This morning after M&M I scrubbed in another lap Roux-en-Y. Both of the attendings were in it, as the senior resident had to finish some things with patients on the floor, and arrived an hour after they started. I got to hold the camera again, as the younger doctor struggled to dissect an amazing number of adhesions for a patient who’d never had surgery before, complicated by massive omentum. He also had to manage his senior partner, who apparently has very little laparoscopic experience. Thus, statements like, “Now – where on earth is this attached to? – if you would just let go of that piece – yes, let go of it – you can let go of it now; please, don’t put any traction on that!” Note: not to put traction on fatty structures, because they tend to bleed easily.

The highlight of my surgical career so far: They both decided to leave the room, one after the other, while there were still two skin incisions to go. Thus, I got to finish the sutures, unsupervised (very smooth sewing); put on all the steri-strips (ok, not so exciting); tape the local anesthetic catheter in place (after my disastrous adventure with the orthopedic epidural catheter, you can believe I was super-careful of this one); and put the wound dressings on. The scrub and circulating nurse were all asking me: Do you want steris? How do you fasten that catheter? Do you want dressings? They must know the answers, but they acted like they needed me to tell them. Ha; this is fun. Of course, when we got to the dressings, I couldn’t remember what was really supposed to happen, so I accepted the gauze from one nurse, and put a few small bits of tape on them. She rolled her eyes at me, and I realized one traditionally puts lots of large pieces of tape. Next time, ok? Can you believe it, they left me alone with an anesthetized patient and a needle?

In the afternoon, I decided to go watch the plastic surgeon’s case, a free flap to repair a skin deficit left by an encounter with a lawnmower. I didn’t scrub, because there’s a visiting student doing a rotation with him. Out of deference to my father, I managed to converse with the surgeon for several minutes, about the complicated process of applying to plastic surgery residency (basically, there are an endless number of ways in which the programs can leave you hanging, and I can’t begin to fathom how one would defend oneself). Then I watched him use tiny instruments under a microscope (fortunately equipped with a tv screen) to sew itsy-bitsy vessels together. He lost his needle several times, that’s how small the things were. Under the microscope, the suture was invisible. Conclusions: plastic surgery has the grossest wounds of all. I thought I was past feeling sick, but apparently not. I guess I don’t mind wounds that we make, on purpose, but the results of accidents really bother me: lawnmower cuts, open tib-fibs, scalps torn open, etc. Also: all surgery requires patience (eg, lysing extensive adhesions laparoscopically), but plastic surgery requires the greatest finesse, patience, and perseverance. I don’t know if I have that. I felt like stretching my arms and screaming after watching him working with tiny controlled movements for just fifteen minutes. I am still trying very hard to have an open mind on the subject, though. (Alice, since when have you had an open mind on any subject?)

It occurred to me in M&M that that’s another thing that attracts me to surgery: surgeons are always right. Even when the subject is controversial, and there are many ways of interpreting the evidence, each attending is always supremely confident that they have the correct and lifesaving answer. This is, again, not necessarily praiseworthy, and certainly not a rational reason for choosing the specialty; but it fits. It also makes life very hard for the residents. . .

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