surgery

i will write one note on surgery.

before i did my surgery rotation, i knew i didn’t want to do surgery. surgery is one of those fields, you either love it or hate it. i’ll start by detailing a typical day.

as a student, the goal is to see as many patients before your intern. keep in mind the intern will start seeing patients at 530-6 am. so you need to be there at least a half hour before them.  your sole function in the morning is to write a “progress note” on the patient, which on surgery consists of:

  • Subjective: no acute event. no n/v, f/c, 1 bm, + flatus
  • Exam:
    • VSS stable, afebrile. u/o 500
    • Abdomen: s/nt/nd, +bs
  • A/P – continue current care

what i just wrote there is a lot. the abbreviations don’t matter. i have had patients talk to me for 15 minutes, and that’s still all i write. if i wrote more, i get scolded by the intern, because then he actually has to read.

after i see the patients, i then have to walk around with my intern and tell him everything i wrote in my note anyway. then we wait around for the senior resident to arrive. the group of us now go around and see all those patients again, telling the senior what we saw upon which he goes and sees the patients anyway.

 after this charade, i am blessed enough to scrub in on surgeries. i was fortunate enough that while on surgery, my scrub nurses were extremely nice (which is unusual because normally the medical student is the brunt of their displaced anger – it’s a food chain).

attending – resident – everyone else at the hospital including janitors – medical students

at this point, i am standing by the patient, usually scrubbed in. i stand there for most of the surgery just watching or retracting skin or fat out of the way. sometimes i get to cut sutures (exhilarating). sometimes people talk to me, usually not. and when they do, i’m not paying attention because i’m used to being ignored for 3 hours. and a lot of times it’s not enough nice conversation, like what’s your name, it’s more like…

“what is the arterial supply of the inferior thyroid pole”

“the inferior thyroid artery”

“where does that artery originate?”

“the thyrocervical trunk”

“what is the embryonic tissue from which the thyroid is derived?”

“…eh…hm…i’m not sure.”

“you clearly aren’t studying. you can no longer capable of even retracting. stand there and don’t talk.”

“yes sir.”

toward the end of the surgery is the pay-off – i get to suture the body closed. this is not something you get to do right away. first you must prove you can tie a knot and use scissors (we’ll come back to this).

after the case is done, i stand around for awhile. if there is another surgery, i go to it. then in the afternoon, we do that same walking around the hospital thing, this time with the attending/surgeon (same thing). we tell him what we told the senior, and he goes and talks to the patient who tells him all of what we told him anyway.

by now it’s 4-5 pm and i can go home. to study.

scissors – unbeknownst to me, there is about a 50 page book just on proper scissor technique in the operating room. in the left scissor hole, you put your thumb. in the right, your ring finger. you index finger rests on the neck of the scissors. when holding the scissors, you must have the screw up. you place one blade on the suture, run it down the suture until it hits the knot. if you are in the body, 3 mm will suffice; if it’s the skin, as close to the knot as possible. when you raise your scissors to the 3 mm knot, you must turn the scissors to a 45 degree angle. you are now ready to cut. to properly scissor, one must push down with the thumb and lift up with the ring finger, to optimize the cutting power. once you cut, and you note the length of the tail of the suture, the surgeon will either tell you it was too long or too short.

i am not kidding.

 however, i will say not all surgery is bad. once you get to know a surgeon, they begin to trust you (assuming they like you) and they let you do more and talk to you. however, you rarely ever rise to a level higher than basic suturing and cutting.

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