This month I’m working with some of the thyroid surgeons here. The other day they didn’t have anybody else to cover a thyroidectomy, so I got to help get started. After having been told all month that this was a case so complicated that it requires a senior resident to be in it, I figured, after reading the atlas extensively the night before, that the attending would just want me to retract while he did things, until a senior resident was available.

And then there we were, the patient prepped and draped, and he just stands there, and the scrub tech hands me the scalpel. I really can’t get over that feeling, when I have the knife, and I’m supposed to start. I’m supposed to be doing the surgery. I cannot believe we’ve gotten to this point. Me with a knife. Ok Alice, get in there, don’t cut anything by accident! (Good thing I actually did read the book last night, hmm?) The way the protocol works, see, is the person who has the knife is doing the surgery, and keeps on doing it until the attending decides you’re too dangerous or incompetent, and takes the instruments back. So I keep moving slowly, waiting for him to say something along the lines of, I knew this was a bad idea, what on earth did they send an intern for, here give me that thing. And he just didn’t.

Before too long the senior resident got there, of course, and I was out. Which was ok with me. Because you have to dissect through these extremely delicate planes, and I couldn’t get over the feeling that the bovie tip was wider than the space I was supposed to be going through, and how could that work? And I couldn’t stop thinking about all the important structures in this tiny area: the recurrent laryngeal nerve, which is what makes your voice work; the trachea, which lets you breathe; the carotids, which supply blood to the brain; and innumerable smaller arteries and veins, which won’t be fatal if injured, but will just get blood all over the operative field and make the case much more difficult, and the attending much more irritated. But I was fascinated by the delicacy of the procedure; I would love to do some more of it. I can see why some of the residents love these cases so much. Two years to go. . .

But they keep giving me the knife, at the beginning of the case. I can’t believe it. I’m doing surgery. The attendings let go and let me do the surgery. Yes, they’re watching and guiding the whole time; but I’m the one with the knife and scissors and bovie. Jesus, I love this job. Thank you so much for putting me here. (How does everybody else manage to be so matter of fact about it? Am I the only one who’s thrilled to death about this whole concept?)

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