Femoral Bypass

 

This was a seven hour operation and nobody gets a break.Sometimes the surgeons get to sit. I stood and watched and these are my thoughts.
 A vein harvesting is like unpicking very fine fabric, you can't damage any of the surrounding material but it is securely and stubbornly attached to it.
 Over a hundred sutures needles are used; the endless counting and opening of sterile packets .All packaging is opened by a theatre nurse in a peel apart movement and then offered to the scrub nurse without handling the contents.
 Bead sutures have big beads on the end.
7-0 needles are very tiny, like thorns.
This procedure requires six surgeons working all at once.
The vein is passed through a metal tube which has been inserted under the flesh, it has been measured to make sure it is long enough and has been checked for twists. It has had a catheter passed along it to check that there are no obstructions.The surgeon noted any resistance he felt as threaded the catheter through. It is like threading elastic through a waistband or threading a rouleaux loop into trapunto quilting, it is all about the resistance, the pull and the timing.
Surgeons use glue.

Finger Tips

The image above perfectly illustrates how I use my fingers when making needlelace but it does not tell you what I can feel with them. Often I know where the thread is rather than feel where it is. The pressure I use to guide both needle and thread is so habitual that it can not be described.It has been written into me.
   This is a riddle that you have to unravel when you teach someone how to do anything.You show them, you guide them and then sympathise when things go wrong.Some learning can only be found during touch.Some teaching can only be done once someone has learnt.Some teaching conversations are just comparisons of experience. '' well you know when you do that thing and it felt like that, well this is a bit like it''.
  The use of tools is something uncommon amongst the creatures of this world and we humans specialise in it.We don't always know just how good we are at it until we teach or talk to others in different fields.
I spoke recently with Mr.Donald Sammut a consultant hand surgeon about what it is to be an expert. Mr.Sammut was drawing long before he was a surgeon and his work as an artist crosses over into that work with his informative illustrations of hand anatomy. We spoke about the importance of empathy in our work and how it is a mistake not to prepare properly beforehand.For Donald this means getting to know the patient and then making sure all decisions are informed ones. I must know about my work before I make it even if it is something I have never made before.Then comes technical preparation which comes from long experience.After that it is possible that you will not know what there is to find until you begin, both as an artist and a surgeon .You rely then on your expertise.
  Interestingly I was told that it is your fingernail that gives your brain the information about pressure. It gives the pulp in your fingertips a sounding board and without it there would be only wobble !