“There is a unique thrill to operating. Opening a belly for example, and knowing how the layers of the abdominal wall will cleave under the line of the knife. The skin, bronzed by the coat of sterilizing iodine, must be opened in a single sweep, for its elastic tension pulls the wound-ends apart, and later extensions to the cut will look dog-eared and ragged. Under the skin lies fat; creamy or a rich yellow, dense or semi-liquid, according to body type and diet. As it parts, the first drops of red are starting from the cut surfaces. They are promptly sealed by cautery forceps, and a wisp of blue smoke and a brief smell of barbecue rise under the theater lights.
Then comes the muscle layer, easiest to split along its fibrous junction in the midline. This must be divided with care, for immediately beneath it lie delicate structures: the sliding contents of the abdominal cavity and the delicate film of the peritoneum that sheaths them. A small hole is made with scissors. The cut gapes likes a buttonhole. You slide your fingers behind the muscle sheath – the first intimate contact with the patient – and the scissors advance, clipping through fibres that grit faintly between the steel jaws.
The peritoneum itself is cut next, its milky blue membrane retracting like an anemone. Retractors are hooked into the wound edges and the frame cracked apart, and a wonderland is revealed. Loops of neatly layered bowel pulsate in slow waves like wind over a cornfield. The edge of the liver, a rich brown, forms a notched line below the ribcage, and nuggets of fat gleam among the fine vessels that fan out between the translucent layers of the mesentery. A faint odour, fresh yet slightly sour, rises from the exposed tissue.”