Hurricane Jill

The art of surgery

Today the residency coordinator told all of us students that we’ll have our interviews for Barrow while we’re rotating here. One of the other women here is also not from a big name school, and we both wondered if it was possibly a courtesy interview.

And of course, today would also be the day when they put me through my stitching paces in the OR. I sewed dura, muscle, galea and skin. Well, I never actually sewed muscle. I can’t work the heavy-duty needle drivers they were using, and those are the ones that no OR wants to part with for the sake of med student self-teaching. I mean, I have the ones that come in those suture kits, and chest tube kits, but those are like the Honda Civic of needle drivers, and the ones today were like Hummers. Yes, they’re both cars, but they don’t handle the same at all. So anyway, the resident had a particular piece of constructive criticism to offer, which was that the mark of a technically excellent surgeon is the ability to manipulate the instruments without any wasted movement.

Right now I don’t do that, but I can totally understand what he means, because back when I was a pharmacy IV tech, I was good at it, in exactly that way. I could put together a very complicated IV solution in a fast and elegant manner, in perfect form for a sterile laminar-flow hood. But it takes time and practice with all the components to get to that point, and I simply haven’t had enough of either, in surgery.

Anyway, the dura incision I was supposed to sew was only slightly larger than the X incision for a burr hole, and in a tiny exposure through the temporalis muscle, which added about a centimeter to the depth. Which is not an insignificant detail. I did manage to get two stitches in, though. But it was a painful experience for all involved. Then the muscle, which I’ve already told you about. Next was the “galeal” closure, and you’d swear I had never closed galea before, I sucked so bad. I’m not sure it was actually galea anyway, but that’s not exactly a good excuse.

Then the skin closure. That was a running stitch, and the skin edges were at very uneven depths, so the resident made me correct for that, and also wanted the external part of the stitches to be perpendicular to the wound, with the slanted part subcutaneous. So that was slow also, since I’d never done that before. Finally, it was over. I felt bad for all the OR staff who’d had to stay there an extra hour while I struggled with all these different closures.

And then in the morning I had scrubbed in with the chief resident, and she asked me to do a running subcuticular stitch on the lower part of a cervical incision. She said it was the easy part of the incision, but I have my doubts about that. The section she closed was straight and already approximated, while the section I was closing was gaping open with sinusoidal skin edges. And she wanted me to make the incision look straight when I was done. I’d only closed one or two trocar incisions with a subcuticular stitch, and it’s doubtful those incisions needed anything more than durabond anyway, so that really doesn’t count. Anyway, it went OK, but not great.

I truly have no idea what they thought of my work. They said nice things, but you never really know.

It was the best of times, it was the worst of times…

So, day 2 at the BNI. Feels like a week has gone by. In two days, I’ve already gotten to do more than I did the entire first week anywhere else I’ve been. It’s truly an outstanding place, where the residents pretty much operate all the time, and scutwork is almost entirely eliminated. Even the OR scut–positioning, prepping, etc.–is done by OR ancillary staff. The resident pins the Mayfield, draws a line on the scalp, and then just goes out to scrub while the ancillary staff do the rest of the prep. Totally cush.

Although, there is a downside to all the help, which is that anywhere you go from here, you have to do more of it yourself, and you don’t really learn how when other people always do it for you.

There are two other women rotating here with me, and one guy. Definitely a turnabout compared to the usual ratio. I went to dinner last night with the other two women, and another from the previous month’s group. We remarked on how many of us there are on the trail this year, and talked about the people we knew in common. It’s funny, and a little disconcerting, how disparate people’s opinions of themselves are in comparison to what everyone else thinks of them. In fact, we all wished there were some sort of anti-couples match, to avoid matching at a program where certain other applicants have also matched. Because the people you work with make so much of a difference in whether you have a good experience or not at a particular program. It’s almost as big a consideration as anything else about the program.

Anyway, I can tell this is going to be a fun, but exhausting month. I just hope I don’t screw up royally in some way.

My application was finally sent out to the schools Friday and yesterday. So until I get that first interview, I’m putting everyone on notice that I may have a fit of insecurity that I won’t get any interviews at all, at any time, day or night. Hopefully this phase won’t last long, because I already am hating life as an applicant.