Charlie Daniels and the OR

Monday found me back at Children's Hospital where the patients are shorter and the atmosphere remarkably more colorful. But between you and me, I think the V.A. could use a playroom of its own--there's no better combination than wound healing and XBox, you know.
So one of the more stomach churning, butterfly arousing moments on surgery are the pimping sessions. But as dearly as I dread them, I find that I learn more from being wrong on the spot than from reading any textbook. At Children's, much like anything else, the pimping has its own style. I walked up to the OR table to hold retractors for an inguinal hernia repair on a little kiddo and the surgeon told me that the one important thing on peds surgery is to know the music played in the OR. "Who's this?" he asked and for the first time I dearly wished I had listened to country music at least once in my life. I knew the title. But not the artist. Strike one against summoning a quick and easy rapport with my attending. So the devil went down to Georgia and I wished I had known when.
Operating on children is, not unexpectedly, more difficult to observe than their elders. I was in the OR when our patient came in, his blue eyes wide and looking around, blonde mullet causing us to feel deeply for his future. We watched as the anesthesiologists wrestled a little to put him out; he wanted in on all the action. I then saw the 6 cm cyst on his right shoulder that we were to remove. A lymphangioma, to be exact. The anesthesiologist beckoned the other med student and I over because the situation needed a "woman's touch". We cooed and distracted until he slumped right into a deep sleep. The surgery attempted to take out the cyst without rupturing it, which would cause a huge gush of blood and lymph that would muddy the field and delay progress. Fortunately I work with pros and they cut and cauterized all around the cyst, down to muscle to clear it all out. The cyst was actually a big glob of smaller cysts, grape-like in form. I kept thinking of him, peacefully sleeping away under the sterile blue cloths, unbeknownst to the pulling, cauterizing, and cutting through his shoulder. In the end, he was sewn up, woken, and was home within a few hours.

Simon Sez

An amusing thought occurred to me today while standing in the OR; my role in the procedure is strikingly similar to being a participant in "Simon Says". Simon, of course, would be the attending surgeon and I, the student, try like mad to move with the right commands. No movement or speech is welcomed unless Dr. Simon says to. I entered the room today and stood motionless until I was instructed to scrub; once scrubbed and gowned I was waved to the table where my hands were directed to rest on the sterile drapes, not to venture from the area unless commanded. Dr. Simon speaks and I move; to hold a retractor, to steady the foot, to let go of the retractor, to move the foot forward, to suction. I don't dare make a move without his instruction. And much like Simon Says, it is relatively easy to stay sharp and with the right moves in the first 15 minutes or so of the game, but I can just imagine that 2 hours into the game (surgery) I could easily find myself daydreaming between commands, and oh, the agony of a wrong move.

Yesterday I played Simon Says to a metatarsal amputation. It was originally meant to be a transmetatarsal amputation but Dr. Simon realized while digging around in the foot that more of it was salvageable than he originally thought. Taking off a big toe is not too dissimilar to pulling a tooth, plus or minus a few tool and skin folds. Dr. Simon remarked during the procedure while yanking around to disarticulate the bone that "it's as though the body doesn't want to lose it." And he has something there, naturally. The framework of bodies was created to be more durable than a Nalgene bottle; the fine craftmanship of the various materials working together to synergistically mobilize a person is fine indeed and impossible (thus far) to duplicate. The most durable man-made heart valves are guaranteed for no longer than 15 years.

I'm feeling the short end of the stick as my colleagues have spent the week holding bellies open for AAA repairs and putting in vein grafts while I watch a guillotined toe, but such is the nature of medical education these days. Hopefully something thrilling will come around soon.