The greetings of the gods22 May 2020
As we walked through the streets of Reykjavík some years ago, during Iceland’s financial crisis, a band suddenly appeared, marching through town. We followed, like kids, to the town square, and when they finished, we asked one of the musicians what was going on. She explained that, with people being so discouraged, they decided that each day, at noon, one band or other would play, to raise the people’s spirits. I found that so charming that I never forgot it. Now, I would like to do my bit to raise some spirits. Years ago, I wrote a number of short stories, mostly light-hearted, almost all non-fiction, about my personal experiences. (I hope to publish them one day, under the title Reflections from the Window. Reflecting on Doors, the first one, was posted here in 2015; it explains the title.) Today we have “The greetings of the gods”, a small visit with the heath care providers who are now serving us so well.
“What’s the difference between God and a surgeon?”
“I give up.”
“God never thought he was a surgeon.”
Fabienne, the head nurse on 4 Northwest, a post-op ward, told me this joke when I met her during a study of physician “well-being” at the hospital. She tells it to all the surgeons, she said, just to make sure.
Operating rooms are the sanctuaries of these gods. So when Jane, who organizes these rooms—and, thus, those gods—invited me to see for myself, I accepted, with great interest as well as the usual apprehension. “Oh no, you can’t do that!” she replied to my obvious question. “You’re not allowed to get a cerebral hemorrhage in there. There’s no one to look after you.” When I told Susie about this, my daughter whose work as a free-lance photographer then included a day a week in medical photography, she asked to join. Good, I thought, she can drag me out, with my cerebral hemorrhage.
Jane was more than happy to accommodate both of us—nothing seemed to phase her, which explains why she could run these sanctuaries of the gods. So we arrived one morning, ready to go. Finally I could play doctor almost for real: we put on green cotton shirts, pants, booties over our shoes, face masks, and surgeon caps as the cherries on top of us cakes—the whole McGilla, so to speak (the Jewish General being a McGill University hospital). Looking like the real thing—only our eyes revealed the truth—we headed into the surgeons’ sanctuaries.
“Hi! Come on in. Let me show you what I’m doing. It’s a hip replacement. You see we …“ This was Dr. R’s exuberant greeting as we walked in. He was standing behind a green sheet on a table, with a splash of red in the middle. There must have been a real person under there, but the whole thing looked rather like modern art. Ten other people moved about the room, including several residents and even a company sales representative (there to “check out a new kind of cement”, no less).
As we gawked from the side sheepishly, Jane explained what was happening, while a resident exhibited the props—a lump of something about the size of a baseball that had come out and a piece of something silver-like that was about to go in.
We left after a few minutes, and headed for the next room, where a tumor was being removed from the side of a head—over the course of ten hours! Jane warned us that this surgeon did not tolerate any noise in his sanctuary. Again there was the green sheet, this time with a smaller zone of red exposed near one end.
It was Jane who whispered something, after a few minutes, and the surgeon looked up in surprise. She introduced us and explained what I was doing in the hospital. “Are you happy, Dr. M?” Jane asked teasingly. “We’re happy when we’re in the operating room” he retorted with somewhat less delicacy than his work on the head. Then, contemplating my presence, he got angry. He thought I had come to interview him on physician well-being—right then and there! We thanked him quickly and high-tailed it out of there.
I guess Jane thought we had now been sufficiently acclimatized, because next we headed into open heart surgery. The “heart,” as the surgeons call the human being under te sheet (or the “hip” or the “head”), was open all right. It sat there, not beating, in a small rectangular cavity, with that ubiquitous green around it. Two surgeons worked on either side, with all sorts of other hearts beating in support, including one monitoring a machine that was beating for the patient’s heart. “That cost us $100,000.00,” Jane said proudly of their newest piece of equipment.
When one of the surgeons finally looked up, Jane introduced us, to which he replied dourly: “We already met,” continuing to work. “He didn’t show up for our meeting last week.” Ye gods, what a place to find out!
From the side of the room, two intriguing eyes fixed on us. They belonged to a nurse, as if in a niqab. As Jane left to attend other things, the nurse took Susie under her wing, explaining everything, while the anesthetist, for whose interview I had shown up, did the same with me. “That’s the cream cheese,” he explained of the yellow blob next to the heart. And “no, that’s not wrinkled skin; it’s the plastic plates we put on either side.”
Suddenly, the whole chemistry of the room shifted, with high alert in everyone’s posture. A critical moment had been reached in the operation—the patient was coming off the machine. Soon they relaxed, as the real heart began beating again on its own. The anesthetist said, “That’s a fairly routine transition. The patient came out OK” but later admitted that the situation had in fact been a delicate one.
Susie went back on the stool that the nurse had provided for her, absolutely enthralled as she peered straight into the cavity. Then the two surgeons sewed in some heavy thread, and as they pulled hard on either side, the cavity gradually closed. “Oh shit,” Susie blurted out in awe. “No,” the anesthetist shot back, “that’s in Room 12. This is blood!”
We had been there the better for part of an hour when Jane returned to collect us. Next was a cataract operation, where a lens was to be inserted into an eye. This time there was no greeting at all, since the surgeon was deep in concentration. Here we encountered the eeriest scene of all—just one tiny hole in all the sheeting, this time blue, out of which peered a single eye, also blue. The surgeon was using a television monitor to see things blown up—like the CBS logo for real.
So far the visits had gone remarkably well. Susie had no need to drag me out, and there was no way I was going to drag her out. Peering into a heart cavity, let alone seeing green, red, and blue on a table, is somehow OK, a visual abstraction. But watching an eye being worked on, especially when the blue turned to red as the lens was inserted, is another matter. I wear glasses, so I figured that I had more chance of finding myself here than in “blood.”
That eye operation finished quickly, and the sheets were pulled back to reveal a conscious patient. “A little old lady under there”, Susie whispered to me. “Suddenly the human appears!” Jane explained that she would be going home in an hour, but when we were taken to see the recovery room twenty minutes later, the little old lady had already disappeared.
Last was a laparoscopic investigation of a knee, of special interest to Susie because she had torn ligaments in both knees ski racing. Before we even got through the door, the surgeon greeted us with “We have Eric Clapton or Elton John.” It took us a minute to realize that we were being offered the choice of music to play. A number of doctors and nurses were chatting, about Sesame Street of all things, while the patient, a big guy, sat on the bed with his head bowed like a prisoner of war. An epidural was being administered to his lower back by the anesthetist who, after having some difficulty, announced: “Thank you for watching, everybody; it does not always turn out the way you like.”
This didn’t turn out the way Susie liked either, because we had to leave before the procedure began. That ended this amazing experience. We live in a world of dazzling technology, yet where else can we see it so vividly displayed.
There are, of course, no gods, at least among men (although I did interview a young woman surgeon, who works in that Room 12, of all places). But when mere human beings can handle a heart in someone’s chest that they themselves stop and restart, perhaps we can understand, if not quite appreciate, the association of that God with these gods. So hail to you, the gods of the operating rooms. I hope we never again meet in your sanctuaries.
© Henry Mintzberg 2020, first written in 1993. We did meet again, 22 years later, in the blood room (quadruple bypass for me). Our hips and our heads remain well, thank you, and our four knees are under control. Although at the time of this revision, cataract operations scheduled for me have been delayed by the coronavirus—while the truly heavenly work of all the gods of health care take over. An article from the hospital study was published in the Health Care Management Review, and you can also see my 2017 book Managing the Myths of Health Care.