Fifty-two year old Pete, the hospital mailman, suddenly experiences severe abdominal pain. He is evaluated and treated in the emergency room. His diagnosis is acute surgical abdomen, but the exact cause of his pain is still unknown. The surgeon-narrator determines that the severity of Pete's condition mandates exploratory surgery. During the operation, "an old enemy" (18) is encountered--pancreatitis.

Afterwards, the surgeon assures Pete that he will get better. One week later though, the mailman dies. His death has been painful. An autopsy is scheduled, but the surgeon deliberately arrives 20 minutes late. He does not want to view the intact body of his deceased patient. No matter, the pathologist has waited for him to arrive before beginning the post-mortem examination. The pathologist closes Pete's eyelids before starting the autopsy, mindful of how the mailman's "blue eyes used to twinkle" (21) when he delivered the mail everyday.


This essay is built around the clinical vignette of a surgical emergency and a postoperative death. Two things shame the surgeon-narrator: failure and pain. Pain is associated not only with failure but also disease, loss, memory, and helplessness. The description of pain in this essay is noteworthy: "Pain invents its own language" (18). The mailman articulates his suffering with "a great primitive howl of vowel and diphthong. This kind of pain owns no consonants" (16). One word especially captures the horror of pain here--unfathomable.

The small hospital is portrayed as a self-contained community where all employees and staff share a genuine sense of camaraderie. Operating on an acquaintance or hospital employee might be especially difficult for this surgeon. The essay emphasizes the absolute trust that a patient places in a surgeon and the burden of that responsibility on the physician. The human body is viewed differently before, during, and after surgery. How so? How is the pathologist's perception of Pete in the hospital morgue unlike the surgeon's view of the dead man?

Once upon a time, there were windows in operating rooms. Surgeons were afforded a peek at the sky and maybe Heaven caught a glimpse of the surgeon at work on his patient. Now that's a room with a view.

Primary Source

Confessions of a Knife


Simon & Schuster

Place Published

New York



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