I know,” Dr. Dalby grinned.
Moe made an incision with one uniform motion in the midline from two centimeters below the umbilicus to just above the pubis. The electro-cautery was used to stop the sub-cutaneous bleeding, then Moe used the scalpel to incise the midline fascia and enter the Space of Retzius. The peritoneum and abdominal contents were retracted superiorly and medially to expose the pelvis. Following this, the lymph nodes were harvested from the external iliac, internal iliac and obturator chains, then sent for frozen section. In fifteen minutes they would get a pathology report on the nodes. Using the argon-beam, Moe photo-coagulated the pubo-prostatic ligaments, then carefully cut them with Metzenbaum scissors. If bleeding was going to be a problem, it almost always started at this point in the operation.
Even though the distinct musky aroma of fresh blood filled the room, the bleeding was minimal and the operating field remained relatively dry. Not waiting for the pathology report on the nodes, Moe proceeded to incise the right endopelvic fascia, then handed the long-handle scalpel to Rusty to do the same on the left side. Dissection was then carried anteriorly down to the apex of the prostate, and the urethra was transected at this level; a few drops of urine dripped into the pelvis and were promptly removed by the hand-held Yankar suction. So far, so good. There did not appear to be much bleeding and there was no evidence of obvious spread of cancer beyond the prostate.
“How much blood have we lost?” Moe hunched his shoulders back, trying to work on his recurrent back spasm.
“Dusty, like St. George in August—maybe 300 cc. Dry surgery, just like they do it in Texas, huh Moe?” Dr. Dalby chuckled. “How did you like the residency program down there in the land of red necks, white lightnin’ and the Lone Star Beer?”
“Don’t forget the Dallas Cowboy Cheerleaders. David, why do I always feel like you’re trying to bait me?”
“Nah, I just want to know about residency training in Texas,” Dr. Dalby said, winking at Judy.
“Yeah, it was good training, but I almost didn’t finish,” Moe remarked. He was one of those rare surgeons who could talk and work at the same time. “Did I tell you about the time I got suspended?”
Meanwhile, Rusty rolled the prostate superiorly toward the bladder, and Moe took down the lateral vascular attachments, cut and clamped the ejaculatory ducts, and freed up the seminal vesicals.
“No, I don’t believe I’ve heard that one,” Dalby smirked.
Moe was obviously feeling better, now that the surgery was going so well and the bleeding was sparse.
“I was stationed at the Veterans Administration Hospital in Temple. It was a thousand bed hospital and I was running my ass off. Not only did I have to do all the surgery, but I had to take care of all the inpatients, do all the consults, cover the E.R. and see all of the clinic patients as well. You see, they had just fired the resident from the year ahead of me, so I didn’t have a minute.”
As he talked, the prostate was dissected from the bladder neck, totally freeing it of all attachments, then it was sent along with the seminal vesicals and a portion of the ejaculatory ducts to pathology.
“One day, I was working in the clinic, must of had thirty patients waiting, and the medical records department sent me a nasty letter through that pneumatic-vacuum tube system, threatening me that if I didn’t get my charts completed, they were going to suspend me. It’s not like I had a lot of spare time. Hell, I hadn’t slept more’n four hours a night for a month and considering what they paid me, it worked out to about sixty cents an hour. The more I thought about it, the more pissed I got. As I was seeing patients, I was getting myself worked up; slavery is still alive and well in America.”
As the story progressed, Moe and Rusty continued to work. The transected urethra was re-anastomosed to the bladder neck using 2-0 chromic catgut suture.
“So when I finished doing a prostate exam on this grizzly old veteran, I was fuming. You know, feeling awfully picked on. In a rage, I jerked off my soiled glove—it really wasn’t that bad, a brown smear and maybe a couple of little chunks—and flung it in the little tube, then vacuumed it back to the records department. Needless to say, the sons-a-bitches couldn’t take a joke and had me suspended.” Moe laughed as he put a Foley catheter in the bladder and two penrose drains deep in the pelvis.
“I wonder why? I’ll bet, that’s the only communication the records department ever got they had to call the biological hazards unit to dispose of!” Dr. Dalby was shaking with laugher. “How did you squirm out of that one, Moe?”
“They eventually saw the light and realized slave labor wasn’t that easy to come by in the twenty-first century It’s been over a hundred and fifty years since the civil war, so they took me back,” Moe said. “You don’t think for a minute that those attending physicians wanted to do all that work, do you? Especially, after they had just fired one resident.”
The pathology report on the nodes came back negative and the surgery was drawing to a close. Moe closed the fascia with #1 PDS suture, that left only the skin to close. At this point in the operation, Rusty broke scrub and turned to leave the operating room. As he walked away, Moe noticed Rusty made eye contact with Judy in what appeared to be some form of silent communication.
“Rusty, don’t forget we’ve got a penile prosthesis next—Mr. Calley,” Moe said.
“Huh? I almost forgot,” Rusty replied. “Rigid or inflatable?”
“Inflatable. AMS-700.”
“Okay, but I’m supposed to be in the office by ten.”
“I guess, you’d better call Sally then, and tell her you’ll be a little late.”
Rusty glanced one more time at Judy, then left the operating room.
“Great job, Moe.” Dr. Dalby turned down the flurane gas knob on the anesthesia machine. “Very little blood loss. The patient did fine.”
“Thanks, David, you can start waking him up, all I got left is to close the skin.” Turning to Judy, he added, “How about some Addison forceps and some skin clips.”
Judy handed Moe the instruments, then quietly said, “Can I talk to you for a minute after surgery?”
“Sure,” Moe replied. “Let me write some orders, and talk to the patient’s family, then I”ll meet you back in the surgery lounge—say twenty minutes.”
After he helped Dr. Dalby wheel Howard’s gurney to the recovery room, Moe sat at a small writing desk, scrawling his usual barely legible post-op orders. Ten minutes later, after finishing with the orders, he walked briskly for the family waiting room to find Connie.
As Moe entered the waiting room, there were two of them, two Connie’s. Both of them looked up at him with a unique mixture of stress, nerves and stunning beauy.
“Dr. Mathis, this my older,” Connie emphasized the word older, “sister, Elizabeth, from Seattle. She just got in.”
Moe reached out and shook Elizabeth’s hand. “Nice to meet you. You certainly don’t look older. In fact if I had to guess, I’d say Connie’s got you by ten years,” Moe joked.
“As usual, Connie is modifying the truth,” Elizabeth said. Her smile was dazzling. “Regardless of what she says, I’m two years younger.”
“Whatever!”
