Dear John

Dear John Doe –

I only met you once in the operating room, and I wish I knew who you were. I have seen inside your body but have never seen your face. While you were exposed and vulnerable, I didn’t hold your hand. Instead, I held your aorta.

Your surgery had already started when I arrived. You were already asleep with your abdomen open and defenseless against the air in the operating room. Even so, you seemed more at ease and prepared to be there than I was. My preceptor had finished for the day and sent me into your surgery; I had never seen a case like yours before.

Your name was written at the top of the large whiteboard in your operating room, but I never looked at it. Instead, I learned the name of your surgeon and tried to decide where to write my name. The board provided designated space for common key players found in the OR:

Attending
1st Assist
Surgical Tech
Scrub Tech
RN
Medical Rep
Observer

Which one was I? Honestly, I wasn’t sure and added my name at the very bottom, in the physical gray area between observer and an otherwise undesignated role.

The conversation being held over your body about the recent holiday party lulled long enough for me to introduce myself and hand my sterile gear to your scrub tech. Your surgeon greeted me with a slight nod.

When I returned, ready to help with your surgery, I slowly inched towards your open belly. “I won’t bite,” your surgeon reassured me, “this is surgery, you should get used to being close together. No use being shy here.” I think he was being kind rather than critical, but I had heard too many warnings about surgeon personalities to trust his tone of voice. I don’t remember replying, but I did settle in close to him.

Instead of the standard conversation ice-breakers asking where I go to school, what year I am in my training, or what specialty I will choose, your surgeon asked me to name the anatomical structures he should be sure not to damage. I forced myself out of the slight daze triggered by the offensive fluorescent lights and the smell of recently used cautery. If I am going to help with your surgery, I really should be able to answer this question.
Think. Think. “The iliac vessels?”
“Is that a question?”
Kind of, yeah. It was the first thing I could think of while trying to mentally reconstruct that day in anatomy lab when we dissected the abdomen and pelvis. Your beeping vitals monitor and my bloody gloves distracted me from maintaining focus with a clear head. Arteries are always important, though. So I respond, “no, you need to watch out for the iliac vessels.”
“Very good.”
Apparently, I passed this initial round.

We held light conversation over your open body; it is amazing how much you were able to withstand. I learned the name of the retractor system used to hold your skin out of the way and was excited to hold tools while your surgeon worked. I entertained myself with your magnificent bowel. Touching it just right induced peristalsis, even while you were paralyzed and heavily sedated.

I will admit, I was not prepared for the day we met. Usually, I will familiarize myself with a procedure before arriving, but I did not get the chance to review your story before meeting you. I was grateful that your surgeon did not test me on the intricacies of the procedure, I think that would have been painful for everyone in the room, except you, perhaps. You might have been the only person spared from the embarrassment when it’s revealed that I mostly did not know what was going on.

Your surgeon paused with his work and dug around for something in your belly. I hoped that he hadn’t dropped something. With his other hand, he grabbed my forearm and guided my hand into your belly until we were swimming up to our elbows in your bowel.
“Feel that?” he asks.
“Yes,” I can barely form the word and spit it out.
“That’s the aorta,” he says, just to be sure we were all on the same page, “don’t squeeze too hard.”

I felt the strong, pulsating vessel in my hand and thought of the first aorta I held two years ago; the aorta of my “first patient”.^[1] My first patient, the donated body that three of my classmates and I dissected in the first few months of medical school, is the crux of my understanding of human anatomy. He is the one with whom I compared your anatomy. His aorta was stiff and only slightly flexible, and I do not remember being very impressed by it. Your aorta was incomparable. Yours was full of life.

Holding your aorta felt similar to my attempt at wrapping my brain around the idea that Betelgeuse may be exploding right now, which means that it already exploded 600 years ago.^[2] To the universe, stars exploding are commonplace. A star just like our Sun explodes about every second somewhere in the massive universe.^[3] Perhaps a star is important for a time but its moment to shine is still only temporary. Just like a star exploding somewhere out in the universe, your aorta was both momentous and also mundane.

From outside my body, I observed myself holding the route of your blood supply. My presence in your OR–in any OR–is temporary, but that did not seem to matter anymore. Just moments ago, I had been preoccupied with my own performance and identity and did not think about yours. The impact you had on me is permanent, and I am sorry that I do not know who you are.