As usual whenever I slip into sharing details about my surgical activities, this story is probably going to scare some of you. It shouldn’t. Whatever my dramatized retelling sounds like, I’m responsible enough, and my attendings know it, to ask for help when I really need it.
I’ve been working like crazy for the last few weeks, and once again getting very frustrated about not being in the OR, especially when I felt that some cases were really fairly “mine.” Of course, there’s no such thing as fairness, or deserved, when it comes to cases for junior residents. The cases belong to the chief. Just because the chief can’t physically make it to every single one doesn’t change the fact that they belong to him, and it’s his right to assign them however he wants. If he wants to give them to senior residents on another service rather than a second-year on his own service, that’s his right. That’s the way surgery residency works. Or so I was reminding myself through gritted teeth. Maybe I wasn’t completely silent on the subject.
Anyway, as I was between two admissions, the chief paged me: “We’ve just added another complex revision on to the afternoon schedule. Why don’t you come transport this last patient to ICU, and do the next case, so I can eat lunch, before the add-on?” I ran down the stairs to oversee transporting the patient (with five tubes and drains, and six monitors beeping the whole time) up five floors and across half the hospital, then finished the admission orders while the next patient was being gotten ready.
Basically, we needed controlled arterial access on both sides. After draping, the attending waved me over to the other side of the table. He checked the landmarks, and drew a line. “Ok, get down to the artery so we can put loops around it.” And he started cutting down on his side.
I stared at the inked line, and nearly missed the tech impatiently trying to hand me a scalpel. Get down to the artery, indeed. I knew that this was a very basic maneuver in vascular surgery and particularly in this procedure, and I knew the senior residents did it all the time, and regarded it as simple. But I’d never seen it done from start to finish. The line seemed like a good place to start. I made the incision, and started in with the bovie, all the while thinking, “the artery is in here; I have to get the artery out, and I have to keep it in one piece; if I bovie the artery, or the vein, they’ll never let me operate on vascular surgery again.”
The attending meanwhile was flying along on his side, one instrument after another. His hole was now quite deep, and he was so far ahead that I couldn’t even look at what instruments he was using for guidance. The tech, meanwhile, kept trying to hand me the instruments he thought I was supposed to be using, but I was going so slowly that they were always the wrong ones.
I came to what looked like a large vein, and made some vague noise to the attending. He glanced over. “Oh, that’s just a varicose vein. Go ahead and ligate it.” I didn’t know you could have varicose veins there; so I ligated it, and went on. The next several such veins I recognized on my own. As I got deeper, though, I got slower. I could not remember what exactly the other surgeons did to not hit the artery. I was not used to being completely on my own. Eventually, the attending finished his side, reached over to mine, and in about three movements exposed the artery, safely covered with a fibrous sheath. The right way to do it, it turns out, is to simply bovie down till you come to the sheath, which there isn’t much chance of going through accidentally.
So there was really no danger the whole time. For all that I hated not being sure what I was doing, it was the most amazing fun, proceeding along on my own, without the attending’s hands in with mine, responsible to find things for myself. I want to do it again. . . Of course, since I made the mistake of blurting out to the chief resident what a thrill it had been to do that for the first time all on my own, he may not let me in such a setting again. . . I may be optimistically mistaken, but I don’t think the attending knows it was the first time I had ever been into that anatomical location. Maybe he does. Either he thinks I’m hopelessly slow and cautious, or he knows it was the first time.
Take this in context: Another attending was relating tales of his days as a cardiac fellow, decades ago, when he never left the hospital all week, and by corollary, did entire bypasses and valve replacements on his own, with an intern assisting. My hours, and my adventures, are small fry to the days of the giants.