her very nicely and she began to feel good about it. After completing the vast amount of paperwork that would allow her legally to start cutting in Abilene, Texas, she and Doc took off for the operating room. He directed her to the women’s dressing room where she got dressed with the female nurses and scrub techs. Male doctors always had their own dressing rooms. Only the newest and largest hospitals had designated female physician dressing rooms. It was only an observation because she didn’t really mind getting dressed with the staff. That way she got to know people. Girl chat while getting ready to work. It could be fun most of the time. She could also get the lowdown on some of the surgeons that way.
She slipped on a pair of grey green scrubs, booties, poofy blue paper hat, and was ready to go. She met Doc out in the sterile corridor and he again introduced her around. She thought she might be the only female surgeon they had ever had around there, never mind being an orthopedic surgeon. There were probably some female Ob-Gyns, but they mostly hung out in labor and delivery. Very rarely did they operate in the main OR. Again, everyone clearly having great respect and affection for Doc Hawley, from which she in turn benefited.
Eula Parsons was ready for surgery. She had an empty stomach, a signed permit for a right hip hemiarthroplasty, and a bag of IV antibiotics hanging. She was prepared for her operation. They stopped by the holding area to talk with her a little, then headed down the hall to the sinks outside the operating rooms where Doc did most of his cases. They scrubbed their hands with a sweet smelling pink soap, held their hands up in the air and went into the operating room. Lots of friendly talking with the patient while everyone was getting ready. The anesthesiologist began to administer the Fentanyl through a syringe in one hand while he rubbed the patient’s eyebrow softly with his thumb. Very nice. The patient went off to sleep quietly, easily.
Then everyone got very busy with intubation, gowning and prepping. She heard a little benign ribbing between Doc Hawley and the scrub tech. Introductions were made again. How would she memorize everyone’s name? At each previous job she didn’t have time and it really wasn’t expected. These people were important in the day-to-day operations but had become nameless and faceless within days of leaving the town.
The charge nurse in the operating room was a guy. He seemed friendly enough and was knowledgeable and efficient. He tied up the back of their gowns and helped them bring their belts around to tie in front. He then took another look at the permit, reminded and confirmed the right hip with Dr. Hawley. The patient had a big red “YES’ written on her right hip exactly where the incision would be. Eula was then gently turned onto her left side with her right side up. Positioning devices were utilized to hold her in place. Her right hip was prepped with gooey Betadine liquid and covered with about a dozen sterile drapes.
Doc stepped up to the table followed by Leslie on the opposite side. He made a curved incision across the side of Eula’s hip and cut straight through to the fat underneath. The bleeders were cauterized. Some were squirting blood and it was harder to stop them. He cut quickly through the large flat tendon that goes all the way from the pelvis to just below the knee and exposed the big bone on the side of the upper end of the thigh. He took some leg measurements now so he could make sure the legs were the same length at the end of the case. He then divided the muscles that rotate the hip outward from their attachment to bone. Blood and joint fluid oozed out from the hip joint and had to be sucked out so he could see. Leslie worked quickly to this end. She took just as much pride in being a good assistant as being the primary surgeon.
A giant screw was stuck down into the broken head of the hip, twisted home and the broken head was pulled out of the acetabulum, holding on for dear life until it gave up with a loud sucking sound. It was a brutal maneuver, without a doubt, but there was something satisfying about pulling out that dead, broken head of the hip bone. It had failed its owner and now was useless, because in the process of breaking it had also lost its blood supply and so could not be counted on to heal. Better to remove and replace it than to try to repair it in a patient this age. They made some extra cuts in the bone and then replaced the dead broken head with a brand new shiny metal hip replacement. It was measured to fit the cup, and the leg length was checked. Leslie then took the leg, pulled firmly and rotated it to the point where it went easily home with a soft sucking sound. Eula would be able to get out of bed the next day, and then start walking when she regained her energy. Her overall feeble condition and not the hip would be the limiting factor.
Leslie thought of her own grandmother, who had died of a blood clot which went to her lungs after a long period of bed rest following a hip fracture. Leslie had been in grade school and only vaguely remembered the circumstances. An orthopedic surgeon had fixed the hip but the fixation methods then were not thought stable enough to allow early mobilization. She was placed at bed rest for an extended period of time and it didn’t take long before she had bed sores and contractures of her already weakened extremities. When she was finally deemed ready to rehabilitate she got up out of bed, became short of breath and died of the pulmonary embolism that had broken off from the clots which had been growing up the deep veins of her legs for weeks. At that time the majority of people who sustained hip fractures were dead within a year of their fracture, victims of those blood clots and other medical complications. Those statistics had improved remarkably in the past quarter of a century. Still, blood clots were a dark potential.
Doc and Leslie started to close the wound. They got into a rhythm, both of them experienced with this operation. The critical part was done and now the closing of each specific layer. The two got their timing down and the closing became sort of an assembly line of throwing stitches, tying knots and cutting them. Doc threw the suture with the needle driver and Leslie pulled the suture from the needle then quickly tied a single hand knot. Bam, bam, bam. Doc looked up over his mask and gave her a nod. They sailed through all the layers of muscles, fat and skin like they had done this together a thousand times. Doc grabbed all the sutures upwards in his big fist and Leslie cut them very carefully, turning the scissors “just so” in order to keep from cutting the knots.
When she was a resident or medical student and cut a knot, she’d get her ass chewed out in front of everyone. And everyone loved to see it happen. Nothing like seeing a student doctor get humiliated. That might also be an opportunity for an attending surgeon to ask some questions to which she might not know the answer, like naming all the stages in the blood clotting pathway, or something. And everyone loves to see that happen too.
Leslie was confident she would never cut a knot, but she did. Doc looked up at her again, this time with a raised eyebrow. She went over the stages of blood clotting in her mind, thinking, once a student, always a student, and Doc said, “Shit, I knew it. You’re a no-suture-cuttin’ fool, is what you are.” Everyone laughed, Leslie included and Doc said, “Now, I’m gonna have to ask you all the branches of the sacral plexus!”
“But I can recite the blood coagulation pathway.”
“Well, that just won’t do.” Again, chuckles in the OR. “Seriously, Doc, that went great.” He put his fist across the table over the patient’s hip, to receive her fist in the manner of the “hood.” They winked at each other and Leslie was smiling under her mask. It really had gone well…for them and the patient.
They helped the nurse apply dressings, then turned the patient on her back. Doc wrote orders while Leslie looked over his shoulder to check them out. They discussed their opinions on deep vein thrombosis prophylaxis and both were basically in agreement on the protocol for that.
In the surgery waiting room they found Eula’s family. Doc introduced Leslie. He told them the operation went great. Talked about the expectations for the next few days, rehab, and the things the family could do to help her progress. Leslie realized she would be taking over the care of their mom and seeing her in the office too. It was strange thinking that Doc would be in Lubbock having his surgery in a few days. She wondered how he was feeling about it. They all shook hands. Doc and Leslie headed off to the doctor’s lounge for lunch.
Leslie drove Doc
