Some friends at church asked me what my favorite kind of surgery was. This blog has given me the bad habit of being frank about my job, so I said, “Vascular surgery, because if you miss a stitch, blood shoots up at the ceiling.” They were rather horrified, and began relating how they had been traumatized by dissecting fetal pigs in high school or college.
Note to self: There is a reason that most doctors never talk about their profession outside the hospital or clinic. From here on, even if people ask pointed questions and seem to be genuinely interested, I will say nothing. I will be a monument of discretion (yeah, right).
Which brings me to my least favorite part, at least of transplant surgery: dissecting out the external iliac artery and vein using electrocautery. This works out to the attending surgeon isolating pieces of tissue which he thinks do not contain any tiny blood vessel branches, and then me bovieing through them. So I’m holding one end of a 9″ long bovie, manipulating the other end deep in a hole, 1mm away from two very large blood vessels. This strikes me as an extremely bad idea. I still don’t know 1) how I get up the nerve to do it every time 2) how come I’ve never hit the wrong thing yet. But I guess that’s the whole point of surgery: cutting small things, surrounded by larger objects which it would be dangerous to cut; if you don’t get comfortable with that, the operation takes twice as long as necessary, to the danger of the patient and the annoyance of everyone else in the room.
The other option is perhaps safer, but not easier for me: right-angle clamp around a tiny vascular branch, pass two silk ties around it, tie off on both sides, and then cut in the middle. Which works out to 1) only 1 out of 5 scrub techs ever seems to grasp the concept of handing ties in a way that is of any use to the surgeon who only has one hand free for it; the attending doesn’t see the antics they’re getting up to, and not-quite-silently blames me for not completing the maneuver faster 2) the attending gets to critique my handling of the ties, and then my method of tying, over and over and over again. Which means I learn a lot, sure. . .