The Italian Test

It was nostalgic to hear the Italians call the operating room “the theater,” a holdover term from earlier in the century when surgeons taught surgical anatomy and techniques to apprentices who stood watching from tiers of raised platforms around the table centered in the room.

An uncovered naked man was asleep and on a ventilator on the operating room table.

Allen’s anxiety spiked. He had no idea what role Consoli expected him to play. Furthermore, he didn’t know the patient’s diagnosis or the planned operation.

Consoli walked over to X-ray films hanging from a lit view box on the wall opposite the door. “Allen, my students speak little English, so I explain in Italian. Franco translates for you.”

Scanning the images, Allen immediately detected the markedly dilated aorta in the belly, along with smaller bulges in both arteries splitting off to supply blood to the legs. Franco translated quietly as Consoli spoke authoritatively to the group. Arms folded, Allen listened. Consoli described the risk of rupture of the ballooned blood vessels—with death an almost certain result—if they were not replaced.

Then he turned to Allen. “We wash our hands, Allen. We do this operation the old way: we make an open incision.”

The two surgeons and Franco scrubbed their arms and hands, rinsing off the soap. Holding their hands at shoulder level, water dripping down off their elbows, they reentered the operating suite. Consoli strode to the back of the room where a female nurse held a metal pitcher. He held his hands over a basin while she poured clear, colorless liquid over them. He clenched and unclenched his fists and shook his hands vigorously, spattering the table and the nurse with droplets, then accepted a towel from her to dry his hands while Allen observed, perplexed. This was not a standard step before an operation in America.

Allen stepped toward the scrub nurse to receive a towel, but Consoli protested. “Allen, you don’t take the water?”

Being in Italy, Allen wondered if Italian surgeons rinsed their hands with holy water before an operation. “What is the purpose of the water, Ugo?”

Consoli was surprised. “It is chilled, sterile water. It refreshes your fingers before an operation. You do not do this in the United States?”

Smiling behind his mask, Allen couldn’t wait to tell the OR nurses at Emory about this practice. He imagined where they would offer to pour chilled water if he attempted to initiate this ritual.

He accepted a pour of the cold water, thanking the young nurse, and toweled off his hands. He informed Consoli that this was a novel step not performed in America and thanked him for the idea. Consoli simply shook his head before muttering something incomprehensible in Italian.

After placing sterile drapes leaving only the patient’s belly uncovered, Consoli made an incision extending from the bottom of the breast bone down the belly to the pubic bone. “Big operation, big surgeon, big incision,” Consoli announced matter-of-factly.

Allen clenched his teeth, saying nothing.

Consoli’s junior staff and trainees stood on metal steps they pulled up behind the surgeons. Allen and Consoli moved intestines to one side exposing the large blood vessels at the back of the belly cavity, freeing these blood vessels from other tissues. Anticlotting medicine was given by the anesthesiologist and clamps were placed above and below the abnormally dilated portions of the aorta and each large artery going to the legs. The two surgeons opened the markedly dilated aorta and the vessels to the legs with scissors and then sewed a large-diameter synthetic graft to the open end of the aorta just below the arteries to the kidneys before sewing the two smaller-diameter limbs in the Y-shaped graft, one limb each providing blood flow to the legs. Clamps were removed and pulsatile blood flow to both legs was confirmed by a nurse.

Consoli reached over the open belly and shook Allen’s hand.