按键盘上方向键 ← 或 → 可快速上下翻页，按键盘上的 Enter 键可回到本书目录页，按键盘上方向键 ↑ 可回到本页顶部！
————未阅读完？加入书签已便下次继续阅读！
ecame essential； and she found herself now； coolly and without personal feelings； assessing the immediate surgical requirements。
The anesthetist； at the head of the operating table； had already given his clearance to proceed。 For some minutes now Lucy's assistant…today； one of the hospital interns…had been holding up the leg which was to be removed； so as to allow the blood to drain out as far as possible。 Now Lucy began to arrange a pneumatic tourniquet high on the thigh； leaving it； for the moment； loosely in position。
Without being asked the scrub nurse handed scissors across the table； and Lucy began to snip off the bandages which had covered the leg since it had been shaved； then prepped with hexachlorophene； the night before。 The bandages fell away and the circulating nurse removed them from the floor。
Lucy glanced at the clock。 The leg had been held up； close to vertical； for five minutes and the flesh appeared pale。 The intern changed hands and she asked him； 〃Arms getting tired？〃
He grinned behind his face mask。 〃I wouldn't want to do it for an hour。〃
The anesthetist had moved to the tourniquet and was looking at Lucy inquiringly。 She nodded and said； 〃Yes； please。〃 The anesthetist began to pump air into the rubber tourniquet； cutting off circulation to the leg； and when he had finished the intern lowered the limb until it rested horizontally on the operating table。 Together the intern and scrub nurse draped the patient with a sterile green sheet until only the operative portion of the leg remained exposed。 Lucy then began the final prepping； painting the surgical area with alcoholic zephiran。
There was an audience in the O。R。 today…two medical students from the university； and Lucy beckoned them closer。 The scrub nurse passed a knife； and Lucy began to scrape the tip of the blade against the exposed flesh of the thigh； talking as she worked。
〃You'll notice that I'm marking the level of the flaps by scratching them on first。 That's to give us our landmarks。〃 Now she began to cut more deeply； exposing the fascia immediately below the skin； with its layer of yellow fatty tissue。 〃It's important always to make the front flap longer than the back one； so that afterward the suture line es a little posterially。 In that way the patient won't have a scar right at the end of the stump。 If we did leave a scar in that position it could be extremely sore when any weight was put upon it。〃
Now the flesh was cut deeply； the lines of both flaps defined by the blood which had begun to seep out。 The effect； front and rear； was rather like two shirttails…one long； one short…which eventually would be brought together and sewn neatly at their edges。
Using a scalpel and working with short； sharp movements； Lucy began to strip back the flesh； upward； exposing the bloody red mass of underlying tissue。
〃Rake； please！〃 The scrub nurse passed the instrument and Lucy positioned it； holding back the loose； cut flesh； clear of the next layer below。 She signaled to the intern to hold the rake in place； which he did； and she applied herself to cutting deeper； through the first layer of quadriceps muscle。
〃In a moment we shall expose the main arteries。 Yes； here we are…first the femoral vessel。〃 As Lucy located it the two medical students leaned forward intently。 She went on calmly； matching her action to the words。 〃We'll try to free the vessels as high up as possible； then pull them down and tie off so that they retract well clear of the stump。〃 The needle which the scrub nurse had passed danced in and out。 Lucy tied the big vessels twice to be sure they were secure and would remain so； any later hemorrhage in this area could be catastrophic for the patient。 Then； holding her hand for scissors； she took them and severed the main artery leading to the lower limb。 The first irrevocable step to amputation had now been taken。
The same procedure followed quickly for the other arteries and veins。 Then； cutting again through muscle； Lucy reached and exposed the nerve running parallel downward。 As her gloved hands ran over it exploringly； Vivian's body stirred suddenly on the table and all eyes switched quickly to the anesthetist at its head。 He nodded reassuringly。 〃The patient's doing fine； no problems。〃 One of his hands was against Vivian's cheek； it was pale； but her breathing was deep and regular。 Her eyes were open but unseeing； with her head fully back； untilted to one side or the other； the pockets of her eyes were deep with water…her own tears； shed in unconsciousness。
〃We follow the same procedure with the nerve； as with the arteries and veins…pull it down； tie it off as high as possible； then cut and allow it to retract。〃 Lucy was talking almost automatically； the words following her hands； the habit of teaching strong。 She went on calmly； 〃There's always been a lot of discussion among surgeons on the best way to treat nerve ends during amputation。 The object； naturally； is to avoid pain afterward at the stump。〃 She deftly tied a knot and nodded to the intern； who snipped off the spare ends of suture。 〃Quite a few methods have been tried…injection of alcohol； burning the nerve end with an electric cautery； but the method we're following today is still the simplest and most widely used。〃
Lucy glanced up at the clock on the O。R。 wall。 It showed 9：15…forty…five minutes so far since they had begun。 She returned her eyes by way of the anesthetist。
〃Still all right？〃
The anesthetist nodded。 〃Couldn't be better； Lucy。 She's a real healthy girl。〃 Facetiously he asked； 〃You sure you're taking the leg off the right patient？〃
〃I'm sure。〃
Lucy had never enjoyed operating…room jokes about patients on the table； though she had known some surgeons who wisecracked their way from first incision to closure。 She supposed it was all in your point of view。 Perhaps with some people levity was a means to cover up deeper feelings； perhaps not。 At any rate she preferred to change the subject。 Beginning to cut the muscles at the back of the leg； she asked the anesthetist； 〃How's your family？〃 Lucy paused to use a second rake to hold back the flesh from the new incision。
〃They're fine。 We're moving into a new house next week。〃
〃Oh； really。 Whereabouts？〃 To the intern she said； 〃A little higher； please。 Try to hold it back right out of the way。〃
〃Somerset Heights。 It's a new subdivision in the north end。〃
The back leg muscles were almost severed。 She said； 〃I think I've heard of it。 I expect your wife is pleased。〃
Now the bone was visible； the whole incision big； red； gaping。 The anesthetist answered； 〃She's in seventh heaven…buying rugs； choosing draperies； all the other things。 There's only one problem。〃
Lucy's fingers went around the leg bone； working up and freeing the surrounding muscles。 Speaking for the students' benefit； she said； 〃You'll notice that I'm pushing the muscles as far out of the way as I can。 Then we can sever the bone quite high so that afterward it will be entirely covered with muscle。〃
The intern was having trouble holding back the overlapping muscles with his two rakes。 She helped him position them and he gumbled； 〃Next time I do this I'll bring my third hand。〃
〃Saw； please。〃