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Educated in the United Kingdom and the United States, Gabriel Weston studied English literature at Edinburgh University before attending medical school in London. She went on to become a member of the Royal College of Surgeons and is a part-time ear, nose, and throat surgical specialist. She lives in London with her husband and two children.

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Surgeons have long been known for their allergy to doubt, an unsurprising trait in professionals who must play God, routinely risking someone else's life to do their job. But in this illuminating memoir, Gabriel Weston reveals the emotions, passions, and doubts normally hidden behind a surgeon's mask.

Interweaving her own story with those of her patients, old and young, Weston evokes both the humor and the heartbreak that come from medicine's daily confrontation with the ultimate unknowability of the human body. With prose that does not flinch from the raw, graphic realities of a surgeon's day, Weston confronts life, death, and the unique difficulties of being a female surgeon in a heavily male-dominated profession.

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Direct Red

HarperCollins Publishers, Inc.

Chapter One

Speed

I am about to faint. Methylene blue. Acridine orange. I have been holding someone's neck open for seven hours. During this time, my attending physician has asked me the same four anatomy questions he asks me every week, but otherwise there has been no conversation. Heart 106.2 is on the third loop of its same old songs. Saffron. Malachite green. My back is cold with sweat under a synthetic, unsoakable surgical gown. My mask feels suffocating, its visor as dirty as a windscreen, spattered with today's roadkill. I am beginning to feel queasily insubstantial, and the continuity of my vision is breaking up. Tyrian purple. Hoffman's violet. And just as I am about to confess my shame and excuse myself from the table, my mantra begins to work. Direct red. The open wound in front of me seems to reconfigure. I start hearing sounds normally again. I stop feeling sick. No one has noticed.

What to do when you feel unwell in the operating room (OR) is never discussed, but it is my private belief that all surgeons have these moments of incapacity and that we each try to save ourselves differently. At medical school, while studying pathology, I was charmed by the names of the colorful dyes used to stain tissues for clearer microscopic viewing. Crystalline as jewels, primary as food colorings used for cake icing and egg painting, the names of these elixirs seemed brighter in my mind than the substances themselves, the Platonic hues offset by their arcane prefixes. And through a process I cannot chart, every time I feel sick in the OR, I summon a rainbow collage of these names to mind. They stimulate my ebbing consciousness and usually call me back from that strange physiological precipice to normal function.

For me, such moments of near collapse are not brought on by dearth of sleep, excess of alcohol, or lack of breakfast. I never stay up late or drink on the eve of surgery; I am always ravenous in anticipation of it. No, it is long operations I cannot tolerate, slowness that gets the better of me, lack of pace that makes me ill. This personal feeling chimes with a more openly acknowledged association I have observed throughout my surgical career between speed and competence on the one hand, slowness and ineptitude on the other.

Slowness characterized the worst surgery I have witnessed. It was my first night ever on call as a general surgery junior. Arriving as a clinical virgin to this daunting duty, I learned that my resident was suffering from pneumonia and had just been given a bed on one of the medical wards. I would be without clinical supervision in the hospital for the entire shift and should call my attending at home if I needed any help.

In the middle of the night, the emergency voice facility on my beeper summoned me down to casualty: "Trauma call! General surgeon to the ER! Please go straight to ER resus!" As I ran down the three flights of stairs and the long corridor toward my fate, all I could think at this threshold of my training was, There's not a single situation that I will know how to handle, feeling keenly the lack of a senior doctor there to guide me.

Surprisingly, the scenario that greeted me was so clear that I did know what to do. My patient was a young woman who had been shot in the abdomen in a local nightclub. She had a hole in her belly where the bullet had entered and no obvious exit wound. Her whole trunk was growing in size before my eyes and was tense to the touch, a sure sign of serious intra-abdominal bleeding. I knew that this woman needed to go immediately to the OR to be opened up and that no investigations or messing about should delay her journey. I felt relieved the decision was such an easy one and asked the emergency room staff to get her ready for surgery. I then phoned the on-call attending, offering to meet him in the OR. "Not so fast," he objected. "You youngsters are always in such a hurry."

It was the first halt in a night that was characterized by this attending's appalling reluctance to act fast. When I return to it in my mind, the whole course of events plays itself out to me in slow motion, as if underwater. My foolish boss took half an hour to turn up. He appeared in the ER with his hands in his pockets and wasted time showing off his knowledge of firearms to the attendant policemen. He ridiculed my sense of urgency. He recommended an unnecessary scan when it was plain to see that a young woman was dying in front of him and desperately needed an operation. When he finally did concede that we needed to go to the OR, he picked up some coffee on the way.

Fortunately, physiology forced pace on a situation that otherwise seemed inexorably slow: once we cut the woman open from breastbone to pubis and cleared her gut out of the way with one deep sweep, we were confronted with the sight of the enormous hollow cavern of the patient's abdomen filling with blood as quickly as a basin fills with water. The two large suction drains given me by the nurse could not keep up with the loss, and blood tipped over the sides, onto us, onto the floor. Later that morning, when I removed my surgical scrubs in the empty gloaming of the women's changing room, my underwear was wet with this woman's blood, and I remember thinking bizarrely and grandiosely of myself like Macbeth and how I too might "the multitudinous seas incarnadine" after such a night.

When I look back now, it seems implausible that this attending did not have a clue what to do, that he didn't know the simplest emergency measures of clamping the aorta or even packing the abdomen with swabs to buy some time. He dressed his incompetence in a mannered slowness of action, and this made his thinking fatally sluggish. It took him almost an hour to admit he wasn't coping, at which point he became desperate and was shouting at the scrub nurse, "Get me another surgeon! Any surgeon!" Another hour passed before the regional vascular attending was able to reach the hospital to sort things out. For this patient, it was too late, and though she survived the night after the second surgeon managed to find and repair the holes in her iliac vessels, she died the following day from multiple organ failure, probably as a result of massive blood loss.

Excerpted from Direct Redby Gabriel Weston Copyright © 2010 by Gabriel Weston. Excerpted by permission.
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