A major step forward in my burgeoning medical career occurred this last week. It was an event which should have happened long ago, when I worked at Harborview, or during my first year of medical school, but it is only now, just before the beginning of my second year, that I can finally say I have watched a surgery. A real surgery. Not just a circumcision, or an excision and drainage, or a closed reduction of a fracture, but an honest-to-God, "holy shit I've never seen this much blood" surgery.
Jodie and I have been getting in some clinical experience by splitting up our time following around several doctors – a pediatrician, two general surgeons, and an orthopedic surgeon. The internal medicine doctor never got back to us, nor has another private surgeon we've tried to get in touch with. In general, however, it's our responsibility to set up clinical hours, and I was interested in orthopedics, so I thought I'd follow him around on some of his cases.
His surgeries are usually on Wednesdays – this one, a reduction of severe gout in the right elbow, promised to be a reasonable 'gateway' surgery – not too grody, not too weird, but legit: lots of cutting, lots of blood, a 'real' surgery, if you will. And it would have been, if this had been a 'reasonable' case of gout – but even the orthopedic surgeon said this was the worst case he'd ever seen. Nearly every joint on the man's body was affected and had the huge nodules that are the most obvious sign of gout. To complicate matters, he was hypertensive, and so they could not operate on him for too long or too often – so they were focused only on the worst of the lesions: a baseball-sized deposit of uric acid crystals on his right elbow that made the limb practically immobile. Gout is a painful condition – basically, there's a build-up of these crystals in and around the joints, and it hurts like hell to move against it (I've heard it often described as having 'ground glass' in the joints) – so the lesion was pretty debilitating.
Now, I don't know about any of you, but I'm a bit of a wimp when it comes to having surgeries done. I wanted to be put out for my wisdom teeth. I was put out to have a cyst removed. I took the gas for a gum graft. If you have anesthesia, I want it, don't even ask. This guy just had a local nerve block – he couldn't feel his arm, and he was mildly sedated, but he was awake. No gas or anything – responsive to questions, cognizant of what the nurses were saying (there is something very odd about hearing a patient converse with the surgeon while they're being cut), but in no pain at all. He couldn't see what was going on – they had draped him such that he was unaware of precisely what was being done, which is just as well, because I don't know how anyone could handle seeing themselves bleed that much.
And I do mean 'that much.' It was just a cut on the elbow, and it gets worse as far as surgeries go, but I have never seen that much blood. Mind you, blood has never really bothered me, and it didn't here, but it's still weird to see that much of it. Everything immediately around the surgical site was just soaked in it, and it did not stop coming. And you know how, in movies, when someone gets cut and blood just shoots from the wound in an arc and splurts (yes, splurts) all over everything in this tiny little jet-stream? I thought that was Hollywood special effects and exaggeration.
Nope. This was Monty Python and the Holy Grail's Black Knight-type shit. It literally hit a nurse standing four feet away on the other side of the instrument table.
For the first 25 minutes or so of the surgery, I was completely scrubbed in and sterile – hands in the air and everything – and holding some forceps to keep the surgical wound accessible to the surgeon, occasionally cleaning up blood, etc. Real "feels like a doctor" type stuff, and it was good, and I was happy that the blood didn't bother me. The gouty mass itself had to be meticulously cut out – I expected some sort of a fluid with granules in it (which actually does exist, and can be squeezed out of the fat like some sort of grotesque toothpaste) – but the crystals were so invested in the fatty tissue under the skin that he basically had to saw out all of the fat under the skin and down to the bone and joint capsule (which I had to stick my fingers in and help expose) with a scalpel. Once the majority of it had been removed in that manner, it became more and more difficult to get the gouty tissue away from the bone – and he had to pry it out with some force, until finally, he was forced to stop the surgery because they had cleaned it out as much as they could without opening his arm completely, something he wasn't willing to do on a high-risk patient. He's supposed to return in a couple of weeks for further operations, but the surgeon didn't want to remove too much tissue at one time. I'm not precisely sure of the specifics of how he knew when to quit, but I trust he did.
As the astute reader may have deduced from the opening sentence of my last paragraph, I didn't actually last the entire surgery. I was doing fine in relative silence, just paying attention to the surgery and what the surgeon was doing, until the nurses got bored and started talking about the surgery. Conversation is fine – it can be a pleasant diversion and all… but for some reason (and my anatomy lab partners, if any of them are reading this, can attest to this) I hate comparing body parts to food. I couldn't stand being told that parts of the cadaver looked like pork or beef or spaghetti or coleslaw or haggis or whatever-the-fuck-else, because it ruined the food for me for weeks (and believe me, I love me some haggis). So when the nurses started talking about how the gouty tissue looked like cottage cheese, I immediately started to feel nauseous. I knew there was a reason I've never eaten cottage cheese.
The conversation carried on for five minutes or so – cottage cheese, cauliflower, toothpaste, porkfat, and popcorn are all off the menu for me for a while – until finally, feeling more than a bit uncomfortable suddenly, I just admitted that I needed to take a breather. I got laughed a bit for it – good-naturedly, of course – but it was better than looking visibly uncomfortable, so I just took off my sterile stuff, tossed it, and sat outside for some fresh air for five minutes. When I came back, I observed the remainder of the surgery (about 50 minutes total, so perhaps 20 more minutes) from the back of the OR to stay out of everyone's way, and encouraged the nurses to find other foods they could ruin for me. No one really gave me any crap for it – actually, one of the nurses was impressed I lasted as long as I did before tapping out, so to speak – and it was a cool experience. It was nice not to be so viscerally repulsed by the sight of surgery that I question my decision to be a doctor – though I admit I would like to believe I would have lasted the whole time if the nurses hadn't started talking about food.
If I DO ever become an orthopedic surgeon – or "bonecrusher," as a dear friend recently put it (while telling me there's no way I'll ever be an orthopedic surgeon, so thanks for that) – that will be a strict rule in my OR:
Never, under any circumstances, are human beings to be likened to food. Ever.
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