I did very much enjoy my time in the operating room (OR) over the past month and a half, though. One of the very few disadvantages of this longitudinal program is only having 6 weeks on Surgery instead of 8 or 12 weeks. My compatriots back in Chapel Hill and Charlotte have a solid two months, but from my understanding, we pack in more hands-on training during our shorter clerkship. When I asked one of my friends from another medical school how he found Surgery and working in the OR, he replied: "Oh, I had a blast. As the medical student, I watched the intern, who was watching the resident, who was watching the fellow, who was watching the attending perform surgery on the patient! I got very good at watching." This is probably a gross exaggeration, but the nice thing about our Surgery block is the ability to work one-on-one with attendings. A number of the services have surgical physician assistants (PAs) on all cases, but that didn't stop me from being "first assist" on quite a few operations. After practicing my suturing on pig's feet, dish towels, and bananas (bananas, by the way, are a horrible excuse for fake human skin), I had the opportunity to sew in tons of cases. I can vertical mattress, horizontal mattress, subcutic, and simply interrupt. I stapled, two-handed knotted, retracted with "Army-Navies," pulled on "Weitlaners," and cauterized with "Bovies." I saw a spleen get taken out ("splenectomy"), a clavicle get plated, and a stomach get wrapped around an esophagus to prevent acid-reflux and reduce a hernia (a "Nissen"). Overall, it's hard to complain.
I'm not surprised that a lot of athletes fall in love with Surgery (as did I). Each case is its own match/meet/game/(insert generic name for sporting event here). It's the ultimate team sport. Each person in the OR plays his or her own very important role, and of course we're all wearing the same blue uniform (mask, googles, hat):
- There's the "scrub tech," who is in charge of the massive number of tools, towels, knives, needles, sutures, machinery, etc. Needle driver? Boom. It's in your hand. DeBakey? Forceps? 10 Blade? Just open your palm and say the magic word. As a medical student, you just get out of the scrub's way. Don't touch the Mayo, and don't try to hand off instruments. You're ass will be grass.
- The "rep" helps the scrub tech if it's a very complicated case with new tools. The rep is from the surgical instrument company, and knows the product inside and out to help in a pinch. But, just like a defenseman in lacrosse, he or she can't cross mid line (lax players please correct me if I'm getting this rule wrong). A rep is forbidden to hand anything to the scrub tech, only the "circulating nurse" can (every sport has their own arcane rules).
- The "circulator" is master organizer, charting the progress of the surgery, grabbing anything not in the room in an emergency, and is usually in charge of the general ambiance of the room (i.e., the iPod).
- The "anesthetist" constantly monitors the patient, basically making sure the patient doesn't wake up during the match. The players are constantly being tagged in and out, or "subbed," for shift breaks to stay fresh. The new line comes in, and no one misses a beat.
- The surgeon and the PA run the offense. The surgeon is the ultimate captain. The surgeon leads the team, directing the troops to victory. When it goes well, the surgeon takes the accolades; when it goes wrong, it's the surgeon's fault. But it really is a "team" in the OR: every person is critical to patient care and success. Surgery is re-living your sports career over and over (including the 5am wake-ups, yuck). Oh, and if needed, a nurse might come in late to be a "closer," both in the metaphorical and literal sense: the nurse will actually close the incisions on the patient to end the match.
As a medical student, it's all about the little victories. Did I go an entire surgery without getting in anyone's way? (Harder than it may seem). Did I suction at the appropriate time without being asked? Did I not get scolded? Did the attending not have to adjust the way I was holding the laparoscopic camera? You won't get praise for doing any of these properly, only corrected when you mess up. And, thus at night, I dream of the perfect case...
I was scrubbed in first, ready and waiting for the attending to glide into the OR and prep the patient in the desired fashion. No one asked me to move out of the way because I stood in the corner expectantly, then moved to the azure blue field and placed my hands neatly next to the Mayo. I did what I was told, answered all queries immediately and effectively. I drove the camera expertly throughout the case, drawing back during every irrigation and cleaning the scope on the liver when needed. I "followed" without being prompted on every fascial suture. I was then left alone to close the abdomen, which was done beautifully with nylon and steri-strips. The anesthetist didn't even need to give more laughing gas to get us through the final stretch. I was the perfect medical student: polite, crisp, undaunted... and never in the way.
What else did I learn? Orthopedists put in a lot of screws. They give new meaning to "drill, baby, drill!" Lots of plates, lots of screws, lots of drilling (and I got to drill!). For the general surgeon, pooping and passing gas ("flatus") is more important than anything... for the patient, that is. The SHELF exam was impossible; studying any more for it wouldn't have helped. And I think I might want to do Surgery.
So yeah, I learned a lot. Drill, baby, drill.
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