The team had only one case on this morning, with the chairman, so we mutually agreed that it was the other student’s turn to scrub in on a big case with him. I meandered around a clinic which contained only two patients, doublechecked on my patient from yesterday (NG tube not draining – resident concerned – did we staple it into somewhere it shouldn’t be?), discovered the well-hidden alcove of the medical library containing a collection of sci-fi and mystery novels I’ve long regarded as unattainably rare, and finally had an attack of guilt for neglecting my education which led me down to the OR, to search the afternoon schedule for a private surgeon I could attach myself to.

Ah: “latissimus dorsi breast reconstruction.” Sounds good; even sounds related to ob/gyn (I can’t figure out why ob/gyns do everything about women’s health, except breasts; seems pretty well-connected, to me). So I stood outside the door of the patient’s room in pre-op holding till the surgeon came by. I had just gotten his name of the schedule; I didn’t recognize him; I didn’t even know what his specialty was. When I asked, he quickly agreed to let me scrub in, and introduced me to the patient.

Back in the OR, I found out what private doctors do who don’t usually have residents or students to assist them: they become very ambidextrous, and the scrub nurse becomes even more ambidextrous. The nurse looked relieved to have someone else in the case, and later explained to me that she can’t quite see any more to cut the sutures as close as he wants. Having had a good lecture on that subject yesterday, today I was quite up to cutting things right on the knot. Other than that, I held various tiny retractors (looking very much like a demon’s implements from the illustrations in the Inferno) as he sliced through skin, fat, and then dissected the whole latissimus dorsi away from the underlying tissue. Amazing. Of course, he asked all about the innervation, blood supply, and function of the lat. dorsi, and of course I didn’t know; I do now. When he got to lots of little bleeders, the nurse handed me the Bovie, to stick against the forceps and burn with. I felt like kissing her. Nobody ever let me touch a Bovie before. So, after cutting away the whole muscle, except for the arterial attachment at the top, he dug a little tunnel through to the front, and pulled it around.

Then, I realized that he was a plastic surgeon. Rather than just cutting a whole along her mastectomy scar, and suturing the new piece in, he had the anesthesiologist sit her up, and move her around, and then cut here and there, and stitched here and there, and put staples in, and took them out, until he got, not just a lump, but a really breast-shaped structure. In fact, the nurses and I whispered to each other, the one he made looks better than the original. (She’d had radiation on both sides, so he’s planning to work on the other one later on.) It was impressive. He was throwing stitches in all along the edges of the tissue, and they magically pulled together, and shaped things. When I realized that he was a plastic surgeon, I abandoned any idea of asking to suture; but he put running stitches all around, over the top of the underlying holding stitches, and handed me a needle to do half of them.

Absolutely perfect. Thank you Jesus for letting me pick him to ask. Of course, he was rather a perfectionist, and wanted everything just so, and the nurses were rolling their eyes at him. But I don’t care; of course I’m very ignorant, both of anatomy, and of technique. I think someone who can do such miraculous things with a simple layer of fat and muscle should be allowed a few idiosyncrasies. As we cleaned up, he told me to keep an eye on her, and check on her in a few hours, and write the post-op note. So now I’m looking for a resident to ask: is there any more of a note needed than the “preop diagnosis, postop, procedure, no complications” note? (Which I already wrote and signed – hey, I wrote my first post-op note!) 😀