It was the first shift of my surgery rotation. As luck would have it, I was to start with a week of nights on the acute care surgery service (ACS). As part of ACS, we could see any surgical emergency, from gunshot wounds to ruptured aneurysms to acute appendicitis and everything in between. Being a newbie to the world of surgery, I had no idea what to expect or even what to do if I was suddenly asked to assist in an operation. Nevertheless, I was excited!
Obligatory Surgery Rotation Scrub Mask Selfie
The evening started off slow, with various consults called that required ACS’s evaluation of minor traumas in the emergency department. But soon enough, a classical surgical emergency presented itself: 40-something-year-old female with fever, chills, nausea, and sharp abdominal pain localized to the right lower quadrant. If you are now thinking appendicitis, you’ve likely had the operation or work in healthcare. When an appendix gets all inflamed and angry, it runs the risk of popping and spreading a nasty infection into the belly, so the treatment involves surgery as soon as possible.
The senior resident whom I was working for took off to the OR as I quickly followed. As we walked/ran, I frantically looked up some of the more common facts about appendicitis, just in case the lead surgeon wanted to test my understanding of its management (surgeons love to quiz med students!). This was going to be my first procedure in the LLU OR, so I wasn’t sure what to expect. Would I be asked to do anything? Would the surgeon throw me out of the OR if I couldn’t answer his questions? What if I suddenly had to use the bathroom??
As we began to scrub for the procedure (“scrubbing” refers to the fancy process by which a surgeon washes his or her hands), the senior resident’s pager started beeping like crazy; a level A trauma was rolling in, and he was needed back in the emergency department. As he began to run off, I shouted after him, arms dripping from their recent bath, “Wait, what do I do?” Looking back over his shoulder, he replied with a confidence inspiring, “just do what you’re told, you’ll be fine!” I stood there for a second, the thought dawning on me, “Wait, I’m about to be assist the attending surgeon by myself?”
I walked into the OR where the scrub nurse helped me don a pair of surgical gloves and gown, chuckling a bit when he saw how short the gown looked on my 6’8” frame. I took my place at the operating table, not exactly sure of what I was supposed to be doing. Typical of an appendicitis case, this procedure was to be done laparoscopically, meaning that instead of opening the patient’s abdomen, three small ports would be placed: one for a small camera, and the other two for various tools (doing a procedure laparoscopically allows for quicker patient recovery and less complications).
A Laparoscopic Procedure. Pretend I’m the Guy on the Far Left!
I introduced myself to the lead surgeon, explaining why the senior resident had to rush off. “No problem,” he replied, “ever held a camera like this before?” He motioned toward a long, thin, silver pole with a black knob on one end. I shook my head no. The surgeon let out a little sigh, saying, “Just pretend your putting me on tv… point the camera and follow me around!”
An Inflamed Appendix. My Job was to Capture Shots Like This!
When you are a student in the OR, there really is no room for self-doubt. It’s kind of like that Nike slogan… Just Do It! So there I was, driving around a laparoscopic camera at 1:30 AM, trying to pretend I wasn’t nervous at all. Now honestly, there’s not much damage you can do when you are simply holding a camera, but that didn’t stop the sweat from beading up on my brow… which of course caused my left eyelid to suddenly have the itch of all itches. I’m talking about the kind of itch that makes you want to remove your skin, run it through some steel wool, then replace it with something that doesn’t need scratched. But when you are scrubbed in, the only things you can touch are the tools around; touch your face and the sterile field could be broken, putting the patient at risk of infection! So dear reader, the next time you want to scratch your nose or something, don’t take it for granted 😉
Anyways, just when I thought the itch was about to make me run from the OR in search of a rake, the attending asked, “So Ryan, what are some presenting signs & symptoms of acute appendicitis?” Thank goodness, a distraction! As I began to list off things like diffuse abdominal pain that migrates to McBurney’s point, I suddenly realized the television screen displaying the camera feed had turned yellow.
The surgeon took my camera-guiding hand and tried to reposition the feed so we could see again. Our patient had received several abdominal surgeries in the past, so our camera was apparently running into old scar tissue that had built up. His questioning stopped, and the next few moments of surgery became an eloquent dance of proceeding, then stopping to readjust the camera. I tried my best to operate the camera on my own, but every so often, the lead surgeon would have to set his tools down so he could help me readjust. It took every ounce of concentration just to keep from showing how flustered I felt every time I lost the surgeon’s field of view. Talk about trial by fire!
Despite the overly dramatized story that was playing out in my head, the surgery went smoothly and before I knew it, the patient was headed to recovery. I had survived! I laughed at the irony of my own survival when the patient probably woke up grateful of the same thing. After thanking the attending surgeon for his teaching, I pulled off my surgical attire and walked out of the OR in search of the ACS team, wondering what challenge would present itself next. And I may or may not have found an empty hallway to perform the celebratory karate chop a certain Dr. Benton once made famous (fans of ER know what I’m talking about!).
3rd year has been full of stuff like this. One really has to set doubt aside and let the teacher’s teach! I’ve found that if I focus on the task at hand rather than any fears I have, things aren’t nearly as scary as they might seem to be. Just do it! I wish I had the time and energy to tell all the fun little stories I’ve experienced up to this point. But now I’ve moved on to my pediatric rotation and I’m spending my time practicing pediatric H&P’s and coming up with ways to distract a screaming infant so I can perform an exam. This year has been stressful and frustrating at times, but I really am enjoying it and can’t believe it’s already halfway over! To close off this post, here’s some various shots of something every student gets to practice perfecting: knot tying and suturing up pig skin!
2 AM Knot Tying Session with the Residents
Classmate Phil is Excited to Suture Up Pig Skin!
Classmate Erik, Focused On His Knots