General Surgery Rotation

On my way home after observing and partially assisting a tracheostomy this morning, I felt an incredible sense of honor for the ability to view the human body in this way. I got to insert my finger into the patient's trachea, feel the isthums of her thyroid, view the pulsation of her internal thyroid artery, and suction the little blood that escaped from the incisions. Anatomy books don't cover this stuff. A living, breathing human being with bubbling fat, warm tissue, and throbbing vasculature dwarfs the cartoon drawings in Netter.

Like my preceptor of 30 years in the surgery business said, "It's still an honor and privilege to perform my job every day."

I started general surgery two weeks ago. Since then, I've seen:
- 4 cholecystectomies
- 1 hemmorhoidectomy
- 1 bennett's fracture
- 1 basal cell carcinoma and benign nodule removal
- 1 umbilical hernia
- 1 tracheostomy (today)

Next week, we're scheduled for a mastectomy, colostomy, inguinal hernia, and hemmoroidectomy.

What's general surgery like? Thrilling. Humiliating. Humbling. Scary. Being a medical student in general surgery is like being a videographer filming a lion attacking its prey. You keep pretty quiet, try to stay out of the way of the techs and nurses, and take in everything that's going on around you. And it's almost deathly when you mess up. First day, I put my mask on backwards AND nearly passed out. Addressing the first mistake, my glasses kept clouding up like I was in a dishwasher. Couldn't see a lot. As to the passing out, I asked to sit down (luckily) before I took a nose dive onto the ground, or worse, into the sterile field. The nurses hate that.

Since then, I've been pretty unassuming. Just slip in and out, say lots of "thank yous," "sorries," and "oh, wows." I only blew my scrub-in once, when I starting tying my gown before putting on the gloves. Oops.

Other than the nurses scowling at you at all times, and realizing that you're the lowest man on the totem poll, being a medical student is surgery has its definite advantages. For one, you get to suture. My step-in preceptor let me suture the entire bennett fracture incision from the lateral thumb to the scaphoid. You also get to stand right next to or across from the surgeon so you can see every bit of anatomy, incision, and probing. Other than that, you sit around a lot, try to make small talk, and formulate good questions and answers to pimping.

How about the preceptor I'm following? Best description for him: knowledgeable, charismatic old kook. He's a character. Always talking, sharing some story about the past or the current, remembering every little detail from names and dates to history and circumstances. He can tell you why every instrument is named like it is. The pathophysiology of most diseases, and even give you a blow by blow of the American Civil War, recounting the Battle of Gettsyburg to the Second Battle of Bull Run. Night time remains difficult for me. When we stop seeing patients at night, he wants to talk politics, NPR news, and the history of medicine for hours. How do you leave that?

Over these past few weeks, I've also had the opportunity to be self-reflective. I'm strong enough for this profession, but it takes some serious self confidence and guidance. I feel like I know jack right now, my information tied up somewhere in different brain compartments. I'm learning how to retrieve the information, but I'm dealing with an antiquated system here. Everyone says H&Ps, Dx, and understanding comes after the third year.

Right now, I'm just putting things together like a puzzle.