Because I was interested, or tempted, which in a man is the same thing, I was on the neurosurgery team for several months that year, where the intern's job is to stay up all night on the lookout for disasters, and to wake up the Head man with any really bad news.

      The work itself was relatively simple: a brain in its hard little box is a lot more straightforward than 20 feet of bowel slithering around with a dozen other decaying organs in their soft bag of skin.  But outside the operating room brain surgeons have an appalling job to do, they're way out on the thin end of the wedge where fantasy and reality eventually collide.  Over and over again they have to confront the horrified, disbelieving faces of loved ones who only hours earlier had laid before them a hero's respect – in return for every last shred of their hopes ... "Well your husband survived the operation ma’am, but he'll never be what he was –“

     My boss, and teacher, was a neurosurgeon by the name of Dr Brennan.  He was old enough to have retired a decade earlier, but it's tough to find a hobby that'll hold your attention for long after a lifetime of cutting up alive human brains.  From my dependent situation it was hard to really know him, and yet he intrigued me with his relentless caution.  I knew that he liked to laugh, yet he allowed it in himself only for an instant as though proximity to so much tragedy had made pleasure inappropriate for him.  He had reduced himself to the most tightly restrained understatement of word and gesture, revealing a modesty unspoiled by any hint of insecurity or lack of pride: he was not the kind to let his private opinions and his professional judgments overlap.  Gruff, morose as he was, old Brennan would shuffle from side to side like a little crab when he had to hand out bad news to a wife or a child – you could see that he was hurting, he never made them accept it all alone.  He was protecting a sensitive nature.  It didn't take long to see what it had cost him.

     One night, a tanned, athletic-looking 60 year old was carried in to the emergency room after he'd taken a spill onto his head during a game of tennis.  He must have torn a vessel in there and started bleeding into his brain.  By the time he reached us he was already comatose, the best he could manage was a little gurgling sound in response to the infliction of pain.  We watched him for several hours, trying to gauge the risk of leaving him alone against the risk of trying to fix him.  Finally, at around three in the morning, Brennan decided there was no choice, we'd have to go in.

     We rolled our patient into the operating room where I scrubbed and shaved his scalp, and with Brennan glowering over my arm, his gloved hand pointing the way like the finger of god, I took a scalpel and made that extravagant, cartoon-like curving gash from behind the man’s ear up across the center of the head and then straight towards the mid-point of his eyebrows.  We peeled back the scalp and clamped off the bleeders under the skin.

     “Pass my assistant the bone saw,” Brennan instructed the scrub nurse, “let’s see if his hands shake when he gets excited –“ and then he barked at me, “Bevel out, 45 degrees, and make sure you cut in straight lines!”

     But the extent of our patient’s dilemma was self-evident the moment we made our way beneath the bone.  The saran wrap which covers the brain was already bulging out with a great oozing clot.  Brennan carefully suctioned out as much of the mess as he could until the sparkling white pulsating gossamer blancmange, the source of all that's human, looked fairly pristine again, other than two or three ugly little blackened electro-cautery marks where we'd had to toast the bleeders.  Then we started to put it all back together again.  It didn't take a genius to figure out this disaster.  Nothing could fix this: our patient was done in, his jig was up, he'd seen his last smile and felt his last ray of hope on this planet.  By then it was very late and nobody spoke as we methodically tied our skull bone window back in and then tugged the two halves of the scalp into place to cover up the carnage.  As we finally started to put the face back together Dr Brennan roughly tossed a couple of sutures into the gash we had made and then dropped his tools onto the operating table, and looked up at me, his eyes suddenly drooping in fatigue.

     "Close him back up," he muttered, as he backed away from the table, pulling off his face mask and sterile gown.  With the tension over he suddenly appeared exhausted, slumped, tiny and old – it's amazing how big and potent he had seemed for as long as he’d been in charge – "And don't take all night with it!" he instructed me, suddenly bored and irritable, "he's had a good life, he doesn't care what he looks like anymore – just make sure he isn't bleeding – I'll go do the dictation -" he concluded as he walked out of the operating room to get his paperwork done, leaving me with this sterile, mechanically ventilated corpse-in-waiting.

     I got down to putting our patient's face back in one piece.  I figured my goal now was to make him look nice in case his people wanted to say goodbye to him in an open coffin.

     Now this fellow had one of those deep furrows which run side to side right across the forehead.  From a lifetime of quizzically lifting up his eyebrows, I suppose, as Time rewards any persistent sense of curiosity with a scar.  And that last pair of sutures Dr Brennan had thrown in had been so careless that he hadn't even bothered to line up the two edges of the man's wrinkle, they missed by a good half an inch so that his forehead looked like a lightening bolt – after you've been spooning around in a man's brain for a few hours you can understand how the skin doesn't seem so important.  But now that we were preparing him for eternity, for a wife's final vision of her other half, well for that it was terrible, it looked as though he'd been branded by divine retribution, or more likely by the devil – it was hard not to laugh, he looked like Frankenstein.  I had a moment of eager cowardice: I wanted to finish sewing him back up as quickly as possible – you can’t just mess around with your brain surgeon's work, they're a touchy crowd, screamers, scalpel hurlers, they can ruin your career in a vindictive performance evaluation with no more reflection than regular folk give to swatting flies.  You have to imagine a cross between drill sergeant, employer, and god.  As an intern, your only safe demeanor is something approximating an admiring doormat.

     But now that Brennan was out of the room, the scrub nurse, who'd been passing us the gadgetry from a table down by our patient's feet, leaned over to take a look at the man's face, and she and I caught one another's eye for a moment – Christ but he looked ridiculous – just imagine his poor wife having to see him like this for their final encounter on this side of life, his face looked like some cartoon ghoul.

     "Oh -" she whispered, "but it's so sad like that -" and she was right.

     The anesthesiologist stood up from behind his little blue curtain and leaned over to see what we were quibbling about – outside the sun would have been coming up, and he wanted to get home too.  At the sight of our patient's new stigmata he guffawed loudly, “Well it doesn't matter now!" and sat back down to complete his charts, "Are you ready for me to wake him up yet?  Come on, let's get out of here -"

     The nurse was still looking at me with a beseeching look from behind her little orange face mask.

     “Oh all right,” I muttered, "hand me some scissors -" and I clipped out Dr Brennan's last sutures, and got down to making this old boy look presentable for his farewell party.  I was working away – I was just carefully lining up his ears, as there's nothing worse than a little facial asymmetry to tip off your brain that something is wrong – when Brennan walked back into the operating room.  I'd been hoping to have the bandages back on before he returned.  He wandered over to see how I was doing, and peered at the patient's face for a long time.  I could tell that he was staring at the forehead where I'd undone his work.  The nurse looked over and was good enough to give me a sympathetic glance.  I put my face a little closer to my work to get ready for the fireworks, but instead, Brennan began to laugh, a low and oddly malicious chuckle.

     "What's so funny?" I asked suspiciously, though without looking up.

     "It's so cute -" he drawled, and then suddenly concluded with a bitterness which surprised us all, "You still care!"

      I’d been struggling with the notion of brain surgery as a career and Brennan had been trying, in a fatherly kind of way, to talk me out of it for some time.  While our squadron of surgeons, trainees, nurses, medical students and orderlies had marched from room to room making our rounds one morning, I had dropped behind to talk with an elderly lady we’d operated on a few weeks earlier and who still couldn’t seem to escape from some deadened inner sadness.  Brennan had walked back into the room and pulled me out by the sleeve of my white coat – 

     "Ah, you still like to talk to people," he’d joked once we were back out in the hallway, and then muttered to me, “listen Ebiz, you're good with your hands and I'll give you a spot in the program if you’re sure you really want one – you don't need to do this to prove anything to yourself.  But you're too nice a fellah for this business -"
      And while I finished sewing up the wrapping on this lifeless but still living brain, Brennan stood behind me, looking on, reminiscing quietly.  "I remember when I was your age, and a lot of these techniques were new then – ah we were so excited, we were going to change the world – we'd all be heroes.  It was just hubris of course.” 

      His voice was flat, and tired, but neither proud nor maudlin.  He wasn’t expecting me to stop working or answer.  "You know what I feel now when I cut a chunk out of some six year old's brain, Ebiz?  I don't feel anything.  Nothing at all.   I don't feel a thing."

     I had finished closing up the gash, and started to wrap the patient's head up in a nice bright white bandage – it looked so deliberate and safe: civilization was being re-imposed.  Brennan was talking very slowly just behind my head.  He could have been discussing the weather, or next week's operating schedule, "I've got a 35 year old son, you know.  We've got nothing in common – we're complete strangers – I just wasn't there -" and then as he began to walk towards the door he turned around and looked at me.  "That's who paid for what I do -" and he shrugged, and walked out of the O.R. and left us to clean up alone.

Ebiz has traveled and worked as a physician from Manhattan to Afghanistan and Texas.  Having seen the Army of Empire up close he is currently writing a novel entitled "Whose Blood and Judgment?"  He has short stories in or forthcoming in Wilderness House Review, Ear Hustler, and the Lowestoft Chronicle.

The business of life, just keeping the boat afloat, is more than enough most of the time.  But occasionally a glimpse of the unknown, or even the sheer indignity of the whole thing, makes you leap over the gunwales.



Copyright 2009