Scutmonkey Chronicles

Commentary on healthcare in general, life as a medical student, and issues of concern thereof. Readers warmly encouraged to contribute their "best" and "worst" experiences with the healthcare system (who knows, some budding young doctor might learn something from your pain...?) Submit via comments section, or email me at oarlock@gmail.com if you'd like to become a regular contributor. Welcome, and don't forget to double-glove!

Monday, November 28, 2005

Oh, the Gall

First day in surgery...three gallbladder removals and a hernia repair. Looks like I've lucked out as far as resident and attending...they're intense and demanding but very willing to teach, and also not mean. The only negative of a twelve hour day was a management level nurse who refused to show me tomorrow's OR schedule on the grounds that it "would be a HPPA violation." Oh well, one miserable curr does not a day ruin.

After the initial panic over getting scrubbed and in position without contaminating everything in the room and/or making a scene, I was pleasantly surprised to find that things in the OR follow a kind of rhythm, and that once you pick up on it, time kind of flies. My involvement today was limited to holding retractors, cutting stitches, and applying staples--not very highspeed--but more than I thought they'd let me do. And pretty cool, even for a person who has not once lick of desire to become a surgeon!

I spent a lot of the day watching the nurses get the tools the surgeons called for and figuring out what those tools are for. There are about six million different kinds of clamps and scissors, all of which are named for long-dead founding fathers of surgery. So although none of the names are self-evident, all the tools have a specific place and purpose. A purpose that I better figure out pretty damned fast.

Retractors are what the people assisting the surgeon use to hold open the incision and surgical field. They are sort of a curved, stainless steel cross between a jai-lai stick and a spatula. Holding retraction is a med student's bread and butter, and can get a little tedious, being that the holder has to apply a good amount of force while standing in an awkward posture. Following closely along with what the surgeon is doing and trying to anticipate the next move makes the task a little less tedious, but it's still very possible for a person's hands to go numb and their mind to follow suit.

Another big med student job is cutting the ends of sutures after they have been placed and tied by the surgeon. This is sort of like being the guy in the orchestra who hits the kettle drum once, maybe two or three times on a good day, during a performance...you're involvement is limited, but if you lose track of time and are not ready at the right moment, it's gonna be noticed. My particular surgeon likes to do eight "throws" on every deep knot and four on the shallow ones. This requires me to count the number of times his hands cross and be ready with the scissors at the right time.

Tomorrow morning will be my first experience dealing with non-anesthetized surgical patients, which should be interesting. One poor fellow went in for a gallbladder removal and is going to find out that we think he also has cancer. I've never had to break that kind of news yet.

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