Would someone please explain to me how I could spent a month at the children’s hospital taking care of kids with gastroenteritis, and never get sick, and then spend two days seeing elderly patients with gastroenteritis in the ER, and promptly catch it? Hmm? I suppose it’s good for a would-be surgeon to remember what gastrointestinal illness feels like, so one doesn’t dismiss patients’ complaints too cavalierly. However, God, I promise this episode will last me for at least . . . twenty years, ok?

I really didn’t think I was so difficult to get along with, so prone to starting turf battles. But I can’t get along with PAs. Can it all be purely their problem, or am I doing something to set this off? I swear the older PA looks like a tomcat getting ready to defend territory, back arched, hair on end, when he walks in to start a shift, and sees me by the doctor’s station. I try really hard to be as respectful to the two of them as I would be to an attending, since that’s basically what they’re functioning as. The younger one and I are on ceasefire terms; but not the older one.

The other day there was an older guy (so nice and sweet and polite and funny, I could have spent all day talking to him, reassuring him that if his family doctor had said he had had a stroke, then he really had, and the two medicines he was on were just perfect for him, and he should definitely keep taking them) with a paronychia: infection collecting just south of the fingernail. His “lady friend” was concerned, and had made him come get it checked out. The attending planned to lance it, but the PA arrived before the lidocaine took complete effect, so the procedure was handed over for the PA to supervise me doing. Yeah right. (Wouldn’t you think that prepping and draping an already infected location would be a safe job to give the medical student? Not according to my friend. I think Tom is going to be a good name for him.) After getting everything set up to his satisfaction, he let me pick up the scalpel, and with much trepidation allowed me to make a 2mm incision. Nothing came out, so he took over with the scalpel, and after edging 1mm in the other direction, got the desired results.

I saw the nurse setting up a suture kit down the hall, so I asked what it was: hand laceration. Admittedly, done with a power saw. I asked him very politely, “Could I help with this one, or would you rather do it yourself?” He said I could assist, but he wanted to be very careful about tendons. So I hovered around the area for half an hour while he saw other patients, until I guess he figured I wasn’t going to disappear, and he would have to do it with me. (There was a PA student around here too; and I do feel bad for edging into his territory; but he wasn’t present when this started, and if Tom had bluntly said, this one belongs to my student, I wouldn’t have minded as much; I don’t think.)  The day before when someone lacerated his wrist, the attending sent me to see it and wash it; although he took a quick look at it, mainly he took my word for it that there were no tendons cut, and no major blood vessels injured. I sewed it up all by myself. (Ok, so it did take me half an hour to do; but there was no one watching me, and the patient was perfectly happy with the result.) So I felt rather injured by Tom’s attitude.

The doctor asked at one point, as I was hovering, if I was going to sew it up. I said, “I don’t think Tom trusts me.” The doctor became a little concerned, and said, oh definitely, it was my job to do any suturing or procedures; but I didn’t want to take it any further. After all, don’t accuse a servant to his master; Tom has worked here for years, and he’s going to be with these doctors long after I’m gone; and if you’re asking who does a better job, of course he does.

Well, a careful exploration of the wound revealed partial injury to two tendons, necessitating referral to a hand surgeon; but we still closed the skin, because you can’t leave such a big wound gaping open. Tom used vertical mattress sutures, with his personal variation, putting the superficial part in first, and using that as an anchor for the deeper ones. Which worked very well, and allowed him to trim the ragged edges of the wound afterwards, so it came out neater. After he did six, he let me do the last two. And I did learn from seeing him do it, and now know how to do a stitch that was mostly a mystery to me before. But somehow, when I make mistakes with Tom around, it’s a much bigger issue than if I do it in front of the attending. (And for all his emphasis on sterile procedure, Tom broke the field himself half a dozen times. So there.)

So maybe I wouldn’t have known how to find those cut tendons by myself. But now we’ll never know, will we? Bother it, in six months I’m going to be a doctor; and I need the chance to do something a little bit dangerous now, otherwise me and my patients are both going to be in even bigger trouble in July. That’s why I don’t like PAs; they’re so good at their job, which is to be a glorified medical student, that there’s no place near them for a real medical student. I think next time there’s a laceration I’m going to ask the attending to tell Tom to let me do it by myself. (I hate the way I sound here; I should just shut up and let Tom do what he wants; I have to learn sometime, though – don’t I? And my father keeps asking me if I’m sure I’m able to handel scalpels and needles. . . If anyone would give me the chance, I’d do as well as the next person.)

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