At eleven o’clock A.M. Dr. Wracks is preparing to go to the cafeteria to eat.  The charge nurse for the surgical unit runs directly at him and says “There is a large aneurysm to be resected in the main surgical theatre. Dr. P and Dr. W want you there now.” Tell them to find someone else to assist them,” says Dr. R.   “They want you now,” says the charge nurse. “Go and scrub in, Now!”  “I have to check a bandage and then eat,” says the Wracks.   The Charge nurse points at the door and says “NOW!”   Dr. Wracks slouches to the hallway ramparts, turn right and key in the code at the surgical unit door and enter.  “Grab a cup of coffee and some donuts,” says Dr. W.  “We may be in there all afternoon.”    dress in a new green and then scrub in.  “Where did you learn to wash your hands like that,” says Dr. Weir.  “In Mexico,” says Dr. Wracks.   “And I got a “C” in surgery operating on dogs.”  “You will do,” he adds.

      The patient is a huge obese lady who is out cold under anesthesia.  We rope her to the table.  Dr. Pan is there with a knife.  “Watch me rip her open,” he says.    He takes the stainless steel knife that glints from autoclave clean, starts at the belly and jerks it up to her rib cage.  Blood spurts everywhere.  “I will clamp the bleeders, you tie them off,” says Dr. W.   We learned to tie knots fast at the Guad.   He clamps, Wracks ties, he takes off the clamps and Wracks ties the next. “We will be in next,” says Dr. P.  He takes all the used hemostat clamps and throws them in the corner eight feet away.”   “We have to count them all before we close,” says Dr. W.   Dr. W. takes a scalpel and cuts the peritoneal membrane and the viscera bulge out of the wound.  They are a beautiful pink on white.  He then sticks his hands into her abdomen and pulls out all of her guts and sets them on her chest on top of a cotton gauze towel.   He puts another towel on top of her bowels and says to Dr. Wracks. “You have to hold them on her chest.  If you let them go, she dies.”    Dr. Wracks starts sweating and he holds and looks inside her body cavity.  Dr. P is clamping off her aorta top and bottoms one large underneath her kidney and two other on the other two femoral arteries.  The aneurysm loots like a huge asymmetrical sac, reddish purple from coagulated blood about eight centimeters in diameter.   “It is ready to burst,” says Dr. P and he goes and gets the polyester pants that will replace the artery.  He holds them up and plays with them like a little rag doll.  Dr. W says, “Is everyone ready?”  By now the whole surgical staff and medical student were watching from afar.  Some of them began to faint and were pulled outside by their friends.  The big fat woman who was dead because her heart had to stop to resect the aneurysm rolled on the table like a huge beached whale.  Dr. P said “Now.”  Dr. W maneuvered to the other side of the table next to Dr. Wracks.  Dr. P took a scalpel and in one motion delivered the aorta with aneurysm to a waiting steel bedpan held by Dr. W.  A charge nurse stepped in and took the bedpan.  I held her guts on top of her chest.  Dr. P put the polyester pants in place and started to sew.  Dr. W. took the top end and started to sew.  When they were done the polyester pants were in place with three clamps remaining.  “Second guess me Dr. W.” said Dr. P.  “It looks good,” says Dr. W.  “Let’s let her rip”.  Dr. P was the chief surgical resident in his fifth year.  He won the by over Dr. W by subjective advantage.  They were both equally good but Dr. W gets all the amputations.   Dr. P slowly, slowly. Slowly took the clamps off the aorta and threw them as far away from the table as he could.  I held her viscera on her chest.   “Start her heart,” Dr. W said to the anesthesiologist.  He injected epinephrine in her subclavian port and shocked her.  He shocked her again and the monitor came alive.  Sine wave and red blinking dot online. She is alive.  The graft inflated like a balloon and it held.  “Lets wait,” said Dr. W.  “I want to see.” The graft held and pulsed slowly. “Let go of her guts,” said Dr. W.  The Wracks muscles were frozen into tetanic spasm and as he came back into consciousness, he let them go and stepped away from the table.  Dr. P stuffed the intestines back into her body cavity and closed the peritoneum with polylysine blue strand. Dr. Ware tied and cut the knots.  Dr. P said “thank you everyone.” And left.  Dr. W. said “Here is the stapler, “you staple her up.”  “I have to do an amputation.” So, Dr. Wracks staples with a large stainless-steel stapler.  A second-year resident held the skin together for me as he stapled.  I asked, “Why staples?”  The resident said, “In case we need to rip her open again, we can pop them quickly.”  The Wracks staples.  The anesthesiologist and the internist wheel her into recovery. They say, “You can go eat dinner now.”   He has to eat dinner because tonight was a call night every third day.  He will have to be up late.  Cigarettes lose their taste.  Coffee gives everyone who drinks a lot of it an ulcer.  What keeps someone going is sheer will, perseverance and faith.  After dinner Dr. Wracks will sleep an hour and then walk my rounds through the hospital till, they tell him they do not need him until tomorrow.  By then it will be tomorrow anyway and the cycle begins anew and he wonders if he is really cut out to be a surgeon.  Dr. Wracks needs too much sleep.  Every man must know his limitations and without knowing these a man is vulnerable to life and in life is birth, death and a new beginning.  Dr. Wracks goes to the locker and scrubs out.  Someone has stolen the earpieces from his stethoscope. He wraps tape around the pipe. Stick them in a pocket and walk towards the cafeteria.  The moon is full outside.  Spring is in the air.  The snow has melted and the air is delicious, but the Wracks is inside doing what needs to be done because it has to be done and he really wonders why. There must be a better way.  The Wracks thinks about how he is going to sabotage his pager because they always bust him at dinner to do a blood gas.  They say I have good hands.  I would rather have a good heart.  The African American cook looks at Dr. Wracks with a smile in the cafeteria. “The same,” he says.  Chicken fricassee with broccoli and a scoop of mashed potatoes. Then coffee and a cigarette.   He does not know why she smiles at me. At this point he does not care.  Dr. Wracks is on call tonight in the ICU.