A surgeon's gloved hand probes inside the chest during minimally invasive heart surgery.

I took this picture during my first visit to the operating room to photograph cardiac surgery. I have photographed many surgeries since, from Seattle to Boston to Brazil, but this photo is one of the most powerful images I have made to date. There's an ominous, dark power in it.

The photo was made during a minimally invasive procedure in which the surgeon does the entire quadruple bypass through a small hole in the patient's chest instead of sawing through the breastbone (a procedure called a sternotomy) and prying the chest open with retractors.

In this photo you can see the surgeon's gloved hand probing through the small hole that gives him access to the heart. Because the sternum is not cut open to allow a full view of the heart, he must employ other means of "seeing" what is within the chest. He had to use a saw to cut three ribs and remove them to reach the heart. After he removed each section of rib he numbered it with a Sharpie pen in order to keep track of their proper orientation when it came time to replace them following surgery upon the heart.