Process Analysis Technique 2

The Knife

Richard Selzer

A stillness settles in my heart and is carried to my hand. It is the quietude of resolve layered over fear. And it is this resolve that lowers us, my knife and me, deeper and deeper into the person beneath. It is an entry into the body that is nothing like a caress; still, it is among the gentlest of acts. Then stroke and stroke again, and we are joined by other instruments, hemostats and forceps, until the wound blooms with strange flowers whose looped handles fall to the sides in steely array.

There is sound, the tight click of clamps fixing teeth into severed blood vessels, the snuffle and gargle of the suction machine clearing the field of blood for the next stroke, the litany of monosyllables with which one prays his way down and in: clamp, sponge, suture, tie, cut. And there is color. The green of the cloth, the white of the sponges, the red and yellow of the body. Beneath the fat lies the fascia, the tough fibrous sheet encasing the muscles. It must be sliced and the red beef of the muscles separated. Now there are retractors to hold apart the wound. Hands move together, part, weave. We are fully engaged, like children absorbed in a game or the craftsmen of some place like Damascus.

Deeper still. The peritoneum, pink and gleaming and membranous, bulges into the wound. It is grasped with forceps, and opened. For the first time we can see into the cavity of the abdomen. Such a primitive place. One expects to find drawings of buffalo on the walls. The sense of trespassing is keener now, heightened by the world's light illuminating the organs, their secret colors revealed--maroon and salmon and yellow. The vista is sweetly vulnerable at this moment, a kind of welcoming. An arc of the liver shines high and on the right, like a dark sun. It laps over the pink sweep of the stomach, from whose lower border the gauzy omentum is draped, and through which veil one sees, sinuous, slow as just-fed snakes, the indolent coils of the intestine.

You turn aside to wash your gloves. It is a ritual cleansing. One enters this temple doubly washed. Here is man as microcosm, representing in all his parts the earth, perhaps the universe.

 Source Cited:

Selzer Richard. Mortal Lessons on the Art of Surgery. Harcourt 1996.