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Best Doctors 2000:
My Surgeon's Secret Life

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Some years ago, my doctor -- my brain surgeon, actually -- invited me to a dinner party. This was not long after he'd operated on my right occipital lobe, near the center of vision, removing some worn, knotty blood vessels. I'd been in Nicaragua when I first suffered a sudden excruciating headache and partial blindness. I shuffled to a series of kindly Central American doctors who offered a variety of diagnoses -- from eye trouble to stomach virus. It was my good fortune that Nicaragua didn't at that time have a brain surgeon, and since New York is home to some of the world's best neurological care, I was dispatched to home.

In fact, New York has more brain surgeons than any other town in the world. Mine was selected for me by a family friend, a neuroradiologist. First my friend told me I'd suffered a brain hemorrhage. Then he said he had just the surgeon for me, a specialist in vascular malformations in the brain, which is what, by now, I understood I had. "He's terrific," I was told.

The operation, as far as I could be aware of it, was uneventful. Brain surgery is painless, and my recovery was quick. It's just a bad haircut, I took to saying. Still, I couldn't help myself. This is what I wondered: Had the person who'd mucked around inside my brain really been the best person for the job? I wanted assurances, even after the fact. So I went eagerly to that dinner party. It was a terrific evening. The surgeon was engaging, cultivated. He smoked a pipe. He showed me which part of the asparagus not to eat -- I hadn't known! He mentioned his collection of medieval surgical instruments, and I got a look at his rare books. He had a Vesalius, I believe -- and he had read it (I saw his pencilings in the margin). The evening was pleasantly reassuring. But toward the end -- during dessert, I think -- I asked if I could follow him into the operating room some day. I wanted to see what I had missed when I was under anesthesia. "Sure," my surgeon responded cheerfully.

We all know a lot about operating rooms by now. The blue dress scheme, the chilling beep of monitors, and, in the center, the sleeping patient draped like a sofa in storage. Still, I hadn't expected the microscopes. Neurosurgeons work through microscopes aimed at a hole a couple inches into the brain. There are microscalpels and a pointy suction that drains accumulating fluids and allows the surgeon to see. A TV was hooked into the microscope. I followed the operation on its wide screen.

As luck would have it, the case on the table was not unlike my own. Since I had no inkling of intracranial anatomy, I watched for dramatic cues. I didn't have to wait long. The surgeon was at a particularly delicate stage of the operation when bleeding started -- a hemorrhage of sorts. That hole in the head was filling with blood. Worse, the suction failed. The entire TV screen turned a sanguinary red. Worse still, it seemed to me, my surgeon was beside himself. He jumped up and down on his stool. He pounded his feet.

"I have no suction," he yelled.

"Checking," came a woman's voice.

"What good does that do, goddamned son of a bitch," he replied.

The suction returned, only to cut out again.

"Get the sucker on! Of all times for this to happen!" The surgeon stomped his heels on the tile floor. His gestures, his voice, were like a mugger's, almost violent, not at all like the thoughtful physician I'd known at my own bedside. The suction returned, but the bleeding was difficult to stop. Blood actually jumped from the head. Like ocean spray, I thought. "I'm doing something wrong," the surgeon shouted to no one in particular. Shouting seemed his way of gaining control in an emergency. "This is a fucking travesty," he yelled. "Control that bleeding!" He worked furiously. "What the hell am I missing here?" he said.

There was no mistaking: This erudite man who collected wines and medieval medical instruments was flat-out; the craft itself was flat-out. I had wanted reassurance of some sort, but seeing the crisis, I couldn't imagine that things were ever different. Control in the operating room must always be in danger of slipping away. I covered my masked mouth. Don't let anything happen to this poor patient, I thought.

Then it ended. The surgeon stopped the bleeding. The routine was reestablished. "I know it gets confusing," he said to the nurse with perfect calm. His gown was splattered with blood.

Afterward, when I asked how he was, he said, "If the patient is all right, then it'll be a high. If his left side is paralyzed, it'll be damned depressing."

Often, when we choose a doctor, we think about bedside manner, or some corollary. She is really nice. He takes time with you. I can get through to her on the phone. "How have you been?" he asks engagingly, and doesn't check his watch. The doctor-patient bond is mostly what patients see. That and the handsome bill. But when it comes to the practice of medicine -- the thing that matters most -- my visit to the OR opened my eyes to the fact that others are best suited to judge. In the case of my surgeon, for instance, it was that family friend, the neuroradiologist, who had seen my surgeon's videotapes and his results, day in and day out. The truth was that whether or not he was engaging or widely read, or whether or not he yelled at himself in the operating room, he was a terrific surgeon, a fierce advocate for a patient. And the doctors who worked closest with him knew this best.

The patient on the table woke up and was fine -- better for knowing nothing of the drama he'd slept through -- and so, years later, am I.


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