December 8, 2016
Written by Courtney Pasco (class of 2016-2017)
Yesterday was my first day in the OR and it was easily the best day I have had in a long time. I got to the morning meeting a couple of minutes late and walked past the stares of twenty or so residents gathered around the table. I snagged an empty seat and settled in to the morning’s discussion on melanoma. I thought the give-and-take style of teaching was quite effective, with the attending presenting hypothetical cases with pictures and asking the residents how they would proceed and why. I was expecting the morning meeting to go way over my head, but I actually learned a lot and all of the talk about childhood sunburns, naturally freckly skin, and melanoma mortality statistics made me want to get to a dermatologist immediately.
After the meeting, I proceeded up to the 5th floor and went to get my scrubs. It was pretty obvious I was new because I made mistake after mistake just getting ready. Once I was, though, I was pretty timid about walking into an OR. All of the surgeries scheduled for 8am were crossed off and it was 8:10, so I didn’t want to walk into an ongoing surgery and disrupt anyone. Eventually, though, one of the ortho attendings (I think it was Dr. Krosin) told me if I “promise not to breathe or move” I could watch a total hip replacement.
The surgery took about two hours in total and the patient was an older arthritic Greek woman who had already had her other hip replaced. At first I was standing by the nurse anesthetist, Linda. She was very kind and explained the purpose of each of the medications she was giving the patient and what she was responsible for monitoring. From my vantage point, I couldn’t really see much past the incision, but I have anxiety and was feeling pretty apprehensive so I was grateful to just get the chance to get acclimated to the room and machines and instruments. However, when the residents who were performing the surgery (Jackie and Jeff I believe were their names), saw that I couldn’t really see into the incision, one of the nurses, Tim, brought over another stepping stool and moved me to the side of the patient. By this point I was over my initial nervousness and could focus on how cool it was to be seeing an actual hip joint! Once the joint was exposed, the attending stepped into assist the residents. Jackie grabbed the saw and within seconds, the entire ball-and-socket had been removed. The next steps of the procedure involved carving out a new socket in the pelvic bone and inserting the new metal joint. With all of the sawing, grinding, and pounding, it seemed more like construction work than surgery! Everyone in that room was really nice about chatting with me and making sure to answer my questions.
In the afternoon, I decided to observe an exploratory laparotomy on a young African American man who had been shot four times that morning. He had one bullet wound in each arm and another two in his abdomen. The surgeons, led by Dr. Palmer, opened him up and after observing the wound to his liver, began to run his bowel. That was easily one of the most amazing things I have seen in my life. I mean I’ve studied the anatomy of the digestive system on models and cadavers, but to see it all pink and alive was simply incredible. After they had determined there was no major injury to his intestines, they observed an injury to his right kidney and closed him up. They didn’t repair either the kidney or the liver and are just counting on the healing on their own. At the end of the surgery, ortho was supposed to come and splint his right arm, where the through-and-through bullet wound had completely shattered his humerus. Ortho is scheduled to fix it on Friday, but there was a lot of bleeding so Dr. Palmer wanted to see if the bullet had nicked an artery before having ortho come in. He widened the hole and he could actually stick his finger all the way inside and feel that it was bone marrow that was pouring out, not blood from an artery. So he proceeded to pack the wound with gauze and wrap him up before ortho did the splint. During this surgery, I talked a lot with the surgical tech, Ana Maria. She was absolutely lovely and taught me a lot about the different instruments and then walked me back to show me how they get sterilized.
Nine hours really flew by and I can’t believe how much I learned, not just about the medicine, but also about myself. For a while now I’ve had this pipe dream about becoming a surgeon, but I’ve never seriously considered it because my anxiety crops up in more intense situations and going into the OR I assumed I would have to excuse myself almost immediately to calm down. But I didn’t. I got nervous, sure, but only for the first hour and then my excitement and curiosity took over. I’m starting to think that this is something I could not only handle, but really love.