Yesterday I was with the chairman of the orthopedics department, whom we can call Dr. Ashley – which is only not comic in such a macho department because he looks and acts exactly like my picture of a “Southern colonel,” minus the accent. He has a white mustache, stands very straight and square-shouldered, and is very courteous to his patients – who love him. I had previously only met him when lecturing to young third-year medical students, who were of course scared stiff of him – which gave me rather a mistaken impression, since he does nothing in person to merit such a feeling from residents or students.

I will admit that when, after he injected his first joint of the day, and nodded easily when I asked if I could do the next, and then proceeded to do another six without giving a sign that I might even be interested or involved, I did start to get a little frustrated. But, those were either new patients who didn’t know him before, or people with very arthritic joints. He did eventually let me do one, and then did another six himself (ok, so I’m no success at joint injections – but I see that as a reason to keep practicing, not to stop) before letting me try again. Then he surprised me at the end of the day by suggesting that by the end of the month he would let me do even the much smaller and more difficult coraco-acromial joints, which he hadn’t let me touch at all.

This morning I came in early, and found that the CRNA I had talked with last week had a CRNA student with him. Determined not to waste my early half hour, I cast about for a gyn patient, and asked the CRNA to let me intubate. She agreed, and let me use a Miller – with the result that I got closer to doing it on my own, but not quite. Maybe I’m not aggressive enough at moving around and trying repeatedly to find the right place before asking for help; but I don’t yet have the anesthesiologists’ supreme confidence in the patient’s ability to tolerate an extra 15 seconds of no ventilation. Here I thought that once I realized that the esophagus is behind the bronchus, it would work better. And lo and behold, there are these things called arytenoids, and they get in the way too.

Dr. Ashley had two total shoulders scheduled for the afternoon. He and my preceptor-of-the-day both thought it totally natural and reasonable for me to prefer to be in surgery rather than clinic, and didn’t even mention the concept of “students who sign up for a clinic rotation should not be in the OR.” Thrilling. I went to the surgery, and tried to intubate the patient again – fortunately, Dr. Ashley was amused rather than upset at my idea of combining anesthesia and orthopedic learning. I didn’t get it on my own. In the OR I was surprised to see my friend the resident, who was supposed to be enjoying a quiet month on foot surgery, showing up for shoulder surgery. Apparently, the powers-that-be neglected to assign Dr. Ashley a resident for the month, and my friend was dragooned for double duty. He didn’t look totally thrilled at being signed up for 2-3 4hr surgeries a day, in addition to his regular duties.

Today I met the total-joint “space suit” for the first time. An amazing helmet, with hissing oxygen right into your face – which also makes it impossible to hear what the attending says, leading to an embarassing number of mis-steps, all the worse because he didn’t get upset about them – and a battery on your belt, and then after you scrub, the scrub tech hooks this plastic faceplate onto the helmet, and lifts a voluminous drape over your head. It looks like an insane cross between Marie Antoinette’s hairdo, and John Glenn’s space-walking suit, and a snowboarding helmet. Actually after a few minutes I got used to the smell of oxygen, and the helmet didn’t give me a headache.

The surgery itself, a total shoulder replacement, was fascinating. I intend to see more, so I’ll wait to describe the details till later. But I asked Dr. Ashley whether he could use me again tomorrow, and he enthusiastically said he would be glad to have help. So hopefully I may be able to take a little weight off my friend’s shoulders, and get into the OR a lot more. As for the ostensible nature of this elective, if the attendings don’t care, I sure don’t.

I offered the resident to come and see the shoulder patients in the hospital in the morning for him, and he said no thanks, not thinking I was serious. I didn’t tell him I wasn’t offering out of a sense of duty, but because he’s one of the nicest senior residents I know, and because he was friendly to me back when he was a lofty fourth year, and I was a very fresh first year student; and of course because I want to be in the OR, and it’s not fair for me to do the cases, and him to have to see all the patients. Depending on how much Dr. Ashley will let me do in lieu of a resident, I’ll try again.

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