Posted by: yogavet | March 6, 2007

Let us go then, you and I

LET us go then, you and I,
When the evening is spread out against the sky
Like a horse anesthetized upon a table;
Let us go, through certain half-deserted barns,
The muttering interns
Of restless nights on-call for surgery
And residents who’d rather be in bed,
Students that follow in a little herd.
A racehorse has come in
With a severely comminuted closed fracture of the left front P1…
Oh, do not ask, “What is it?”
Dean asks questions, you give answers.
 
In the stall the nurses come and go
Talking of Barbaro.
 
The barn cat that rubs its head upon the stall door,
The barn cat that rubs its muzzle on the stall door,
Licked its paw against the corner of B barn,
Lingered upon the nursing station desk chairs,
Let fall upon its back the straw from stalls,
Entered the main hospital, made a sudden leap,
And seeing that it was a soft October night,
Curled up in the surgery suite, and fell asleep.
 
And indeed there will be time
For at least four radiographic views,
Lateral-medial, dorso-palmar, and obliques;
There will be time, there will be time
To prepare a surgery suite for all the staff to meet;
There will be time to stabilize and sedate,
And time for all the drills and surgical steel
That will create support where bone had failed;
Time for screws and transfixation pins,
But no time for a hundred indecisions,
Nor for a hundred visions and revisions,
Before the surgery must begin.
 
In the stall the nurses come and go
Talking of Barbaro.
 
And indeed there is not time
To wonder, “Do I dare?” and, “Do I dare?”
To merely reconstruct the bone with lag screws,
Since an intact vertical bone strut is absent —
[Dean will say: “That’s a ridiculous idea!”]
The track’s Kimsey splint is on the leg for now,
But more than external coaptation will be essential soon—
[Dean will say: “Finally a good answer!”]
Do I dare
Elect external skeletal fixation?
In a minute there is time
For decisions and revisions which a minute will reverse.
 
For I have considered the options all already:—
Transfixation pins in the third metacarpus, incorporated into a cast.
Or a true external skeletal fixator, with tapered pin sleeves;
Lag screws to fuse the fetlock later on,
And this colt a breeding stallion may become.
  So how should I proceed?
 
And I have known the benefits already, known them all—
Decreased joint movement within a transfixation cast.
Minimized surgical trauma at the fracture site.
A weight bearing column with decreased risk of luxation.
Then which should I choose?
Increased versatility is offered by a transfixation cast.
  And how should I proceed?
 
And I have known the risks already, known them all—
Recovery may incite catastrophic fracture through pin holes
[But we have a pool we can wake him up in!]
Infection and pin-loosening
May cause distress.
Lack of perfect alignment will result in pain.
  And should I then proceed?
  And how should I begin?
      .      .      .      .      .
Shall I say, I have decided on a true external skeletal fixator
With two pins placed in the metacarpus above the shattered bone
And tapered pin sleeves to increase stiffness and load to failure?…
 
I should have been a medicine intern
Scuttling down the aisle of CMK.
      .      .      .      .      .
And now the colt, the racehorse, sleeps so peacefully!
Induced by the anesthetists,
Asleep … prepped … and he is ready.
Stretched on a table, in right lateral recumbancy.
Should I, after cap and mask and scrub,
Have the strength to force the moment to its crisis?
But though I have wept and studied, wept and prayed,
Though I have seen my gloves [size 7.5] opened upon the table,
I am no surgeon—that’s no great secret;
I have seen the moment of my greatness flicker,
And I have seen the scrub nurse hold my gown, and snicker,
And in short, I was afraid.
 
And will it have been worth it, after all,
After the footplate is glued on, and two parallel holes are drilled,
The pins inserted, the tapered sleeves attached,
Will it have been worth while,
To have attached side bars and an outer foot plate
With vertical arms to provide rigidity,
And filled the side bars with polymer for strength.
To say: “He has a fifty percent chance of surviving to breed,
And as for racing, he has no chance at all”—
If the owner, settling down in your office,
  Should say: “That is not what I wanted at all.
  That is not it, at all.”
 
And will it have been worth it, after all,
Will it have been worth while,
After the recovery and the nursing care and the hospital stay,
After the pin removal, after the fetlock arthrodesis, after the cast application—
And this, and so much more?—
It is impossible to say just what will happen!
But if everything goes smoothly and the colt can mount a mare:
Would it have been worth while
If Dr. Turner, after completing a breeding soundness exam,
And turning toward the owner, should say:
  “There is no semen here at all,
  He has no potential here, at all.”
      .      .      .      .      .
No! I am not Dean Richardson, nor was meant to be;
Am a lowly intern, one that will do
To remove a splint bone, start a suture line or two,
Advise the students; no doubt, an easy tool,
Deferential, glad to be of use,
Politic, cautious, and meticulous;
Full of high sentence, but a bit obtuse;
At times, indeed, almost ridiculous—
Almost, at times, the Fool.
 
I grow old … I grow old …
I shall wear the bottoms of my scrub pants rolled.
 
Shall I answer my Nextel? Do I dare to go to rounds?
I shall wear a light blue scrub top, and walk into the stall.
I have heard the surgeons talking, each to each.
 
I do not think that they will talk to me.
 
I have seen them riding eastward in their trucks
Off to Philadelphia to teach another batch of students
When the sun rises over Kennett Square horse fields.
 
We have lingered in recovery all night
The students and the interns have to stay
Till our colt is up and munching hay.

an adaptation of T.S. Eliot’s The Lovesong of J. Alfred Prufrock.   🙂 

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