Something New

Surgery day 3
6:30pm - Today was busy. Real busy. Started out with attending to a few patients in the ER. 1st was a middle-aged lady with a 3cm abscess on her left breast which needed some I&D (incision and drainage). She was a diabetic and her sugars have been running unchecked for a while. She was worried it was something more serious, like breast cancer, but luckily it wasn't. Nice way to start an evening with the resident, with a little procedure.

9pm - The evening continued on at another hospital...as my resident gets a call from another facility she was covering. So we take a ride to the town next door and check out another ER case. Another middle-aged lady, this time she's having nausea and some vomiting with abdominal pain for the past 3 days + a history of chronic constipation. Her belly was getting pretty distended and after further imaging/testing, it was decided that she needed surgery to decompress her abdomen, fast! So the surgeon and the resident allow me to scrub in with them. Mind you this is my first time scrubbing in, so I have no idea as to what to do nor do I have any clue about the dos and don'ts inside the surgical suite. I felt like a bull in a china shop.
Remember when I told you that surgery people are mean (see Jan 24th blog)...well this was not the case. The scrub nurse was very eager to teach and she guided me pretty well with scrubbing, gowning up, and keeping myself from messing up the sterile field. The surgeon was very cool and he let me assist as much as possible.

12am-ish - This ain't no cadaver. Everything about this is so different from anatomy class. Everything was so...Fresh! 1st incision was made, from the suprapubic, up around the umbilicus to the halfway mark between the xiphoid and the bellybutton...a straight vertical line going down the belly. Soon after, I was wrist deep in intestines, suctioning, retracting, and cutting sutures. At one point, I got fixated on the small bowel doing its peristaltic action (way cool).

2am - after much exploration and looking through every nook and cranny of that poor lady's bowels, we finally figured out what was causing this poor woman's belly pain...a small perforation, about a millimeter in diameter, located in her sigmoid was releasing fecal material in her peritoneum and this was making all sorts of abscesses all over her guts. We irrigated and washed all of her bowels for what seemed like forever. The woman got a hemicolectomy (the portion of the perf-ed bowel was removed) and the open end of the large bowel was made into a colostomy.

3am - Once the colostomy was in place, we began decompression immediately. There was no way we can put this woman's guts back inside because she was so full of S*%#! This was the REALLY MESSY AND GROSS PART. I'll save you the gory details save for one...the surgeon was milking and squeezing the large bowel like a giant tube of toothpaste. You can fill in the rest of the details yourselves (or not).

4:30am - The surgeon was finally satisfied that everything looked clean, that there was no more bleeding, and the ostomy was in place, so we finally closed her up. It was pretty impressive to watch both the surgeon and resident truss up the patient like a stuffed bird, as blunt as it may sound. But they did a very good job. The patient was brought out of anesthesia and was sent to recovery with no other issues at that time.

5:30am - My back hurts. My feet hurt even more. After that surgery, there was another emergent appendectomy that I got to scrub in on too. This time the surgery was done with a laparoscope so it wasn't too traumatic (only 4 dime-sized holes were needed). I got to hold the fiberoptic scope as the surgeon removed this thumb-sized appendix with pincers and cautery tools. The whole procedure took about 45 minutes. And the patient did well.

And so goes my 3rd day in surgery. Way cool.

Song of the day: "Jungle Drum" - Emiliana Torrini