I get the feeling that surgeons like control (now now, don’t get testy; takes one to know one). “Management” sounds much better than “control,” so I guess that’s why they use the former, but I was really blown away by how much of surgery is patient, uh, management. And it’s my favorite part of the surgical rotation so far. I expected to just be in the operating room for 12 hours a day (sometimes it’s close to that), and wash my hands of patients once they’re stable in the recovery room, but the surgeon takes a patient from pre-op and diagnosis all the way to recovery and discharge from the hospital.
One of the neatest parts of surgery, says my attending (and I agree), is the fact that in surgery, you get to make a diagnosis, and then see if you were right. You see a patient acting a certain way, with a certain set of signs and symptoms, and you make an educated guess that their gall bladder is inflamed. So you open them up, go in, and see if your pre-operative diagnosis matches your post-op diagnosis.
The other great thing about surgery is that there’s really a limited number of things you’re really worried about. As opposed to internal medicine, where you’re trying to manage 20,000 chronic diseases with 30,000 medications to treat them, surgeons seem to care about, in order that I’m thinking of them: infection, farting, pooping, blood clots, fluids/dehyrdation, peeing, nutrition, vital signs, and walking around. If you’ve ever had an inpatient surgery, you have been asked these questions. Over, and over, and over, and over, and over again, by the medical student, the intern, the resident, the chief resident, the nurse, and the attending. We cheer if you pass wind, we applaud when you eat all of your meal, and we scold when you lay in bed all day.
This is not to say that a patient’s other medical problems are unimportant or ignored; many times a disease can affect something on the above list: diabetes can complicate nutrition, medications can complicate bowel movements, and so on. I think if surgeons had the time, they’d try to help manage a patient’s mental health status, or their heart disease, or their kidney failure, but sometimes the daylight’s wasting and there’s 10 other patients that require your management, too.
The cutting itself is pretty fun too-when you’re allowed to do anything. The medical student’s role is usually reserved for observing, being pimped (asked questions rapid-fire by a resident or attending), suctioning, retracting and, if you’re lucky, suturing incisions closed at the end. During the first week, you’re no help anyway: your sense of awe at the human body leads to an inevitable puddle of drool that collects at the bottom of your mask. I remember the first time I saw laparoscopic surgery (where they use a camera to look in the abdomen), and I was Simply. Blown. Away.
Next when I was invited to stick my hand in an open patient and feel a liver, a spasming colon, the aorta, and then the beating heart, it was almost too sci-fi to be real. This is a person. MY HAND IS INSIDE A PERSON! I’M INSIDE A PERSON AND THEIR HEART IS HITTING MY HAND! Does their heart have any idea this is going on? This whole surgery thing? That it has a HAND next to it?
And then the seriousness of it all comes down at you like an anvil from 100 feet above. The fragility of life is taken to a whole new level when something starts bleeding during your first surgery, even a little bit, and you think to yourself, “Holy shit. This guy could die. Right now. On this table.” It’s even stranger when you take care of the patient after their surgery, and you think to yourself, “My hand was inside you.”
I’m going to stop all this “hand inside you” crap now because I’m starting to feel a rectal exam joke coming on.