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Across The Red Line: Stories From The Surgical Life

Richard Karl

Publication Year: 2010

Richard Karl, a doctor and teacher, takes the reader closer than any writer before into the corridors of the hospital, on the surgical table, and into the world of medicine. In these pages we see the tragedies and triumphs of modern medicine: the beauty of surgery done well, and the aftermath of operations that fail to deliver on the hopes of the doctor and patient. We witness the "M&M"—the morbidity and mortality meeting—where doctors scrutinize their own work and mistakes, and the often inevitable outcomes of treatment. Suffused throughout are Karl’s keen observations on the workings of the human body and its immense capacity for healing. "...I celebrate the rich privilege accorded the practicing surgeon. The surgical life is really about bearing witness to the human condition and about respecting the many almost whimsical variations of biology and about the intersection of the two. It is remarkable, really, the way I get to know people so intimately so quickly, and to observe the brave and often noble behavior in them, while I witness the relentless push of biology, the aging and decay, the growth and development, but most especially the healing, both physical and emotional. It is this natural drive of our bodies to repair themselves from all injuries (including the surgeon's wounds) that is the centerpiece of medicine. Without it no surgeon could cut." Written with economy and subtlety, Across the Red Line offers a vivid picture of disease and the miracle of life. It will interest anyone who's ever been on either side of the surgical table.

Published by: Temple University Press

Contents

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pp. vii-

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Acknowledgments

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pp. ix-x

hardest part, they say, of publishing a book is to find someone, somewhere, who believes in it. I have been multiply blessed. Howell Raines, executive editor of the New York Times, knew me not from Adam’s house cat, but sent the manuscript on to his agent, Timothy Seldes, of Russell and Volkening. Timothy took on the project and ...

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Introduction: Across the Red Line

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pp. 1-12

... am sitting in a patient examining room, on a stool with wheels, waiting while a 67-year-old man rummages through his wife’s pocketbook, looking for his list of questions. I’m thinking of trying to write down what this is like. His shirt is unbuttoned and he cannot see well without his glasses and his wife is trying to help but she is nervous ...

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1. M & M

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pp. 13-23

He wants to know if the operative team opened the breastbone in order to gain access to the heart. “Yes,” responds the fifth-year resident. He is the chief resident on the Trauma Service and this is his last year of training. It’s Monday, 7:30 A.M. We’re at M & M. It means Morbidity and Mortality Conference. Once a week the entire ...

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2. How It Comes About That a Successful Operation Ends in Disaster

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pp. 24-32

... the phone is in my hand. My eyes fight to focus on the aquamarine numerals of the digital clock that sits on the chest by the bed. I work to make sense of the time. It’s 2:24 and it’s dark and I didn’t hear the phone ring, although I know it must have, and I recognize the voice of the intern. He’s excited, disjointed, worried, and, worst of ...

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3. Fate

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pp. 33-39

... are times in medicine when I feel like a bystander watching a traffic accident. I have no direct influence over events; I cannot make widespread cancer disappear or restore function lost to a bullet’s capricious path. But I try hard to force the foul ball fair with lots of body English and hope and careful attention to detail. Still, there ...

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4. A Columnist Comes to Work

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pp. 40-49

... have some friends in the newspaper business. Through some of them I met another, a columnist. During dinner one night, he seemed intrigued by surgery and his questions made me think that he had some ability to discern and wasn’t a reckless man. I told him he could come and watch someday. I didn’t expect he’d take me up on the ...

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5. Four Patients in Santa Fe

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pp. 51-56

... reaches down into a hospital crib and scoops up a four-year-old sleeping child. It is 8:30 in the morning, but the boy is still asleep. Next to the bed his mother rocks gently in the plain wooden hospital rocking chair; she blinks at the winter sunlight just now cresting the Sangre de Cristo mountains and sliding down the snow-covered ...

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6. Hanging

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pp. 57-64

... don’t care what they might tell you, any surgeon feels remorse and guilt when things turn out badly. Even if I have done the best I know how, a patient not prospering after a big operation takes over my life. In fact, I can say that each patient, from the time I make the incision until they are discharged from the hospital, fit and recovered, ...

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7. Helping Sal—Knowing When to Quit

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pp. 65-74

... of the hardest things I know is when to give up. Knowing when to give up on hopeless projects is the province of the truly gifted practitioner of any craft. There is a little poem or prayer that asks the Lord for the strength to know what can be changed, the serenity to accept what can’t and the wisdom to tell the two apart. In surgery it is ...

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8. On the Table

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pp. 75-88

... was a freak Friday accident, really. Another surgeon in an adjacent examining room had given a patient a mild sedative. The patient, a big, strapping 19-year-old, had become confused and combative. I heard the commotion and went to see. It looked as if he was about to fling himself out of the sixth-floor window. Careening from wall to wall, ...

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9. Hotel Utah

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pp. 89-96

... cut my finger in the operating room today. It wasn’t that painful but I let out a pretty loud yelp when it happened. It made me shiver. We were just closing this man’s chest after taking out his esophagus. It was one of those big needles used to approximate the ribs. They are about 31⁄2 inches long with a pretty good curve to them. These days ...

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10. Midwest Bulletin Board

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pp. 97-105

... was in the army that I first became aware of where patients came from. Until then they just seemed to show up at the hospital and the medical part of their story was so captivating that I don’t remember ever wondering what their home was like or whether or not they had a cat. But working the night shift at the emergency room at the Fort ...

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11. Retirement Party

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pp. 106-116

... am sure I went into surgery because of my father, who was a surgeon. It isn’t one of those pretty stories of a young boy hanging around with his patient tutoring father, though. We didn’t talk about what he did so much as I was given to understand that what he did was very important and very serious. ...

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12. Match Day

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pp. 117-126

... fourth-year medical students are getting anxious. It’s getting close to match day. In a few weeks they will find out where they’re going to spend the next several years of training. This spring, after they graduate, most will pack up and move to another city and another institution to start their internship on July 1. Some will stay here, of course, ...

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13. The Norwich Classic Car Rally

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pp. 127-137

... whole business about health care in this country has gotten beyond the breaking point. In clinic today I saw a young man who could not have been more than 45. He had had a rectal cancer at age 38. He’d been operated on, then received chemotherapy, then radiation. Now the tumor has recurred. He’s been left impotent by the surgery ...

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14. Luck

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pp. 138-147

... been a long time since I found out about the surprising lack of correlation between a surgical job well done and a smooth, successful postoperative recovery. I remember as a resident, even, noticing that sometimes a beautiful operation performed by one of my heroes, one of the best, would end in bad result; either a major complication, or a ...


E-ISBN-13: 9781439904374

Publication Year: 2010