This morning we got to come in an hour later, because grand rounds and didactics occupy the morning, so we don’t have to finish rounds before surgery. I found notes on two of my post-hysterectomy patients’ doors, saying they didn’t want to be disturbed between 9pm and 7am. The third year resident on OB (some of the GYN patients are put on the OB floor) started interrogating me about what I was doing on her floor, so I succumbed to the temptation to run away and ignore the patients. They weren’t even on our service; I was observing a resident on a GYN endocrinology rotation assist her attending with them. So no one cared if I saw them, and they definitely cared for me not to; so I left them be.

After lunch the chief was doing a vaginal hysterectomy on a staff patient. I had already claimed the right to go to that surgery; whereupon he announced to the other student that another doctor, who usually took a resident to assist, was doing a nice anterior/posterior repair, and all the other residents were busy in clinic, so he should go. Nuts! I’ll find out tomorrow morning how much he got out of it. Needled by that happenstance, as we walked over to the OR I asked the chief if he would kindly show me how to maybe clamp something during his surgery – carefully specifying that I had never done it and had no idea how, but also attempting to demonstrate that I did understand the general idea of the proceedings. He very politely informed me that those clamps go on arteries, which are vital, and this is a complex surgery, only allowed to residents in their third year. I privately agreed, and shut up. But then he let me prep the patient – which I did wrong – and drape the patient – which the nurse helped me do wrong – and cath the patient, which I finally did right. It was a very bad surgery; it had been scheduled by the “gunner” surgeons on the last rotation, and probably should have been abdominal. She was a tiny lady, and she had a huge uterus; there was no room to work. My arms ached from retracting; I could never see that I was moving anything, but the chief was very insistent that I should keep doing whatever it was. They had to take the uterus out in pieces, and he let me pull out one of the fibroids. Then, when it was all out and the bleeding stopped and the attending left to talk to the family, he let me put a figure-of-eight stitch in the vaginal cuff, and didn’t say a thing about me fumbling to get the needle placed correctly. I still don’t know what a figure-of-eight stitch is, but I didn’t think right after he let me do one was the best time to ask. I was quite satisfied with that amount of involvement in a tricky case. Then we went over to the clinic, and he told me to do a pelvic exam on a patient complaining of dysmenorrhea. I couldn’t find the cervix, after trying a great deal; of course when he put the speculum in it was right there obviously. Again he was very nice, just explaining his method of finding it. So I managed to look like an idiot again in front of him. He’s probably very nice; he was very patient with me. I can’t blame him for thinking me quite disastrous, the way I fall to pieces whenever he’s paying attention to what I’m doing.

But I think I discovered a good strategy; I’ll ask for an outrageous amount, and then fall back on more reasonable level. Usual bargaining technique. Two more days on this service, we’ll see how it works. Actually, when I saw the uterus they eventually dragged out, I was horrified at myself for asking to do anything.

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