow skin. A bloodless cut the length of a pen runs towards the navel. As the skin rises and falls, the incision parts, revealing the red tissue beneath. Dr. Cohen reaches in and pulls out a wet pink tube, dangling with bulbs of orange fat.
“See it moving?” he asks us. “That’s peristalsis.” My long-suppressed physiology lectures bubble back into consciousness. Peristalsis is the autonomic movement of intestinal smooth muscle to push food along. This man is digesting while his intestines are being held up half a foot over his body.
Translucent webs of connective tissue between loops of intestine are pulled taut with forceps and examined in the body cavity. The senior resident strokes the tissue with a thin metal wand that crackles and sears through it, effortlessly sealing the ruptured blood vessels with intense heat. Wisps of smoke rise from the body as I slip my mask off to sneak a sniff. It smells like burnt hair.
Behind us, beeps issue from the anesthetist’s gallery of screens. She is a relaxed woman who does not flinch when the patient’s heart becomes arrhythmic and his systolic blood pressure drops fourty units.
“The patient’s blood pressure rose because he was in pain,” she explains later. “So I gave him some morphine to bring it back down.”
They take turns feeling for the tumor—the rectal cancer we’ve spent the last hour unraveling bowels to find.
“We’re gonna get this mother out!”
A section of contracting intestine is laid on a device that looks suspiciously like a kitchen mandolin. With a swift slice, it is cut neatly in two, sealed on both sides with a row of staples. The blood-stained gloves are withdrawn, as the yellowed flaps of skin fall back into place and a white towel is laid over the incision.
The entire party moves towards the patient’s elevated feet as everyone arches over Dr. Cohen’s shoulders to get a closer look. He sits facing the patient, as a beam of light from a vaguely orthodontic headpiece illuminates everything between the patient’s legs.
I was worried that I would be struck with the juvenile urge to laugh inappropriately at moments like this. However, the thighs and buttocks, swabbed with yellow iodine, look more like scientific specimens than a man’s backside. A metal device exposes the anus as Dr. Cohen takes up the electrocautery once again.
The room is hushed as he dexterously cuts through the layers of flesh around the opening. Blood pooling at the base of the incision drips into the pan on his knees. My back aches when the cautery is finally laid down an hour later.
He reaches in with a pair of blunt forceps. With a gentle tug, the rectum slides out and slumps into a metal pan, bloated and slick with blood. One end is still stapled shut. I crouch over, incredulous, staring into the cavity. Distilled water, poured in from a perineal incision, rushes out, caught in a container labeled “biological waste.” Over the next half hour, the opening is meticulously cleaned and sealed with tiny stitches.
There is now a quarter-sized hole on the left side of the patient’s abdomen. Reaching into the abdominal cavity, the senior resident threads the remaining intestine through, leaving the end protruding like a large red navel. He places a doughnut-shaped sticker over the stoma, the colon’s opening.
“This part can get a bit messy,” he says mischievously as he snips off the staples, opening up the intestine. Finally, a plastic pouch is fastened to the sticker: the new endpoint for the patient’s excretory system.
Only then does it occur to me that the patient will have to live with a colostomy pouch for the rest of his life. He will experience the emotional triumph of beating cancer, but will have to endure the consequences. Days after the surgery, I am still berating myself for getting swept away by the blood and gore, reducing the patient to a jumble of bloody organs and iodine-stained limbs. It is frighteningly easy to do, especially when you never see their face.
The pressure on the surgeon—who personally meets with the patients and often, their families—is immense. The next time I see Dr. Cohen, I ask him how he deals with the anxiety that comes with so much responsibility.
“You learn from your training and your mentors that you’re in charge in the operating room. You saw all the people milling around: nurses, anesthetists, visitors, residents. There are ten to twelve people out there.”
For him, the patient is always at the heart of the experience. “If you lose control or get excited, everyone around you gets excited and you can never proceed. You’re the captain of the ship and you have to stay calm, even if you may be a little nervous. Mainly because when you get in a flap, you can’t do a good job with the patient.”
