A few days ago I was allowed to do my first laparoscopic cholecystectomy (gallbladder removal). For once, I knew about the case the day before, so you can be sure I spent the evening studying Zollinger’s atlas of surgery on that subject. (Zollinger, as in Zollinger-Ellison syndrome (a tumor that secretes gastrin, causing uncontrollable production of acid, leading to intractable stomach ulcers). The Dr. Zollinger was a professor of surgery at OSU. I had attendings in med school who had trained under him, and they used to tell us horrifying stories of his mental cruelty and sometimes downright physical violence towards residents and students. Now I can never think of the pancreatic endocrine cancer syndromes, let alone open this key textbook, without picturing the most dramatic of those stories (concerning the fate of a medical student unfortunate enough – insane enough – to point with an unscrubbed hand to an object in the operating field. Or maybe he tried to touch it. I suspect that at least half the story is apocryphal by now.) The Dr. Zollinger has died, but the textbook is continued by his son.) (And the textbook didn’t do me that much good, because our attendings use different port placements and different instruments.)

I had the idea that the attending – the one who has already suffered through several laparoscopic cases with me this month – would probably just want me to assist, since who in his right mind would want me touching the cystic artery and duct? But no, he handed me the instruments and told me to start dissecting. I am very grateful to the OR staff, who made absolutely no sounds of frustration as I dragged the case – which should take half an hour or less when done properly – out to an hour and a half, struggling first to figure out where I ought to be going, and then how on earth to make the instruments do what I wanted. The attending, with superhuman patience, touched the instruments only every two minutes or so. Otherwise, when I was heading for the right place, he kept quiet and let me figure out how to get there. The patient seemed to do well, and was discharged that day. I haven’t heard anything more of him yet, which is good.

Thoughts on laparoscopy: 1, I wish I had enough money to buy some video games and equipment, since everyone swears they’re so good for teaching hand-eye coordination, and even that there are studies proving that people who play them do better with laparoscopy. 2, watching someone else do this surgery is very frustrating (when the instrument wavers, or it takes several tries to get something done), but contrary to my expectations, it was not as frustrating to do. 3, I can’t believe the chief and attending let me do that. I suppose, since this is a surgery residency, I have to learn sometime. They no doubt decided to bite the bullet and get the first one over with. 4, it doesn’t make things any simpler to have to hit pedals with your foot as well as juggle with your hands. They should call it hand-foot-eye coordination. Why can’t it be arranged so the cautery is controlled by the hand on the instrument, rather than with the feet?

For the rest, I am tired of getting insane consults from medicine teams, for problems which have no surgical solution, or for problems which have a solution so commonsense that you shouldn’t need a surgeon to explain it to you, or for patients on whom two other surgical teams have already been consulted, so why on earth do you have to drag a third one in? (I suppose some of our consults seem equally insane to them: diabetic management on a patient whose sugars really are not that high, or cardiology for a patient whose only problem is hypertension, within control if you use enough medications, or ID for patients whose culture sensitivities come back a few hours after the consult is placed.)

(Which is why I don’t say anything to the medicine residents about this. They would say, as I do when asked to explain an illogical action, “I did it because the attending told me to; don’t ask me what he was thinking.” I really hate having to tell the nurses that. “Why are you changing this patient’s medications, since the current ones seem to be working just fine? Why are you transfusing this patient? Why are you feeding/not feeding this patient?” I just do what the attending says. . . )