By Stephen Aguilar
It was December and snow was falling on the parking lot. Big lights, to ward off carjackers and muggers, made the white ground twinkle. A line of snow-covered cars slumbered. The hospital rose from the ground and kept watch over the night. I crossed the lot, scanned my badge at the side door, and was let into bright warmth.
For my urology rotation, I was assigned to follow an older surgeon. The first surgery of the day was a partial nephrectomy. The patient had a mass in the right kidney. An incidental discovery during a workup for colitis. “Likely Cancerous” was bolded in the radiology report.
The patient was married to a teacher. We waited for the school day to end so she could be there when we read the report. The surgeon was old fashioned like that.
“Well, ain’t that quaint?” The Patient said. “Incidental…” He looked at me and I nodded in agreement.
“We have uncovered one of the great mysteries of your life.” The Surgeon said. He put his hand on the patient’s shoulder. “Why God gave you two kidneys.”
The wife did not find that funny.
He was in his late sixties, the surgeon. Coke bottle glasses clung to the end of his nose. He knew his eyes would be what kickstarted his retirement, but he made do for now. He had a highly educated finger. It endured a rigorous curriculum of rectal exams and surgical sweeps. “A noble pursuit of any digit,” he told me.
In the OR, everything was blue and white. There was an illusion of purity. A scalpel was put in my hand. The patient was draped and on their side. The bed had been bent to elevate their flank. Skin parted with the slightest pressure on the blade. It was like God’s will. What a will. Beads of red ignited at the edge of the incision. The surgeon followed with the Bovie. Blood burned up and was tamed.
Once the first layer was opened, he nudged my hands from the field. He wiggled his finger. “It’s the little guy’s time to shine.” He cut along the fascial plane. His finger did a sweep around the newly exposed site before moving forward. Cut. Sweep. Cut. Sweep. The hole in the abdomen was dark. It looked cold. The surgeon adjusted an overhead light. The darkness turned pink.
“I call this next part The High Priest.”
The educated finger descended in search of the kidney. Light from the overhead was blocked. The finger communed with the organs in the chamber. It happily moved side to side.
Then it stopped.
The surgeon did not take the finger out of the body. Slower this time, his hand began to move. His eyes closed. Lines of time splayed from the corners of his lids. He took his hand out and the incision became pink again. He grabbed my hand and put my finger in the incision. Into the darkness.
“Peek,” he said. I felt the kidney. The cancer sort of jutted out like a piece of gravel. He moved my finger up to feel the liver. It was uniform in texture. Smooth, slick, and rubbery. With my finger in his hand, he swept it back and forth.
Then…
“Shriek,” he whispered. My finger, still on the liver, touched something hard. It was a nodule disrupting the uniformity of the organ. What a will.
The Surgeon let me suture the wound with one of the residents. He and his failing eyes left the room, the cancerous kidney still inside our patient. The nodule too.
What is to be done? Death slumbers in the shadows.
Three surgeries were added to the end of the day, so I didn’t leave till it was dark. I walked to my car over the slush. “Leviathan,” came to mind when passing the line of tightly packed cars. The one at the farthest end started up. The headlights glared at me. In my car, I shivered while waiting for the heat to start.
…
On the last day of the rotation the old surgeon pulled me aside. It was the end of the day. Christmas break was within reach.
“Come look at this,” he said. “The holidays can wait a few more minutes.”
I followed him to a computer. We huddled around it. He opened a patient’s chart.
“It’s the guy we cut on a couple weeks ago. Your first Peek and Shriek, right?” he asked.
“Yes sir.”
“We got a PET scan.”
He opened the image. A tunnel appeared in the wall, and I thought we were meant to crawl through. But it was just the first picture of the scan. Anechoic chaos, air. The surgeon scrolled. From the choas, the outline of a man materialized. Radiology shines light where Death hides. Shadows of organs appeared. In the liver, something twinkled. The nodule. He scrolled more. The piece of gravel in the right kidney lit up as well. The two lights glared at me, as if to challenge their authority. Again, more scrolling.
“There,” the urologist said. “A Christmas tree. From me to you.”
The shadow man was alight. The margins of his lungs burned orange. A great jewel sat in the brain. Even his bones seemed to be wrapped with those finnicky tree lights.
“Sometimes,” he continued. “You can only bow your head.”
Outside, snow fell silently. The sun set and the hospital’s shadow stretched out to become the night. Flood lights turned on to help the weary people cross the parking lot.
Stephen Aguilar is a medical student at UAMS. He will complete medical school this year and will start his residency training in Internal Medicine at UAMS.