"my first time....."

  We all remember our first time. The jitters, the tentativeness, the churning stomach, the excitement of anticipation....our first appendectomy! Mine came early in that sub-intern year at Kings County.
One night, around 11pm, I was scrubbed in on a knife-wound case with my chief resident Greg Rauscher, a good-looking, mild-mannered, cocky guy who was headed for a plastic surgery fellowship the following year. Greg always had time to teach, no matter what was going on, and he let me scrub in routinely on these big cases, mostly because I was always hanging around, but also because I was another pair of hands and legs when he needed them. I do credit him with getting me interested in plastic surgery at an early stage, and with demonstrating to me how important teaching the residents who were coming up after you was.
Nothing fazed Greg, that I remember, and it was comforting to be around someone who showed no fear when a terrible motor vehicle accident, or stabbing, or multiple gunshot wound victim was brought in. You need to be cocky, I think, to be a good trauma surgeon. Even if you're not exactly sure about what to do in that first instant when the patient arrives and the EMT is shouting data into your face, you can never let anyone else become aware of even the slightest indecision on your part. You're the general at that moment, and the troops need to be led, even if, rarely, it might be in the wrong direction.
Greg still runs a very successful plastic surgery practice in NJ and I see him once in a while at the plastic surgery meetings in New York.
Anyway, someone had called up to the OR from the emergence room while we were huddled over this young man with the knife wound. There was a woman in the ER with signs of appendicitis. Her lab-work was pending but the ER doc was pretty sure this was the real thing. They needed someone from surgery to take a look.
Greg, at that point, was up to his elbows in blood which was oozing out in a steady untamed stream from the patient's nicked vena cava. He was attempting to place sutures into the vena cava's fragile side wall before it disappeared beneath the liver, a feat which is as precarious and difficult as it sounds.  Without looking up, he mumbled, "Steve, go take a look." So I scrubbed out and left.

"Jesus Christ, you MUST be kidding," the woman said when I walked into the exam room. Of all people, an ex-girlfriend from college who was now in her last year of nursing school at Downstate, was propped up on one arm on the gurney.
"Just the welcome I had hoped for."
"No really, you're not going to lay one hand on me."
"Sorry, Cindy (I changed her name to protect her medical history, among other things) you don't have much choice at this hour of the night."
There are moments, we've all had them, when Karma and Coincidence conspire to make things, shall we say, a little more interesting than they might have been. Seriously, how unlikely was this? How sweet for me! I hadn't seen Cindy in over four years. I knew she was in nursing school at Downstate, but our paths had just never crossed there. Until now.
Cindy had been working the night shift in the ICU at the County, felt pain in her lower right abdomen, got nauseous, and assumed the worst. Instead of heading across the street to the University Hospital, she just thought she might as well head right down to the Kings County ER to be checked out. And then I show up.
"So let's make this as professional as possible," I said. "Lay back and let me take a look."
"Do you even know what you're doing? I need a real MD. Where's the resident? This is just too ridiculous."
Some of her snarkiness, I was sure, had to do with my failing to come up with Rod Stewart tickets at Madison Square Garden in September of 1972, at a time when I was in love with her, but she was in love with Rod Stewart. But I also realized that Cindy most likely had no recollection of that episode, and that my own memory was surely clouded by the fact that she had dumped me around the same time that those tickets became an issue, moved on and was now dating a guy who would become her future husband.
"You are DEFINITELY not operating on me,"  she offered.
"Of course not," I said. "How could you even think that? I'm a sub-intern. The fourth or fifth year resident will do it. And that's assuming something needs to be done. Can I just take a look and see?"
She slumped back onto her back, lifted her gown and put both her arms behind her head in a huff.
"Take a feel," she said.
Suppressing the urge to laugh, or even smile, was unbearable. I put on the most serious countenance I could muster, warmed my hands like my physical diagnosis instructor Saul Grossberg had told me "always" to do, and began to poke around Cindy's belly. It was softer, and smoother and more perfect than I had remembered, but then I thought, I really had never run my hands like that down by her pelvis before. I had gotten to second base maybe, but definitely no further, when the "ticket incident" impeded any further progress.
"What are you doing?" she shouted.
"Examining you."
"Well, yeah, I can see that!"
"Oh for God's sake. Let's be adults about this," I said. "Does this hurt?" She shook her head. "Here?"   "No."
Finally, when I got to the right lower quadrant, she winced and jerked back. "Hm, that's pretty significant," I nodded. "And your white count is 13,000." After taking a history and confirming her periods were normal, which is a rather delicate conversation to have with an ex, and after the gynecology resident examined her and told me she didn't think Cindy had an ovarian cyst that had ruptured, or a tubal pregnancy, we all agreed (including Cindy) that her appendix needed to come out. Now these were the days before sonography or laparoscopy (let alone CT scans) were widely available, and it would be a long while before they were  available to the poor patients at Kings County Hospital, for sure. So appendectomies, and other emergency surgeries were routinely performed on a good exam, some basic blood work, and the hope that you were right. So up to the OR I brought her, where, I assumed, she would be operated on by the first available qualified surgical resident, even Greg Rauscher if she was lucky enough to catch him when he was done with the knife wound.

TO BE CONTINUED