The surgeon-narrator and his team of assistants (the anesthesiologist, scrub nurse, circulating nurse, surgical resident, and medical student) perform a difficult operation during the night. The patient has an infiltrating cancer of the stomach (linitis plastica) that has eroded his aorta. Because of uncontrollable bleeding, the operation (an exploratory laparotomy with attempted repair of a malignant aorto-gastric fistula) is as doomed as the patient himself.

The surgeon soon comprehends the hopelessness of the procedure as well as the patient's terminal condition. He turns off the oxygen from the gas tank and stops the patient's blood transfusion. Minutes later, the man dies. Blood is all over everything. The doctor must now deliver the bad news to the man's family. He has the medical student tag along.

Members of the patient's family are upset and some are even out of control so he dispenses tranquilizers to them. The surgeon returns to the operating room (OR) and even now finds blood everywhere. The OR team is still working. The doctor showers and then goes back to the OR once more. The room is now dark and empty but clean. The surgeon imagines the dead man's body with a row of abdominal stitches that he likens to hieroglyphics. The unsuccessful operation and the surgeon's actions are thus both concealed and unforgettable.


The image of blood saturates this story and especially tinges the surgeon and medical student. "Blood is everywhere" (58)--filling the cavity of a cancerous stomach, hemorrhaging from the aorta, oozing from a traumatized lip, sprinkled on surgical gowns, covering surgical gloves, flowing through the intravenous tubing of a transfusion, and streaming on the floor. The medical student is "baptized" with the patient's blood. The surgeon's scalpel is an important symbol here. It is an instrument of healing but also a potential weapon that can stab the patient and provoke bleeding.

The story raises many weighty questions: Are the surgeon's actions (discontinuing the oxygen and blood transfusion) ethical? Are his interactions with the medical student and the patient's family appropriate? How does the surgeon view the patient's body both during the operation and after the man dies?

The story speaks to issues of medical futility (and when to call it quits), loss, scars, breaking bad news, and medical education. The final scene is instructive. In a sense, the surgeon's hands will always be "bloodied." Perhaps his own "wounds" must remain hidden in order for him to continue to function efficiently in a profession that requires quick action and hard decisions.

Primary Source

Confessions of a Knife


Simon & Schuster

Place Published

New York



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