I did ask about helping with the surgery this morning, and got kind of slammed for it, which really I should have expected. Everyone knows that there are “intern cases” and “not-intern cases,” and I didn’t really need to be told that this one didn’t fall into that category. Yeah. So I got a very educational pimping session on all the different kinds of scalpel blades (there are seven, numbered nonconsecutively, plus another odd group), their shapes, and their functions. Likewise on how the bovie works. And although I was disappointed, I can’t really object. A surgeon ought to know those things, it’s fairly inexcusable that I haven’t inquired into it before, and it’s good to know now. Afterwards I did get to do a fair amount of sewing up, which turned out very neatly, and I can sew faster and neater than the medical student, so I feel semi-secure.

But discussing “intern cases” brings up the question of, aren’t lipomas and basal cell carcinomas essentially the definition of an intern-level case? So how come I can’t get the attendings to let me do anything on those cases? Okay, yes, it’s a private patient, and they’re awake. But if I can’t practice on a case of appropriate simplicity, how am I ever going to earn the right to do anything more difficult. Catch 22. The solution is, wait for a year. Then I’ll by definition be allowed the hard cases, and then I can get glared at for not knowing how to do things. But at least I’ll have some instruments in my hand.

Sunday some of the trauma team found themselves in an exploratory laparotomy that became more complex than they had anticipated, and they paged me to come help. Which was simply thrilling – some surgeons actually wanted me?! Admittedly, it was for the purpose of holding a retractor, which I did as enthusiastically as possible. There was a point at which a large clamp needed to be released as a silk tie was knotted around the blood vessel it was holding. I fumbled the release badly, leading the resident and attending to inquire solicitously whether I had ever done that maneuver before – correctly? I was furious with myself. I’ve done it many times – but of course not when I have a chance to make a good first impression! Then they asked whether I was categorical or preliminary, probably just being polite, but it felt like they wanted to find out how seriously the program had suffered by matching me. (I’m blowing the episode up; but I do wish I could stop being in the middle of doing idiotic things every time I meet another senior resident or attending!)

So the question for tomorrow: attend the free flap, at which I’ll get to do absolutely nothing, or go hang out in the minor procedure room, which is my level, but where I’ll also get to do nothing?

(And yes, I’m feeling grouchy because my book ended. I hate it when a book has a bad ending, but it’s almost worse when the ending is good, because you get kicked out of a perfect world.)

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