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17. Surgery
Morning: Kimi reports to Surgery. In dressing room Sanya hands her a green top and bottom – scrub suit – and starts to get into one. Despite age 60 Sanya is slim with well supported breasts that have wide brown circle of each nipple. Abdomen is flat and firm and pubis shaved. She takes a frank look at Kimi, so frank Kimi blushes and quickly gets into scrub suit wondering: Is Sanya like that?
With Kimi copying her every move, Sanya scrubs hands and forearms under running tap water and, after they finish, Kimi follows her into a large sunlit surgical suite whose window's south exposure reveals Tokyo Bay full of ships huddling together for safety from American submarines.
On surgical table, Kimi recognizes the perfectly made-up face of the mitotic Mitsue. Contrasting her bright beauty is a raw red, knobby, foul, pus-exuding, swollen and rotting, cancer-eaten left breast being cleaned gently by a surgical nurse assistant in olive-drab surgical scrub-suit, who, Kimi learns later, will have her own breast operated on next week. Gray-hair nurse-anesthetist in green garb places intravenous needle into Mitsue's large blue vein on back of right hand. Also in room, as chief operating nurse, is a thin older woman who as they enter holds up sterile white gown for Sanya. Kimi watches as Sanya arms stiffly extended, steps forward to fill the gown with her body. While the circulating assistant ties the gown's strings behind, Sanya alternately plunges each hand into sterile rubber glove held open for her by other helper.
On surgical table, Kimi recognizes the perfectly made-up face of the mitotic Mitsue. Contrasting her bright beauty is a raw red, knobby, foul, pus-exuding, swollen and rotting, cancer-eaten left breast being cleaned gently by a surgical nurse assistant in olive-drab surgical scrub-suit, who, Kimi learns later, will have her own breast operated on next week. Gray-hair nurse-anesthetist in green garb places intravenous needle into Mitsue's large blue vein on back of right hand. Also in room, as chief operating nurse, is a thin older woman who as they enter holds up sterile white gown for Sanya. Kimi watches as Sanya arms stiffly extended, steps forward to fill the gown with her body. While the circulating assistant ties the gown's strings behind, Sanya alternately plunges each hand into sterile rubber glove held open for her by other helper.
She turns to Kimi. “Now do as I do.” It seems as if everyone in the room including Mitsue is watching as she struggles into gown and gloves trying not to un-sterile them while Sanya and first assistant drape Mitsue with green sterile sheet, leaving left breast exposed through a diamond-shape opening.
About to sleep, Mitsue drops her smile and looks pleading up at Sanya. “Please, lady professor! I beg you do your best by me and If I cannot be saved then kill me.
“I shall take good care, Sister.” At that, Mitsue’s face lights in smile. “You are just like a Big Sister to all of us, lady professor, now I shall sleep happy.” And at signal from Sanya the anesthetist injects and Mitsue’s eyes become vacant and her head lolls to left. Anesthetist steadies it and quickly inserts tube down Mitsue's throat and starts mechanical breathing by squeezing balloon.
“Come here below me,” Sanya says and motions Kimi to get beside her toward Mitsue's feet. “You be second assistant, which means you do nothing till you hear from me to hold the retractors as I tell you.” First assistant stands alone opposite and facing Sanya.
18. Cut! Cut! Cut!
Sanya picks up scalpel in right hand between thumb and forefinger, its glinting razor tip 45 degrees off point of skin in Mitsue's left armpit where breast tissue ends; then, in sweeping rapid motion the scalpel makes a long cut extending diagonally down across chest wall curving outwardly around the breast then curving back to a point on lower left rib margin. Seconds later the incision reverses upwards curving inwardly so that the whole tumor-filled breast is between the lines of the cuts.
Kimi never saw subcutaneous flesh before: the yellow under-skin fat, hazing red from tiny severed blood vessels surprises her but even more surprising are the hands of the first assistant deftly moving over the cut, clamping off bleeders as soon as red appears, blotting darkly bloody stain from severed vein, allowing Sanya to see central bottom of incision as she deepens it.
Kimi never saw subcutaneous flesh before: the yellow under-skin fat, hazing red from tiny severed blood vessels surprises her but even more surprising are the hands of the first assistant deftly moving over the cut, clamping off bleeders as soon as red appears, blotting darkly bloody stain from severed vein, allowing Sanya to see central bottom of incision as she deepens it.
“We shall be doing the Halsted radical mastectomy,” Sanya informs through her mask as if Kimi understands. “I spent time at Johns Hopkins Baltimore
While speaking, she pulls up a clamp on a severed blood vessel and First Assistant places a loop-tie and cinches the piece of pinched off tissue; then, Sanya loosens the clamp with one hand and snips the tie near its knot with scissors in her other hand, and the piece of tissue falls back no longer a bleeder. To Kimi the combined handwork is a display of artistry.
Sanya works while talking. “You know, I have an intuition about cancer of breast. I see breast cancers that vegetate; I mean, the tumor sits in the breast for years and does not move, and the woman knows nothing unless she is unlucky and has it discovered and then suddenly is made aware she has cancer and it makes her unhappy because it starts a clock ticking in her brain that constantly is saying ‘You shall suffer and die from the cancer.’ So she gets into a surgeon's hands and the hacker hacks her up, injuring but not eliminating the cancer. It is like shooting a big bear. Unless your bullet immediately finishes him off, all the bullet succeeds in doing is enraging the beast. So many times do I see a woman who begins to suffer only after the surgeon attacks her breast and the cancer starts to rage through her body. In Mitsue's case, some quack did an oriental treatment moxa skin burning over the lump last year and it seemed to have started it to become the terrible thing you see now.
Sanya works while talking. “You know, I have an intuition about cancer of breast. I see breast cancers that vegetate; I mean, the tumor sits in the breast for years and does not move, and the woman knows nothing unless she is unlucky and has it discovered and then suddenly is made aware she has cancer and it makes her unhappy because it starts a clock ticking in her brain that constantly is saying ‘You shall suffer and die from the cancer.’ So she gets into a surgeon's hands and the hacker hacks her up, injuring but not eliminating the cancer. It is like shooting a big bear. Unless your bullet immediately finishes him off, all the bullet succeeds in doing is enraging the beast. So many times do I see a woman who begins to suffer only after the surgeon attacks her breast and the cancer starts to rage through her body. In Mitsue's case, some quack did an oriental treatment moxa skin burning over the lump last year and it seemed to have started it to become the terrible thing you see now.
"I wonder: shouldn't we better leave sleeping tigers lie? But Science will tell us the answer by control experiments after comparing treatments and the outcomes in matched patient populations.”
Sanya is now removing the breast. Starting from below at lower margin of chest she strips the large zone of tumor and overlying skin and adjacent muscle off the rib bones all the way up to apex, all the time working automatically and letting her thought process come out as talk.
“Problem is we have no alternative to surgery other than x-radiation which is also a problem because it destroys normal tissue as well as tumor, blocks healthy immune response and causes more cancer later.
"There are many quack approaches – vitamins, whatever, and they do not work so we need some medicine that will kill or slow the growth of cancer cells in order to stop surgery; and so the study I am starting is important. The physician aphorism: Primum non nocere in Latin, or ‘First do no harm’ can be extended to ‘Do the least harm for the most or equal good.’ Thus, less surgery that gives same result contra cancer even if it does not cure will save suffering.”
At this point Sanya cuts the mass of excised tissue away from its last anchoring strand in armpit. “I checked the armpit lymph nodes by biopsy and no sign of tumor so at best Mitsue should have a one in two chance but most surgeons do not check the nodes, which if positive rule out massive surgery. ‘Cut! Cut! Cut!’dominates a surgeon's thinking so he does not desire to discover a reason not to; and the pitiable patient ends up suffering and dying badly.”
"There are many quack approaches – vitamins, whatever, and they do not work so we need some medicine that will kill or slow the growth of cancer cells in order to stop surgery; and so the study I am starting is important. The physician aphorism: Primum non nocere in Latin, or ‘First do no harm’ can be extended to ‘Do the least harm for the most or equal good.’ Thus, less surgery that gives same result contra cancer even if it does not cure will save suffering.”
At this point Sanya cuts the mass of excised tissue away from its last anchoring strand in armpit. “I checked the armpit lymph nodes by biopsy and no sign of tumor so at best Mitsue should have a one in two chance but most surgeons do not check the nodes, which if positive rule out massive surgery. ‘Cut! Cut! Cut!’dominates a surgeon's thinking so he does not desire to discover a reason not to; and the pitiable patient ends up suffering and dying badly.”
She continues: “My creative dying concept does not work once your body has been damaged by massive surgery so we need to escape this crippling cutting. Thus the experiment that Mitsue is part of! We must be scientifically sure our ideas are proven correct.”
The breast cancer removal part is over and Kimi glances at wall clock: 20 minutes since first cut! Sanya turns her attention to Mitsue's left thigh. Using finely honed, long barber razor, she shaves a wide sliver of skin to use for skin graft to cover the skin defect where the left breast was.
Ten minutes later an assistant is tightly strapping Mitsue's left chest with adhesive, leaving drainage tube in place at lower end of incision so tissue fluid does not accumulate and ruin the skin graft.
19. Embrace and Kiss
Kimi assists as Sanya cuts off an elderly diabetic man's left foot at ankle. As a habit, he had taken to dipping his big toe in the bathwater to test the water's heat before getting into the bath; and one time it was too hot, but, because his years of high blood sugar from diabetes had so damaged his sensory nerves, he had lost feeling in tip of toe and got a bad burn from the toe dipping. Now he must lose his foot or his life.
Next, another prostate surgery on an old man, whom Kimi recalls seeing on rounds unable to pass urine. While moving an electric blade back and forth to shave off the blocking prostate tissue through a cystoscope metal sheath in penis, Sanya comments: “This may complicate his sex life because it frequently leaves one with reverse sexual ejaculation. The man gets erection and has orgasm but he shoots it back into his bladder instead of out into his woman. At his age I do not think it matters much; still, one never can be sure because some of these super annuities are still at it hot and heavy with prostitutes.”
In dressing room after surgery Sanya says, “You did well.”
They are alone en dishabille, Kimi having taken off her gown.
Sanya, pulling scrub dress up over head and dropping it, suddenly, nakedly embraces Kimi, and her old, still firm breasts press nipple against nipple as she kisses Kimi on the lips indicating with her tongue-tip she wants soul. Kimi, her back against wall is surprised but passive to the older woman's passionate frontal rubbing. Not a word is said as Sanya uses her erect clitoris like a penis rubbing against Kimi’s mound of Venus, and, after a minute, Kimi feels Sanya trembling with twitching pleasure and allows herself to be pressed passionately and kissed by the older woman spending her climax passion. Then it is over and Sanya steps away saying “I am glad of you, girl. You are good for an old lonely lady” and, before Kimi can feel embarrassed, Sanya puts on her clothes, checks face and adjusts hair before a mirror as if the sexual encounter were nothing special. “Now let us see that little girl for a second penicillin injection.”
They are alone en dishabille, Kimi having taken off her gown.
Sanya, pulling scrub dress up over head and dropping it, suddenly, nakedly embraces Kimi, and her old, still firm breasts press nipple against nipple as she kisses Kimi on the lips indicating with her tongue-tip she wants soul. Kimi, her back against wall is surprised but passive to the older woman's passionate frontal rubbing. Not a word is said as Sanya uses her erect clitoris like a penis rubbing against Kimi’s mound of Venus, and, after a minute, Kimi feels Sanya trembling with twitching pleasure and allows herself to be pressed passionately and kissed by the older woman spending her climax passion. Then it is over and Sanya steps away saying “I am glad of you, girl. You are good for an old lonely lady” and, before Kimi can feel embarrassed, Sanya puts on her clothes, checks face and adjusts hair before a mirror as if the sexual encounter were nothing special. “Now let us see that little girl for a second penicillin injection.”
Passing the patients recovering from surgery, Kimi spots Mitsue who is lightly asleep and wonders How is it to wake up with an ache where your left breast was? She considers what she herself would do discovering cancer in breast and she touches her own left breast. It feels the same as usual but she is changed. The advent of Sanya is something else!
Sanya looks at Kimi with understanding. “You are still a child. But then we are all little children but only some are aware of it.” She gives Kimi a gentle squeeze on right shoulder.
It is 2 PM , time for the child's second injection and they are off to her ward. In contrast to previously, the girl sits up in bed licking a lollipop but seeing Sanya she needs holding down by her mother and two nurses for the injection, which causes healthy screaming.
“Penicillin will revolutionize treatment of infectious disease but with such fragile source of supply we must limit it to children and fertile women,” Sanya comments later as they sit in eating hall for a lunch of egg and lettuce & tomato sandwiches.
To read on now, click 11.20 Astounding Abortion
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