The Surgeon’s Stitches

A thin rope spurted out of the exposed chest cavity, fraying at its peak into soft red droplets. This was not a good sign for Jim, the squat surgical resident leading the operation. The patient’s aorta had torn, and blood now seeped through the stitches he’d sewn only an hour before. Without hesitation, my dad, who’d been assisting Jim on the case, leaned over the chest cavity and tried to make sense of the spraying mess.

He took the needle-holder and suture from Jim and quickly plugged the widening hole with his left hand and sewed the repair stitches—six in all—with his right. Giddy and awed, a medical student next to me whispered, “Your dad’s good, huh?”

An hour before the rupture, Dad had been telling Jim, over and over, “Focus on your knots; think of nothing else.” When Jim made a stitch too far from a previous one, Dad corrected him. Jim followed it up with a tight stitch, which made Dad lean back from the table and writhe as though Jim had scratched an itch he couldn’t reach.

“Oh yes, Jim! Right there! That’s the spot!”

Dad began to field questions from the medical student next to me.

“How do you determine what type of valve to use in each surgery?”

“Well, what are the advantages and disadvantages of each valve?” Dad said. He answered the student’s questions with questions for another few minutes, but never forgot about Jim. “Focus on your knots; think of nothing else.”

After the surgery Dad would tell me, “I was responding with questions because he was asking stupid questions.”

“Don’t you think that’s a little harsh?” I squeaked as I remembered the most eloquent question I’d asked during the case was, “What’s the blue stuff?”

“They were stupid questions because he already knew the answers to them,” Dad said. “He just hadn’t taken the time to think about them. And questions you haven’t thought out are stupid ones.”

On the morning of surgery Dad hunched over the sink in the hospital locker room and furiously scrubbed his white clogs, which were caked in blood, while I tried to shake myself awake. I’d spent most of the night worrying that I’d accidentally bump Dad’s elbow and send a scalpel slicing through the patient’s heart.

When I was a kid, if I ever fell and scraped myself, I’d turn to my parents and squeal, “Is there blood?” Dad’s attempts to improve my dexterity by buying me LEGOs failed, and when we dissected fetal pigs in high school, the tearing sensation of the blade against the pig’s tender pink skin made me want to throw up. It was no mistake that I had never seen Dad operate before.

Once the blood had been washed away, we rode the elevators down to a pre-operative meeting where a gaggle of surgical assistants gushed about Dad’s skills and told me horror stories about people who’d passed out watching surgery. An assistant recounted how she fainted in training: once during knee surgery, “When they snapped the patellar tendon, I was on the floor”; and another time during childbirth, “They said bring out the forceps, and I was thinking about the small forceps that fit between your fingers, but these were huge,” she said, gesturing like a fisherman bragging about a big catch. I winced.

The surgical assistants presented the details of the case: the patient needed a replacement for his aortic valve, which had become encrusted with calcium deposits. These deposits were preventing the valve from opening all the way. Because of this, the patient’s heart wasn’t pumping enough blood through the rest of the body.

The case was supposed to be straightforward. Dad does two or three aortic valve replacements a week. He has to stop the heart and put small tubes in the heart’s root to supply it with oxygen. But here’s the tricky part: these tubes go into the most fragile section of the aorta, the outer curvature, and when he prepares to close up the body and remove the tubes, the aorta can tear. Small tears require one or two repair stitches, but anything more can escalate into what Dad calls an “unfixable problem.”

We left the room so Dad could wash up. He has few superstitions. He doesn’t wear special scrubs or a customized surgical cap. But he’s particular about how he cleans his hands. There’s a new foam that allows surgeons to clean up in about a minute, but Dad prefers to take his time. He uses an iodine sponge to disinfect his hands and lower arms because, he says, he “likes the ritual of it.”

At a deep, wide sink just outside the operating room he rinsed his hands and arms and then coated them with a yellow iodine solution. Then he took a brush and methodically scrubbed under his nails. When he finally finished, after about five minutes, we returned to the operating room.

Jim had already sawed into the patient’s sternum and cauterized the blood vessels to prevent the chest cavity from becoming a spraying mess. As the cautery burns the patient’s flesh it releases an acrid stench, but by the time Dad and I entered, the operating room only smelled like latex and hand sanitizer.

The OR speakers hummed with “Hungry Like a Wolf.” I was able to stand right behind the patient’s head, while Dad stood across from Jim. Once they removed the faulty aortic valve, which was the size of a walnut and coated with white beads of calcium, they spent twenty minutes scraping debris from the surrounding tissue and dropping the white flecks into a metal pan. Between complex moves like removing the valve, Dad would take a deep breath and lean against the operating table the way some guys casually order a drink at a bar.

Jim sewed in the artificial valve.

“Focus on your knots; think of nothing else.”

On the night before surgery, Dad lay awake in bed and performed the entire case in his head: every slice and stitch. When he finished he gave in to sleep, and that night he slept well. But if he’s ever woken up, he can’t go back to sleep, and he’ll go into the office in the middle of the night to edit peer-reviewed articles on things like “Treatment of obstructive thrombosed prosthetic heart valves” and “Pseudocoarctation of the aorta secondary to aortic intimal sarcoma.” Or he might revise speeches with catchy titles like “Learn from My Mistakes: A Personal Journey Toward High Reliability Team Performance.” He’s invited to speak all over the world. Istanbul. Vienna. Tokyo. Guangzhou.

Dad recruits surgical residents like Jim by asking them just one question: “Why wouldn’t you want to be a heart surgeon?” He has no time for their groans about arriving at the hospital at 4:30 in the morning and working until 11:00 at night. “For surgeons,” Dad says, “the only problem with those hours is that they have to leave the hospital at all.”

As a surgical resident, Dad unwound by practicing his stitching technique sewing up oranges instead of romancing my mom. When she grew fed up and recorded a breakup tape, he asked, “If I give you a ring, do I still have to listen to the tape?” Five years later, at 3:33 a.m., she gave birth to a son who would be squeamish at the sight of blood, fail his ninth grade biology quiz on the heart, and ask many stupid questions. To witness my birth, Dad switched shifts with another resident at the last minute. Then he sprinted across the hospital in time for 5:00 a.m. surgical rounds.

When he was a student at Princeton, Dad pulled an all-nighter at the library once a week. He graduated summa cum laude, majored in biochemistry and shattered the curve in his embryology course (“You’re Sundt?” the professor gasped when he looked at his grade book). In high school, Dad spent a lot of his time alone, driven to accomplish a goal that had been planted years earlier. As a child he liked animals. He thought he might want to be a wildlife biologist and spend every day outside studying marmosets and tamarins and great big blue whales. But my grandfather, a world-renowned neurosurgeon, told Dad, “You can grow up to be any kind of surgeon you want.”

If Dad was going to be a surgeon, he wanted to be a confident one. And when he’s standing over a beating heart, blood spraying in his face with his purpose defined and his mind clear, he is.

But outside of work Dad seems lost. He doesn’t like to watch violent movies because he says his life “already has enough horrifying in it.” When he’s drained, his eyebrows slide down his forehead and his lips droop into a frown. If he loses a patient—which is rare—he will come home and sit on the couch in his scrubs and stare at the TV and say things like, “Tell me something good.”

Dad finds it easy to make acquaintances but hard to make friends. If I visit him on a weekend we’ll spend our quality time in his office: I’ll grade papers and he’ll answer emails. Then we’ll get a late afternoon beer at the Sevens on Charles Street and Dad will drink his pint in four big gulps because he doesn’t know how to sit at a bar and just be.

I don’t mind. I get restless, too. On Friday nights I will blow off friends to work in the library, and during the school year it’s hard for me to talk about anything besides my lesson plans or my latest project. In the first month of my first teaching job, my stress ravaged my immune system and I got shingles. In college I played basketball, and one muggy summer night when my parents were out of town I threw a party at their house, but I left just before it began so I could shoot jump shots by myself in an empty gym. I cried most days before elementary school: scared of classmates, scared of teachers, scared of deadlines, scared of art class, scared of everything. Now I turn to work whenever I look in the mirror and see that scared boy staring back at me.

Aside from my borderline hemophobia, I used to worry about seeing Dad in his element because I thought I’d find his proficiency threatening, and instead of bringing us closer together I feared it would only shed light on the vast differences between us. But instead it helped me understand why Dad feels so at home at work. Because when he’s there he can stop running from the same fear that’s in me.

Two days before I watched Dad operate we took our dog for a walk in the park. As the dog sniffed around a light pole, Dad stared at a nearby merry-go-round. Some of the horses moved up and down, while others remained motionless, fastened to the base of the ride.