on the Innards of Animals and Children

Some people just can’t bear to think about the insides of bodies; others of us are completey fascinated.  When I’m operating I still delight at the little twitches of the intestines as the muscle pushes the food along them, just like when I first saw this on work experience aged thirteen.

I like to look at skulls and notice all the tiny holes. Anatomists name bony landmarks in much the same way that settlers name valleys and hills; hands up who knew they had a hole called the ‘Mental Foramen’ next to their chin, where the ‘Mental nerve’ peeps out?

I have fingered lung tissue on the slab: it’s cold, it’s solid and it’s meaty. But i have also watched the lungs of a live patient (through a hole in the ruptured diaphragm of a dog, for example) rising and expanding with comical improbability as they admit a breath. Lungs never look real to me: they could have been made of latex.

The curiosity doesn’t stop with my patients though. They usually put up a screen between the mother and the op site when they do a ceasarian section, but when Toddler was born I was lucky with the reflection in the surgical light and was able to see the doctors cutting my womb and then through a mass of squiggly tissue (placenta in an unexpected place) to pull out a massive, white-blue baby. The baby cried and turned pink and they put her next to me and I saw her tiny squidged-up nose….. so I forgot all about watching them sew up.

But that was the start of me getting squeamish because it has occured to me since that there are some innards I just don’t want to think about. And they are the innards of the people that I love.

What if the owner of the perfect, fluffy white cat lying limp (anaesthetised) in front of me could see what I can see? A square has been shaved bald on her uppermost flank, then covered with a green cloth with a square hole in it. The bald skin in the middle of that hole is split with a scrape of the scalpel; a sliver of white fat is cut away to reveal the smooth plane of muscle glistening beneath.  If I cut a small hole into that muscle, I can push a finger through it into abdomen. The intestines against my finger feel like udon noodles. Then I can fish out the womb…..

Would the owner still be watching, I wonder?  Or would they be horrified and feeling sick? Or maybe both, rooted to the spot, unable to turn away…..

And then a chilling thought: What if someone were to have to operate on my child?

The time I saw Toddler with a jar of screws in her hand and worried that she’d eaten one, I had the biggest sinking feeling ever. My stomach contents simply plummeted, from the top of Everest to the bottom of the Pacific. I’ve known all sorts of objects come out of animals – a fork, a brillo pad, bits of teddy-bear, plastic toys, stones, fruit stones, plastic bags, corn-on-the-cob….and three of those were in the same animal.  I’ve seen some horrible, friable gut that looks as if it’ll never hold together.  In fact, we sometimes have to remove whole sections of it, the foreign body having caused so much damage that the gut just won’t survive. Sometimes we sew back up thinking, ‘will this work?’

But never has the surgical wound in the intestine wall seemed so vulnrable, so poorly stitched, so likely to come undone and let stomach contents leak and cause a stinking abdominal infection as Toddler’s imaginary one for a screw that she hadn’t even swallowed.

People you love shouldn’t have innards. Bodies are clever, intricate things where everything relies on everything else.  The more you know about innards, the more you understand the massive potential for innards going wrong.

What went wrong for Mum was that a few little cells, when splitting to make more little cells, made a mistake. They started to divide too quickly. They weren’t the fastest dividing cells so not much would have happened at first. But over years, a little lump of them appeared, somewhere in her bile duct….. and gradually, it grew…..

Ironically, cancer under a microscope can be beautiful: swirling shapes made of irregular cells, often stained pink or purple on a slide. They’d make nice prints for the wall or patterns for a crazy teenager’s curtains if nobody knew what they were.

Likewise, the backs of retinas, circular and colourful, look to me like planets in space – and they are all the more visually interesting when they have bleeds or folds or wriggly vessels across them, or any number of other features that could make a person blind (just google-image retinal detachment or one of my own fears, diabetic retinopathy).

Damage to bodies happens everywhere. Smooth, white joint cartilage helps the bones to slide past one another easily… but it can become roughened and painful arthritis can ensue. A clot can get caught in a tiny blood vessel and cause a stroke, stopping the blood supply to part of someone’s brain and altering their thinking perhaps for ever.

Too much sugar in your veins – over time – can force apart the selectively leak-proof cells that line those marvellous little tubes and thus the blood vessels can begin to leak. If the ones in the kidneys go, that can be very bad news for the whole body: another diabetic side effect I’m afraid.

My children, it turns out, will never have any of these problems. Because I’ve decided that my children don’t actually have insides. How can they have? They are just their perfect, dimpled exteriors that breathe and eat and poo and pee by magic: it’s all I need to know.

The other week, a puppy bounced through the door on three legs. It wasn’t weight-bearing at all on the fourth and I didn’t need to do an x-ray to diagnose a fracture: the foot and hock were swinging around at the most painful-looking angle.

‘Och I can’t look at that,’ the owner said over the consulting table. ‘If it were one o’ me Children, no problem. I’ve worked in children’s A & E for 50 years. But animals-‘ she wiped away a tear, ‘I just can’t.’

Funny old world.

(facts have been changed to preserve patient confidentiality)

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