“I think,” he said, pausing. “I’m going to find a radiologist to help me look at these. I don’t want to do a surgery on you tomorrow if it is not going to help you, you know what I mean?”
King stared at the wall, then blinked. Looking into her eyes, Sugarbaker could tell that she had not considered the possibility of being turned away. He did not know that two other surgeons had declined to perform this very procedure on King; one had even told her that she was “a lost cause.” But he was impressed with her determination — “I’m a fighter,” she had said more than once — and her biography. The single mother was an emergency room physician who knew the risks and was desperate to win more time with her daughter.
“You are eager to go ahead with this, aren’t you?” Sugarbaker said. King nodded. “Let me go find a radiologist.”
After consulting with the other doctor, who reviewed the scans and convinced Sugarbaker that the operation might be helpful, the surgeon returned to the examination room, sat down and said, “I think we can try. But I wish you were a little more of a straightforward case.”
“If anyone can do it,” King replied, “it’s you.”
Sugarbaker and Lana Bijelic, an attending physician who often assists in his surgeries, retract more of King’s skin to get better access to the abdomen and continue to scrape and zap cancer nodules.
The surgeon turns to the greater omentum, an organ that helps the body’s immune system. It is covered in tumors, one the size of a plum. The omentum is fed by about 40 arteries and veins, and each must be dissected to allow him to remove the organ. It is a tedious process. Sugarbaker first clears scar tissue in the area — King had two previous operations to treat the colon cancer and a bowel obstruction — then ties knots an inch apart on each vessel before snipping between the knots.
So far, Sugarbaker and Bijelic have exchanged a total of only a dozen or so words — they have worked together so often that she knows what he is going to do before he does it.
Sugarbaker has long believed that surgery should never become too tedious, because that is when mistakes are made. So after separating the 26th artery, he turns his attention to another part of the peritoneum, where he spots a fist-sized tumor in what he calls the “gutter.” It takes him about 15 minutes to wrestle it loose. Then he scours the liver’s peritoneum with his cauterizer, turning the pink surface gray.
He shifts focus back to the greater omentum, and after 30 minutes of cutting and searing, he removes it, the gall bladder and the spleen in one big cancerous clump. The ovaries, uterus and a large chunk of the peritoneum go next.
Five hours into the operation, King’s temperature has dropped to 94 degrees, and Sugarbaker tells a nurse to pour warm saline into the abdomen. For the next 20 minutes, Sugarbaker washes away blood and tissue so he can better remove tumors and stitch shut bleeding vessels.