I am not cut out for this thinks Dr. Wracks.  I must be smart enough or I wouldn’t be here.

Stop daydreaming says Dr. Clancy, there is a presentation at two on thyroid surgery in the surgeons’ lounge by Dr. Canta.  Go there now.  They will have some bagels to eat

All the surgical residents except the two lead residents are in the lounge for the presentation.  Dr. Wracks grabs two bagels while they are still there.  They go fast.   Dr. Canta is a medium-height man with freckles and greyish-brown hair with huge horn-rimmed spectacles.  He wears a doctor’s smock over his suit and he is at the blackboard, with some chalk, and he begins.  He is an endocrine surgeon.   The thyroid is a wondrous organ that maintains homeostasis in the human being.  People with thyroid disease have heart problems and sugar problems.  Thyroid hormone maintains the body’s metabolism, regulates the heart rate, rhythm, and contractility, and augments metabolism.  People with thyroid disease also are cold and hairless.  A magnificent organ, the thyroid has four arteries that feed the organ, superior and inferior, and this demarcates the thyroid as an extremely important organ.  

To remove the thyroid Dr. Canta states, we must ligate the four arteries before extirpation and remove it from under the cricoid cartilage.    the patient must take the T4 hormone for the rest of their lives.  Be aware that the internal carotids are near the organ and feed it directly through tributaries, so we must be delicate to not sever them when we remove the organ.  Dr. Wracks eats his second bagel and nods his head.  Dr. Canta looks at him. 

Tonight, he is not on call so Dr. Wracks walks to his attic room in town to get needed rest and listen to the radio.  He locks the attic door and sleep overtakes him.

After rounds in the early AM, Dr. Wracks is sipping coffee in the cafeteria with a bun.  One of the lead residents tells him to get to surgery because he is on the board for an early procedure with Dr. Canta.

Dr. Wracks is late and all the donuts are gone, and he takes a quick slurp of Styrofoam container coffee in the waiting area and then walks to the board.  On the board is written in black marks a lot ink, “Baloney”, 

and he moves to the surgical sinks and scrubs in.   Walking backward into room four, Dr. Canta is waiting for him.   Hold the trocar while I incise, says Dr. Canta, tie off as I enter, the Beauvy makes too much smoke for this procedure.  Lifting the cricoid cartilage, the thyroid is revealed.   It is white and pink and perfused with blood that is not yellow, atrophied, and wasted as described in medical textbooks. 

Hashimoto’s Thyroiditis says Dr. Canta Look closer.

Dr. Canta cuts the inferior left thyroid artery and with his fingers directing the flow, he squirts bright, hot blood in Dr. Wrack’s face until his entire mask and surgical hat are covered.   He then clamps the artery and Dr. Wracks ties the vessel.   He looks up at Dr. Wracks.   Three more to go.

After cutting three more arteries and Dr. Wracks tying them off, he delicately excises the thyroid with a light green scalpel, desiccates the tissue, and then removes the organ.   A nurse appears and the thyroid goes into a surgical stainless steel pathology bucket.  The surgeon then closes, no one without a license in surgery can sew fascia or peritoneum or do amputations. 

The surgeon leaves and Dr. Wracks accompanies the patient to the waiting area the patient’s trachea tube is removed and Dr.  Wracks sits there covered in blood.   Thyroid surgery is extremely bloody. When the patient breathes normally and the vitals are stable Dr. Wracks runs to the locker room to wash off his face.  He discards his surgical gear into the contaminated discard bin and washes his face and head with cephadyl three times.  Lunch time is passed and Dr. Wracks skulks to the library to hide.  No one ever will find him there except his only friend.  Back on the surgical floor, one of the chief residents asks him if he wrote “Baloney” on the surgical board.  Dr. Wracks denies it.   I thought I saw Dr. Cuban do it says Dr. White but I am not sure.  When Dr. Wracks sees Dr. Cuban, he bows his head and makes the sign of the cross.  Is he the next to go thinks Dr. Wracks?   But it isn’t. 

Dr. Canta moves around the surgical floor like a phantom silhouette.   He carries a fresh scalpel in his hand raised to face level to strike.  His face and grey eyes glare in a leer.   When people see him, they start to run.   A scalpel is extremely sharp and can cut through nearly anything.  Dr. Wracks again makes the sign of the cross.  Dr. Cuban was not the next to go.  Dr. Wracks looks out the window on the observation floor at the world in New York in its beautiful summer.  Immense green punctuated with verdant thunderstorms as sudden squalls move into the area and the huge skyscrapers loom in the distance.  Life is really beautiful for the lucky few thinks Dr. Wracks.  If I go back to the surgical floor, they will have me taking blood gas from the ICU.  My mother wanted me to be a doctor.  It’s time to get back to work thinks Dr. Wracks

Another patient is coming in with abdominal pain says the charge nurse.  Dr. Ix wants you to work him up and do a guaiac after a rectal exam.  He is in the emergency room now, Go meet him.  The day moves on into the afternoon and eventually, there will be a “Light in August”.    And so it goes, et mas.