I spent a couple too many minutes in the doctor’s waiting room, reading the brochures for face lifts, breast lifts, eye lifts, nose jobs, tummy tucks, etc etc. Ick. Cheaters. I don’t especially like the idea of getting old, but when I do, I don’t intend to lie about it. Tsk. That’s not medicine.

But it sure pays a lot. A lady who came to see Dr. Mark, my preceptor, for followup of some injury he’d repaired, wanted to talk about getting a tummy tuck. The first item of discussion was: how much it would cost, and that everybody – surgeon, anesthesiologist, and surgery center – would need to be paid upfront. Then they started discussing medical contraindications, and surgical techniques. To be fair to Dr. Mark, whom I like, part of that was the patient’s emphasis – she wanted to be sure she had enough money saved. But part of it is the nature of the plastic surgery business.

Most of his office time yesterday was spent removing sutures from facial injuries he’d repaired. I understand now why, when we were setting up this elective, he sounded skeptical about me sewing anything while with him. He uses 8-0 prolene, which in spite of being blue-colored is practically invisible due to its tiny size, and makes itsy-bitsy bites. The first patient I saw, I didn’t even realize there were any stitches to be taken out. I don’t even think I’ll dare ask to remove these sutures, let alone put them in.

I have mixed feelings about plastic surgery right now. I hate the cosmetic and money-driven side of it. I also think that nasty skin wounds are more nauseating than abdominal stuff (I don’t know why; that’s so illogical; it would be so nice for me if I didn’t feel that way); I hate the look of free flaps, and ripping injuries that disfigure extremities. I’d rather look at and handle dead bowel; maybe because you can close the abdomen up neatly, no matter how bad the stuff inside is; except for the really bad cases where you have to use a vac; and even a vac is neat, compared to a free flap 48 hours after surgery. But, I love suturing. That’s one of the things that drew me into surgery. I love the idea of patching things together and making them neat. I love using my hands to fix the patient. And plastic surgery is all about your skill in manipulating your suture and the patient’s skin.

Dr. Mark is a neat, dapper little man, if possible one inch shorter than me (which unfortunately means that I’m more likely to talk and not watch my words around him than around some of the more imposing surgeons I’ve worked with). He has a good fashion sense – which stopped in the mid-80s. He homeschools his children, and hates government intervention in life, especially in medicine. We’ve already had some great conversations, and I foresee more coming up. Even if I don’t get to do anything, just stand and watch, his unconventional approach to medicine and life will keep things from getting boring. One good question will set off a ten-minute rant.

This afternoon we spent two hours removing two skin cancers from a patient’s face; or rather, he removed, and I watched. He handles the scalpel and tiny sutures so deftly that he makes it look easy. Thus, at the end of the two hours, I was emboldened to ask to put some closing prolene sutures (over anchoring subepidermal maxon sutures) in the scalp – where hair would cover it, so the cosmetic result matters a little less. I figured that was the only place I’ll have a chance to touch this month, so I wouldn’t miss it for lack of boldness. To my surprise, he let me, and didn’t say anything as I stumbled along, getting the stitches just a little bit not deep enough, and tangling my knots in the patient’s long hair. Afterwards he said, “Good job,” and then asked whether I’ve sutured much. I didn’t know whether to tell him yes, lots, and hope he would let me do more, or try to downplay how much I’ve done, by way of excusing my clumsiness. I settled for, “Every chance I get.”

Tomorrow is office all day. Even that should be relatively lively, since Dr. Mark is a firm believer in educating the patient about the economic and libertarian implications of government actions and insurance company interference.

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