Brachial plexus and operative report

When I created masculiknity some time ago in college between commercial breaks of Law & Order: SVU reruns, I had no idea that it would last as long as it has. Much like ballet lessons, shorthand, and my childhood collection of pyrite, I just assumed that it would eventually fade away and join my growing list of abandoned side projects.

And yet, here I am, five years later, obsessing over where I could’ve put a much-needed parenthetical in my two preceding sentences (special victims uknit) and trying to decide which picture (eight year old ballet daniel or san francisco ocean beach) I should insert next to transition from my cold open to the first main paragraph.dsc_0463So, given that there is very little in this world that would stop me from knitting and writing, I took the plunge and bought www.masculiknity.com (no more of this .wordpress.com nonsense)! I tried justifying it by saying it was a Christmas present to myself (along with three button ups, a waffle knit long sleeve, eight skeins of yarn, and two books), but in all honesty, it was really just a treat yo’ self kind of purchase (along with my new raincoat, uniqlo socks, and bluetooth earphones). In addition to the big boy domain name, I also gave my site a hefty facelift, adding a thematically appropriate banner and an edgy yet classic san serifed header. Now all I need is for a celebrity (preferably jessica chastain but will also accept martin sheen as jed bartlet) to discover me and then this stitch is ready to go viral!dsc_0902
If you guys think back to a couple of Octobers ago when I knit a human eye, I recently completed a project that runs in a similar vein, in that it is equally esoteric (esewteric) and exclusively relevant to medical students and professionals. This is the brachial plexus, a network (knitwork) of nerves that supplies the upper extremities divided into roots, trunks, divisions, cords, and terminal branches. When I was in anatomy lab, I remember the brachial plexus being impossibly difficult to memorize (despite frank knetter’s iconic rendition) and how helpful a physical model would have been.dsc_0884Well, thanks to season three of Black Mirror (san junipero amirite?) and the workweek bliss that was my anesthesia rotation, I had ample time to experiment with I-cords, testing out various ways of connecting and branching them. And then, many awkward stares and ninety five hand-stitched letters later, I completed my anatomically correct (albeit simplified) brachial plexus! I can’t say that it’s the most aesthetically pleasing project (pretty sure that yellow is red heart super saver…), but it’s probably one of the nerdiest things I’ve ever done (except for third grade, when i voluntarily skipped recess to help sort mail).

Coming up next in my aknitomy series: the GI tract (that ish is gonna be hard #poopjoke).

I was reminded of the brachial plexus originally during my OB/GYN rotation last month, since some newborns (especially the fatties) are at risk of damaging these nerves during childbirth. The rotation itself was quite an experience. A fluid-filled, miraculous, fluid-filled (so many fluids. just. so many.) experience. One of the more challenging parts of it was my week on nights, which disassembled just about every internal rhythm that I had (i ate a donut for breakfast and was full for the whole day). The first night was particularly brutal, and so to keep from falling asleep (aside from chugging ice water), I decided to write. Here’s what I wrote.

Oh yeah. Also, in case there’s any doubt: as irreverent as I am towards the personal space and privacy of others (one time i accidentally joined a stranger inside what turned out to be a single-use restroom), there are some things, like HIPAA (and boys who do ballet), that you just don’t mess with.


Operative Report

“Time out,” she says.

The words alone are enough to ice the atmosphere. It happens instantly, like the turning point of a séance. Even the surgeon stops mid-sentence. We look up at the flat screen bolted to the mint green operating room wall, and the circulating nurse reads from it without an ounce of enthusiasm, her words blurring into one long string of gibberish. The surgeon and I are gowned and gloved, standing on either side of her with our hands out in front of us, held awkwardly above her swollen belly. Blessing it, it would seem. Protocol demands sterility, so the room is swimming in every tint of blue, drapes glowing alive from the harsh lighting. And we are all silent and attentive, following along with the words that are being chanted, waiting for something, or someone, as if seeking guidance from the beyond to instruct us on how best to proceed.

We delineate our incision with a purple marker at the crease where her belly folds and reflects over a patch of brown pubic stubble. I hold her stomach up so the surgeon can draw a gentle arc that looks like a smile, and I imagine the boy swimming between my hands, centimeters beneath the surface, breathless and waiting. The scrub tech hands the surgeon a scalpel that gleams beneath the overhead lights and I can’t believe we’re bringing a blade so close to her skin—his skin—daring to separate two so intimately tied.

A flash of white. Adipose tissue like cotton batting emerges from the incision. For a moment I think we’ve torn open a stuffed animal, and then, sleepy vessels stir awake, and it begins to bleed. Bright red, pouring out like velvet. She cuts deeper, undeterred by the trauma we’re inflicting. I dab the area with soft squares of white cloth and watch as blood races along the fibers.

The surgeon is liberal with the scalpel, to the point where I’m nervous on her behalf. Doesn’t she know how sharp that is? Muscles fibers, arteries, veins all weaving together. And then, in a single stroke, gone. Regardless, we press on, identifying and dividing the various layers as we tread deeper, inching our way to him. At times we use the bovie, frying strings of fascia and fibrotic bands, cauterizing weeping blood vessels. It sizzles through tissue with an energetic hum and pop, cooking it brown, then black, then crispy with a metallic sheen. I hold the suction close but it doesn’t make a difference. It still smells of burning flesh. Like Doritos. Cool Ranch.

After clearing away fat and superficial fascia, we at last reach the rectus abdominis: a long, striated muscle bathed in intra-abdominal fluid, emanating something between a deep mahogany and a bruised purple. Unlike everything else we’ve encountered, this seems vital, ostentatiously alive. I put my fingers on it and it’s warm through my gloves. It surprises me, how personal this gesture feels. The muscle has two bellies, so we find the gap between them and pull. Hard. I am on one side of the table and the surgeon is on the other, and together we lean back, putting our full body weight against the integrity of this woman’s abs. I think about what we’re doing for a second too long and at once feel nauseated. What if we rip her apart? The taste of bile creeps up the back of my throat.

The neck of the uterus is a speckled lavender. The surgeon picks up the scalpel again and makes very small incisions. One cut, then two, then, without warning, fluid jets out and splatters across the plastic guard in front of my face. It lasts only a moment, the gush of amniotic fluid immediately waning into a gentle outpouring that fills the plastic gutters hanging off the sides of the table. The fluid is clear and tinted a pale yellow. Flecks of blood and whitish pieces like lint are carried away by the current.

I see the top of his head first, which is covered in dark, drenched hair. The baby turns and I see his geriatric face, which is blue and grey and seems to be etched in granite, severe wrinkles furrowing his brow, forcing his eyes shut. The surgeon puts a forearm on the woman’s belly and pushes his arms and torso out. They, also, are a dusky blue, lined with generous folds. A clean, white umbilical cord stems from his stomach, and the helix formed by the arteries and vein within the cord is kaleidoscopic. The surgeon pushes again from above, and this time his legs are delivered. Fat thighs, dimpled knees, terminating in ten pea-sized toes. I hold him while the surgeon clamps and cuts the umbilical cord. He’s shimmering from a nine-month bath, and I struggle to keep him from slipping away.

He feels warm and familiar in my arms, eyes closed and limbs outstretched. His hands grasp the air—tiny fingers, tiny fingernails. He opens his mouth to reveal a pair of empty gums. It’s like he’s still floating in a world of fluid, used to the ease of weightlessness and the darkness of the womb. I suction his mouth and nose, and he grimaces, adding even more folds to his brow. But eventually he cries, and it reaches every corner of the room. It’s loud and altering, like my ears popped and I realize that I’ve been listening through layers of wool for who knows how long. Tension melts away. Somebody laughs. Time continues and we return.

A nurse takes the baby to a clear crib off to the side while we deliver the placenta, pulling out an off-white, filmy sac, engorged with bulging vessels red and deep blue. We explore the uterus for any placental remnants and then replace it gently into the peritoneal cavity, a task that all of a sudden feels painstakingly tedious. It’s that post-anticipatory exhaustion—the drive home after Christmas dinner—and it hits me unexpectedly. My back aches and my arms feel abruptly awkward and strained holding the retractor so still. At last, the surgeon sews up the uterus and imbricates the incision, leaving only a neat, tram track of black suture in its place.

Our mission complete, we leave the way we came, closing the various layers that we’d hastily torn through just minutes before. For the skin, the surgeon uses a straight needle, the same kind used to darn a pair of socks, and the result is impressive—just a thin grey line, the edges kissed together perfectly, at a glance nothing more than an innocuous fold or slim bruise. We cover our closure with clean, white bandages and proceed to break everything down, tearing down drapes, unhooking various monitors and tubing, throwing them all indiscriminately into oversized garbage bags. With everything gone, I can see the woman, now a mother. Her head is turned away from me and looking at her son. His eyes are glued shut from erythromycin drops, but every once in a while he pries them open to reveal curious brown irises.

I remove my gloves and gown, my mask. The operating room is frigid in just my scrubs. We clean and dress her and I bury her beneath a mountain of warm blankets. In the commotion my arm innocently grazes her thigh, but she doesn’t notice. Her epidural is still plugged into her spine like a power cord, obliterating all sensation south of her belly button. As we leave I take one last look around the room, now in disarray, a story written on its walls: bloodied debris strewn across the floor, soiled blankets tossed aside and leads left dangling from knee-high monitors, a plastic bucket three quarters full with murky serosanguinous fluid. I hold the door open so they can wheel her into the recovery room.

It’s not until later, standing in front of the bathroom mirror, that I notice my right forearm—a hazy rhomboid, the size of my thumb and the color of an old penny. All blood looks the same once it’s spilled, I hear, but I know this is hers. Like I can see the AB+ radiating from it, the maternal antibodies floating within. I crouch awkwardly to fit my arm within the sink basin and play back the events of the past hour, trying to recall how such a breach could have gone unnoticed: her skin, bowing inwards, separating smoothly beneath the blade; the tepid fluid as we break the sac, shallow warmth flowing between my fingers like checking the water of a running bath; and him, the newly born, recently non-existent, unnamed novelty—predated by nothing else in the ever-expanding universe—one hand feeling the gaping sutures of his skull and the other at his ankles, each malleolus like a marble pressed into my palm. The entire journey to the center of her, all of it’s there except for this. This is gone. Our singular collision, lost in the blind spot of my memory. Maybe at the end, I think, while I was dressing her, my elbow dropping just an inch too low. Maybe, but I’m not sure.

I turn off the water and inspect my arm closely. Not a trace of her remains. There’s a scar on my wrist that I’ve had for so long I only notice it every other month, a thick dash from my sister’s marshmallow roasting fork that one summer at Big Sur. A bolded hyphen branded along my distal radius when I was twelve or thirteen. I vaguely remember the scorch, the chaos around a smoky fire pit beneath ponderosa pines, the sweet relief of the water spigot. I don’t remember when I realized it would scar.

I think back to him and her, son and mother, one necessarily scarring the other, though I admit I had a hand in that as well. Her incision will ooze, ache, and keloid, but it will fade and soften with time. I imagine her tracing it listlessly while in the shower, or in the car, and while she breastfeeds, as she recalls that wonderful, traumatic expulsion. Her vision obscured by drapes, but a visceral pulling, and all that fluid, which she couldn’t see but she could feel spill out of her, just like her baby. Perhaps she remembers me, brown eyes between a cap and mask, or perhaps not—there were many eyes and many caps and many masks. But I remember her: my first cesarean, a swollen belly center stage in a mint green theater, an aliquot of blood by my elbow and a pool of rose-colored water, lasting just moments before trickling irrevocably down the drain.

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3 thoughts on “Brachial plexus and operative report

  1. I am too a medical student and I make things to remember when my brains capacity to memorize by reading or hearing or watching is exceeded. I enjoyed your c-section account – you have a way with words.

  2. Lovely piece. Very sensitive, just very nice and lovely. Thank you. I wish the mother in the story could read it, it would warm her heart.

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