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Across The Red Line

Across The Red Line: Stories From The Surgical Life

Richard C. Karl
Copyright Date: 2002
Published by: Temple University Press
Pages: 176
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  • Book Info
    Across The Red Line
    Book Description:

    Richard Karl, a doctor and teacher, takes the reader closer than any writer before into the corridors of the hospital, on the surgical table, and into the world of medicine. In these pages we see the tragedies and triumphs of modern medicine: the beauty of surgery done well, and the aftermath of operations that fail to deliver on the hopes of the doctor and patient. We witness the "M&M"-the morbidity and mortality meeting-where doctors scrutinize their own work and mistakes, and the often inevitable outcomes of treatment. Suffused throughout are Karl's keen observations on the workings of the human body and its immense capacity for healing. "...I celebrate the rich privilege accorded the practicing surgeon. The surgical life is really about bearing witness to the human condition and about respecting the many almost whimsical variations of biology and about the intersection of the two. It is remarkable, really, the way I get to know people so intimately so quickly, and to observe the brave and often noble behavior in them, while I witness the relentless push of biology, the aging and decay, the growth and development, but most especially the healing, both physical and emotional. It is this natural drive of our bodies to repair themselves from all injuries (including the surgeon's wounds) that is the centerpiece of medicine. Without it no surgeon could cut." Written with economy and subtlety,Across the Red Lineoffers a vivid picture of disease and the miracle of life. It will interest anyone who's ever been on either side of the surgical table.

    eISBN: 978-1-4399-0437-4
    Subjects: Health Sciences, Sociology

Table of Contents

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  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Acknowledgments
    (pp. ix-xii)
  4. Introduction: Across the Red Line
    (pp. 1-12)

    I am sitting in a patient examining room, on a stool with wheels, waiting while a 67-year-old man rummages through his wifeʹs pocketbook, looking for his list of questions. Iʹm thinking of trying to write down what this is like.

    His shirt is unbuttoned and he cannot see well without his glasses and his wife is trying to help but she is nervous and in the way.

    ʺTake your time,ʺ I say.

    I am in no rush. Already I see and feel some things that must be told. This man is returning for his first postoperative visit after having most...

  5. 1 M & M
    (pp. 13-23)

    ʺDid you split the sternum?ʺ asks Dr. Stack, the attending trauma surgeon. He wants to know if the operative team opened the breastbone in order to gain access to the heart. ʺYes,ʺ responds the fifth-year resident. He is the chief resident on the Trauma Service and this is his last year of training.

    Itʹs Monday, 7:30 a.m. Weʹre at M & M. It means Morbidity and Mortality Conference. Once a week the entire surgery department gathers together in a lecture hall at the medical school. The purpose: to discuss each error, each complication, each bad result and every death that has...

  6. 2 How It Comes About That a Successful Operation Ends in Disaster
    (pp. 24-32)

    Somehow, the phone is in my hand. My eyes fight to focus on the aquamarine numerals of the digital clock that sits on the chest by the bed. I work to make sense of the time. Itʹs 2:24 and itʹs dark and I didnʹt hear the phone ring, although I know it must have, and I recognize the voice of the intern. Heʹs excited, disjointed, worried, and, worst of all, frightened. My sudden awakening and the disorganization of his thoughts which are virtually pushed into my ear by his anxiety make the tale hard to understand, but I know something...

  7. 3 Fate
    (pp. 33-39)

    There are times in medicine when I feel like a bystander watching a traffic accident. I have no direct influence over events; I cannot make widespread cancer disappear or restore function lost to a bulletʹs capricious path. But I try hard to force the foul ball fair with lots of body English and hope and careful attention to detail. Still, there are times when coincidence is so eerie and a patientʹs fortune is so inexplicable that there seem to be larger forces at work. This last year, the story of a man and his father has been unfolding with just...

  8. 4 A Columnist Comes to Work
    (pp. 40-50)

    I have some friends in the newspaper business. Through some of them I met another, a columnist. During dinner one night, he seemed intrigued by surgery and his questions made me think that he had some ability to discern and wasnʹt a reckless man. I told him he could come and watch someday. I didnʹt expect heʹd take me up on the offer. I assumed he was just being polite. When he called, I was a bit chagrined. Nonprofessional visitors are rare and issues of safety and patient privacy are not well worked out. I promised to ask the public...

  9. 5 Four Patients in Santa Fe
    (pp. 51-56)

    Rob reaches down into a hospital crib and scoops up a four-year-old sleeping child. It is 8:30 in the morning, but the boy is still asleep. Next to the bed his mother rocks gently in the plain wooden hospital rocking chair; she blinks at the winter sunlight just now cresting the Sangre de Cristo mountains and sliding down the snow-covered mountainside into their hospital room.

    ʺCome on, Josh, wake up.ʺ Rob is firm but pleasant. He doesnʹt placate or small-talk. You can tell he means it: Get up.

    Josh has had hydrocephalus (water on the brain) and he has spastic...

  10. 6 Hanging
    (pp. 57-64)

    I donʹt care what they might tell you, any surgeon feels remorse and guilt when things turn out badly. Even if I have done the best I know how, a patient not prospering after a big operation takes over my life. In fact, I can say that each patient, from the time I make the incision until they are discharged from the hospital, fit and recovered, occupies a space at the back of my mind. I am on tenterhooks, sometimes more, sometimes less, about the outcome. Surgeons who tell you that once they have finished the operation, itʹs ʺup to...

  11. 7 Helping Sal—Knowing When to Quit
    (pp. 65-74)

    One of the hardest things I know is when to give up. Knowing when to give up on hopeless projects is the province of the truly gifted practitioner of any craft. There is a little poem or prayer that asks the Lord for the strength to know what can be changed, the serenity to accept what canʹt and the wisdom to tell the two apart. In surgery it is the same thing. There are decisions about which natural biological horrors to take on, about whether a tumor is resectable, about the patientʹs ability to withstand a big operation and her...

  12. 8 On the Table
    (pp. 75-88)

    It was a freak Friday accident, really. Another surgeon in an adjacent examining room had given a patient a mild sedative. The patient, a big, strapping 19-year-old, had become confused and combative. I heard the commotion and went to see. It looked as if he was about to fling himself out of the sixth-floor window. Careening from wall to wall, crazed, the boy struck the 60-year-old doctor. I tried to wrestle him to the ground. In time others arrived, the boy was subdued, and order restored. He was fine.

    I do not remember being hit myself, but I felt bruised...

  13. 9 Hotel Utah
    (pp. 89-96)

    I cut my finger in the operating room today. It wasnʹt that painful but I let out a pretty loud yelp when it happened. It made me shiver. We were just closing this manʹs chest after taking out his esophagus. It was one of those big needles used to approximate the ribs. They are about 3½ inches long with a pretty good curve to them. These days the greater pain is in the recognition of the risk, not in the actual piercing of the skin. Todayʹs patient was a 63-year-old man with a cancer in his esophagus. We hadnʹt given...

  14. 10 Midwest Bulletin Board
    (pp. 97-105)

    It was in the army that I first became aware of where patients came from. Until then they just seemed to show up at the hospital and the medical part of their story was so captivating that I donʹt remember ever wondering what their home was like or whether or not they had a cat. But working the night shift at the emergency room at the Fort Knox hospital forced me to see where the patients came from; Iʹd often see the wrecked car on the side of the road as I drove home. Once I was flown out to...

  15. 11 Retirement Party
    (pp. 106-116)

    I am sure I went into surgery because of my father, who was a surgeon. It isnʹt one of those pretty stories of a young boy hanging around with his patient tutoring father, though. We didnʹt talk about what he did so much as I was given to understand that what he did was very important and very serious.

    When I was ten or twelve heʹd come home late—usually after nine—and have a drink. My mother, who had saved dinner for him and had not eaten herself so that she could join him, would bring the food out...

  16. 12 Match Day
    (pp. 117-126)

    The fourth-year medical students are getting anxious. Itʹs getting close to match day. In a few weeks they will find out where theyʹre going to spend the next several years of training. This spring, after they graduate, most will pack up and move to another city and another institution to start their internship on July 1. Some will stay here, of course, but even so, the friendships of the past four years are about to undergo the same disassembly that high school students discover when they finally go off to college.

    The fourth-year students are pretty worldly now. They are...

  17. 13 The Norwich Classic Car Rally
    (pp. 127-137)

    This whole business about health care in this country has gotten beyond the breaking point. In clinic today I saw a young man who could not have been more than 45. He had had a rectal cancer at age 38. Heʹd been operated on, then received chemotherapy, then radiation. Now the tumor has recurred. Heʹs been left impotent by the surgery or the radiation, I donʹt know which. About six months ago the auto dealership where he worked went under and now he has no insurance. He and his wife of 19 years have about $25,000 worth of assets—well...

  18. 14 Luck
    (pp. 138-147)

    Itʹs been a long time since I found out about the surprising lack of correlation between a surgical job well done and a smooth, successful postoperative recovery. I remember as a resident, even, noticing that sometimes a beautiful operation performed by one of my heroes, one of the best, would end in bad result; either a major complication, or a major complication and death. On the other hand, I saw some none-too-well executed operations conclude with happy patients and what I thought was undeserved praise for their less-than-expert surgeons. What could explain this incongruity, this breach of the moral connection...