I was encouraged the other day to discover that I am in fact turning into a surgeon, and possibly even a competent one. The fellow had been talking me through a procedure, my first time, and it turned out quite simple and easy, perhaps a little to his surprise (I didn’t know enough about it to be surprised one way or the other).

That night I had to do the same procedure, on a patient who was not intubated, and quite jumpy. Let’s just say that it’s difficult to get good local anesthesia if the patient jumps half off the bed every time you get a 28-gauge (ie very tiny) needle 0.5mm under the skin. . . despite some iv sedatives in assistance. And of course this time, in the middle of the night, without the fellow around, the procedure was much more complicated than it had been in the morning. Also, the instrument tray the fellow had advised using contained instruments that were next to useless for the purpose at hand.

So I got to try and keep that patient calm (with the nurse’s very good help), through a procedure that lasted much longer than I had planned on, without letting on to anyone else that I had very little idea of what I was doing, or what I would do if that didn’t work. . . It did work, finally, when I was about ready to declare defeat and go looking for a better instrument set and/or someone senior to me.

Perhaps it’s not reassuring to the public to say, but to me, being able to improvise in a difficult situation, through a procedure that I’d never seen done quite that way before, means I’m learning how to operate, and how to make instruments do what I want them to do. A small step in the path of the legend of the vascular surgeon repairing a ruptured AAA with a set that turned out not to contain any vascular clamps. . . (the legend doesn’t mention whether the patient survived; I ought to ask).