There are some days during medical school that are quite unforgettable. My first day in my third year surgery rotation is one of those days. Not because the patient was particularly interesting. It was my first exposure to a world of medicine that is quite different from everything else that takes place in the hospital. Surgery suites operate with a completely different set of rules – many of which are rather bizarre, and all of which take a little getting used to.
This is the story of my first day on my surgery rotation as a third year medical student. I was in a rural hospital in England, working with a vascular surgery team on a patient who was getting his aorta replaced. Yeah, they can do that – I didn’t know at the time either.
The rules regarding where you stand, what you touch, and how you do just about everything, are very closely monitored. Unfortunately, none of those rules were given to me before I actually walked in to the operating room. I had changed in to sterile scrubs – that part was easy. Scrubbing in, putting on the surgical gown, and donning the sterile gloves was another matter altogether. I had to mimic the resident – and managed to look like a complete rookie (which I was) when I had to ask how to do just about everything. It’s like being in Kindergarten all over again.
The job of a medical student during a surgery is pretty much just to stand there, not pass out, and keep your hands where they tell you – which is usually pinned far away from the actual operating field. If you get lucky, you may get to help hold something (like an organ) out of the way. I got lucky that day. The conversation that ensued was something that I would never have believed could take place in a real operating room. It went something like this:
We were elbow deep in the patient’s abdomen. Having moved most of the internal organs out of the way, the surgeon (with the help of a resident and a nurse) was about to cut out the old and diseased aorta.
Surgeon: “Student. I need you to hold this, you have the best angle. What’s your name?”
Me: “Erich. What do I hold?”
Resident: “Take this clamp hold it just like this.”
Nurse: “Too far up. Lower a bit.”
Surgeon: “Yeah, lower. No, that’s too low.”
Resident: “Now I can’t see. More to the right.”
Me: “How about here?”
Surgeon: “Now I can’t see. There isn’t enough light. I need more light.”
Resident: “Can’t we turn the overhead light?”
Now, at this point it’s important to note that among the four of us, I’m easily the tallest, at 6’2″. The nurse couldn’t reach the overhead light if she were on a ladder, and besides, she was on the wrong side of the room. The resident and surgeon had both hands full, there was no way they could reach the movable lamp above the operating table – even if they had a free hand. The anesthesiologist looked asleep – although I suspect he was only reading a boring novel. (No, really)
Surgeon: “Rick. Move the light a bit my way.”
Me: “Erich. And I can’t reach unless I move my hand off this big slimy thing I’m holding back for you.” I couldn’t even believe I’d just said that.
Resident: “Is that what they taught you to call the liver – ‘a big slimy thing’? Who let’s the Americans in here anyhow?”
I got a fair amount of jabs at being American over my time there, but that’s another story for another time.
Me: “Yeah, I know it’s the liver. I just lost my train of thought.” I strained to reach the light with my right hand as I kept my left on the big slim… er… the liver. I was stretched to my limit, on the tip of my toes.
Surgeon: “Lose that a lot I bet. Hold that STEADY RICK!”
Nurse: “I think it’s ‘Erich’
Me: “Close enough.” Streeeeeeetch.
Resident: “I don’t think he can reach. Damn, that artery is bleeding everywhere. Let’s clamp it.”
Surgeon: “I can’t see for (*#$#. I need more LIGHT!”
Erich: “Working on that. But I think it’s going to be the light or the liver. Pick one – I can’t reach both.”
Nurse: “Bloody hell.”
Surgeon: “Just hand the clamp to David (the resident), move the light, and get your hand back here.”
Me: “Okay, where do you want the light?”
Resident: “More to the left.”
Surgeon: “Towards me. More. More. Twist it up and over. More. Back. Back.”
Five minutes of incremental fiddling with the overhead lamp followed. Most of that time involved the resident and the surgeon bickering over placement of the light beam. I’ll spare you the dialog.
Surgeon: “Wait! That’s perfect!”
Resident: “Yup. Perfect.”
Me: “Good. Back to the liver?”
Surgeon: “With both hands please.”
I hated surgery. Every day of my twelve week core rotation was pure hell on Earth. It didn’t help that I did it during an English winter, when the sun rose at 11am and set around 1pm (seemingly). I didn’t see real sunlight for three months. And everyday was filled with experiences that were all to similar to the dialog above. It was educational torture. Who knew that the placement of a light was something a surgeon could argue about for five minutes while a patient sat unconscious on a table with his aorta about to be cut open? Bizarre.