Turns out you don’t have much time to blog during surgery. At my school, the surgical rotation is split in three: two weeks for a “subspecialty” rotation, which for me was anesthesia, and then three weeks each for paired general surgery services. My pairings were trauma and laparoscopic GI surgeries, better known as “GI-Lap.”
Surgery was a wonderful experience and I learned an insane amount of information. I got to do stuff with my hands, see lots of patients, and saw a decent variety of different procedures. I was also thoroughly and publicly humiliated at least once every day. You get used to it.
I have many stories.
On GI-Lap, a typical day meant waking up at 4AM, going to school and “prerounding” on patients I’d helped operate on the previous day, present those patients to the rest of the team, round with the team on all the patients, then head to the operating room for the day. (Rounding will be a separate subject. I hate rounding with a passionate, burning fire, and I am sure that on my medicine rotation I will write many angsty things about it.) A standard day on surgery generally ran until 6 PM or so, but I often got out earlier since my service was more relaxed than most.
One particular day, I was assigned to a case with a surgeon I’ve never worked with before. As is customary, I Googled him the night before to find he was a big deal at my institution. He was the kind of surgeon for whom every sentence must end with, “Yes, Dr. James” (not his actual name) or “yes sir.”
I ran into him in the hallway outside the OR and introduced myself. He was pleasant, gregarious, and wearing a full three-piece suit. With pocket square. I was wearing two-day old scrubs with a piece of food stuck on my left pant leg. With a paper hat.
“Nate, right? I’ll remember that,” he said, smiling a shark smile. Foreshadowing.
Like a good med student, I left to help prep and move the patient. The resident came in after awhile and asked, “Have you ever operated with Dr. James before?”
“No,” I replied.
I could see his slow grin from behind his mask. “It should be… interesting,” he said.
The surgery began. As has been the dominion of every medical student since the Dawn of Time, aka the Invention of The Scrub Tech, my job was to hold retraction and to answer pimp questions. Holding retraction is a thankless, labrum-tearing job that involves holding a curve flat hook in the incision site and pulling the skin away from where the surgeon is doing Things You Can’t Do As A Student, like everything.
I was holding excellent retraction, my arm feeling like it was about to disintegrate into a pool of lactic acid, when Dr. James yelled out, “WEDGE! I said pull UP on that retractor, not back!”
I blinked. “Yes Dr. James. Sorry, sir. And… wedge, sir?”
“I’ll tell you at the end of the case.”
Over the next four hours, I was to answer only to Wedge. No, Wedge, I don’t want you to pull there. WEDGE! What is the lymphatic drainage of the breast?! Tell me, Wedge, what is the difference between a radical mastectomy and a modified radical mastectomy? Pull UP, Wedge, not back!
And so on. He also wrote letters on the resident’s glove every time he repeated a mistake, eventually spelling out “PIG.” When he completed the word, he jubilantly yelled out, “PIG! THAT’S WHAT YOU GET FOR MESSING UP IN MY OPERATING ROOM!”
As we were closing – and he let me close, so all Shaming of the Student was forgiven – he finally says, “Ok, son, do you want to know why I called you Wedge the entire case?”
Yes sir. Please sir do enlighten this dim vessel with your worldly luminous knowledge.
Dr. James looked over at the resident with a twinkle in his eye. “A wedge is the simplest tool known to man.”
Everyone laughed, including me. The scrub tech, who had already yelled at me for doing something stupid earlier, laughed the hardest and the loudest. I get it, scrub tech, you don’t like med students.
Unfortunately, Dr. James sir, I wasn’t supposed to laugh.
“Wedge, hold your left foot up for the rest of the case.”
Shit. Was he serious?
“I’m serious. Carrie” – he indicated to the circulating nurse, a nonsterile person in the OR – “Carrie, if he puts his foot down, contaminate his sterile field.”
“Yes sir, Dr. James sir.”
I guess I wasn’t supposed to laugh. I ended up throwing my subcuticular stitches – a below-the-skin stitch that we use to make an incision site look pretty – while standing on one foot and sweating under the staring eye of Dr. James, the wedge-user.