Having taken the recruits that far, the two veterans headed for the game in the Painless Polish Poker and Dental Clinic to pass the two hours until the patients would be ready for surgery. When they figured that the patients had been sufficiently transfused and adequately resuscitated, they headed back to the OR, scrubbed and joined their junior partners.
Duke and Captain Russell had a boy whose small bowel was somewhat perforated, requiring removal of two different areas and closure of several individual holes. This sort of work is done ritualistically in most surgical training programs, because it is basic to belly surgery and should never be learned incorrectly, and as a result, the surgical residents in their third and fourth years of training, particularly in good teaching hospitals, may still be at the ritualistic stage. Captain Russell surely was.
Duke having determined that all they had to do was fix the small bowel and that time, up to a point, was not going to be a factor, decided to sweat it out. For two hours he stood there amusing himself by mildly insulting Knocko McCarthy, who wouldn’t hurt him while he was scrubbed, and assisting in wonder as Captain Russell performed a small bowel resection as performed by the residents in a large university hospital.
“Do y’all mind if I do this one?” he asked, as Captain Russell finally advanced on the second area needing repair. “I lost twenty bucks in that poker game, and I’ll never get even at this rate.”
He didn’t wait for an answer. In twenty minutes he removed the damaged segment of bowel and sewed the two ends together.
“Y’all probably noticed,” he explained to Captain Russell as they were closing, “that when clamping and cutting the mesentery, I wasn’t quite as dainty as y’all were. Y’all will recall that I didn’t do the anastomosis with three layers of interrupted silk, like y’all did. I used an inner layer of continuous catgut and interrupted silk in the serosa. Where y’all put twelve sutures on the anterior side of yours, I put four. Y’all observed that the lumen in my anastomosis is as big as yours, I’ve got mucosa to mucosa, submucosa more or less to submucosa, muscularis pretty much to muscularis and serosa to serosa, and there ain’t any place where it’s gonna leak. It took y’all two hours, and it took me twenty minutes. Your way is fine, but y’all can’t get away with it around here. Y’all will kill people with it, because a lot of these kids who can stand two hours of surgery can’t stand six hours of it.”
“But …” Captain Russell started to say.
“That’s right,” Duke said, “and if I’m really in a hurry I’ll ride with just the continuous catgut through all the layers.”
So it went, for several weeks. The recruits, being polite, listened and, being intelligent, learned. They had both, however, been born and bred, as well as formally educated, to be fastidious, so the shucking of old habits did not come easily. Captain Pinkham, in particular, still tended to get bogged down in detail. He would become completely absorbed in repairing damage to a hand and ignore or sublimate the obvious fact that the patient could die of his abdominal wounds. Once, in fact, on a busy night while Hawkeye was occupied elsewhere, he spent six hours on a case that should not have taken more than two hours and managed to miss a hole in the upper part of the stomach. The patient almost died, early, from too much surgery and, later, from the missed hole. Hawkeye took that one back to the table and, two days later, with the patient well on the way to recovery, he was able to make this the case in point.
“Now I’ll offer you some thoughts,” he told the much relieved Captain Pinkham. “This is certainly meatball surgery we do around here, but I think you can see now that meatball surgery is a specialty in itself. We are not concerned with the ultimate reconstruction of the patient. We are concerned only with getting the kid out of here alive enough for someone else to reconstruct him. Up to a point we are concerned with fingers, hands, arms and legs, but sometimes we deliberately sacrifice a leg in order to save a life, if the other wounds are more important. In fact, now and then we may lose a leg because, if we spent an extra hour trying to save it, another guy in the preop ward could die from being operated on too late.”
“That’s hard to accept at first,” he said, “but tell me something, doctor. Do you play golf?”
“I do,” Captain Pinkham said, “but I haven’t been getting much in lately.”
“Then let me put it this way,” Hawkeye said. “Our general attitude around here is that we want to play par surgery on this course. Par is a live patient. We’re not sweet swingers, and if we’ve gotta kick it in with our knees to get a par that’s how we do it.”
“I can’t argue against that,” Captain Pinkham said.
“Good,” Hawkeye said. “Come on up to The Swamp for a drink.”
Colonel Blake, of course, was enormously pleased. He had not only hit upon a project that was at least partially intriguing Captains Forrest and Pierce during their final months, but also Captains Pinkham and Russell were obviously benefitting. He had established a kind of teaching hospital. Then Captain Pinkham came to see Colonel Blake and Colonel Blake came to see Captain Pierce.
“Have a drink, Henry,” Hawkeye said.
“Yeah,” the Duke said. “Join us.”
“No, thanks,” Henry said. “How’s it going?”
“Good,” the Duke said. “Can we go home now?”
“No,” Henry said. “What I want to know is how Pinkham’s been doing lately.”
“Good,” Hawkeye said, “although the last couple of days I’ve had the feeling that I’m starting to bore him.”
“He’s got a problem,” Henry said.
“We all have,” Hawkeye said.
“Not like his,” Henry said.
“What’s wrong with him?” the Duke said.
“His wife,” Henry said.
“Too bad,” Hawkeye said, “but he married the broad. You didn’t, so why is he bothering you?”
“Yeah,” the Duke said.
“Ever since he landed here,” Henry said, “he’s been getting letters from his wife saying she can’t live with his parents and their kid is sick, she thinks, but the doctor doesn’t, and why doesn’t he come home and take her off the hook? The damn fool woman seems to think the guy can break it off over here any time he wants to.”
The two Swampmen were silent. Henry looked from one to the other.
“Come on, you guys,” he said. “You always got ideas. What the hell am I going to do? I didn’t think I was sent over here to run a kindergarten.”
“If I was y’all,” said Duke, “I wouldn’t do a goddamn thing.”
“Sure,” Henry said. “That’s the obvious answer, but I have a hospital to run and you know how hard replacements are to get, and I have to make the ones we get as useful as I can. This guy was just starting to shape up, but this week he got four letters, all saying the same thing but each one worse than the one before. She’ll drive him nuts.”
“I don’t know,” Hawkeye said.
“Me neither,” Duke said.
“Thanks a lot,” Henry said, as he departed.
The next day Captain Pinkham received another and more desperate letter from his wife. This time he didn’t tell anyone about it, but at 2:00 a.m. it was obvious to Hawkeye, who was watching him closely, that Captain Pinkham was trying to concentrate but that he was failing. Between cases he gave the Duke the word and they took Captain Pinkham to The Swamp, gave him a beer and asked: “What’s the trouble? Anything we can do?”
Captain Pinkham showed them the letter. After reading it, they took him to his tent, gave him a sleeping pill and said: “Sleep and don’t worry about the work.”
The next day Captain Pinkham awakened still impaled on the horns of the kind of trouble only hardnoses can survive, and Captain Pinkham was no hardnose. Two days later, fortunately for all, salvation came. It came to Colonel Blake, via the Red Cross and the Army, in the form of orders to send Captain Pinkham home on emergency leave. His wife had folded and been placed in a private fool farm.