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The Masked Medical Student — by Sara Weiner
Some medical students weasel their way into a surgery the very first second they can. They stand outside the OR, peering through the window like a wistful puppy dog, waiting for a sympathetic surgeon to finally wave them in so they can gaze reverently at a two inch long appendectomy incision. Those are the future surgeons.
I was the opposite. I dreaded seeing my first surgery. I had already come close to passing out during a renal biopsy during my medicine rotation and that didn't even involve blood. In the months leading up to my surgery clerkship, I had horrible visions of my unconscious body sprawled across the sterile field. My goal for my surgery rotation wasn't to impress the attendings or get a good grade. My goal was to not faint.
I was assigned to the thoracic cardiovascular team and my very first surgery was a carotid endarterectomy. Whatever that is, right? We took a little class on "how to scrub" the day before, so I got to try it out for real on the morning of the surgery. I was extremely slow. Three other people started and finished scrubbing in and I was only on my third finger. You know, I honestly don't think those other people were scrubbing every quadrant of their fingers ten times each.
When I finally finished scrubbing about two hours later, I went into the OR. What you do is you back into the OR holding up your freshly scrubbed hands and the scrub nurse has a gown ready for you to put on, then she puts your gloves on for you. I was so scared of getting contaminated, having to re-scrub and probably just spend the entire surgery scrubbing. It seems almost arbitrary what's sterile and what isn't. For instance, you could be digging around in someone's guts and still be clean, but if you touch your facemask (which is disposable), then you're contaminated. Sensing my uncertainty, the scrub nurse instructed me to keep my hands "at boob height."
I went around telling everyone in the OR that it was my first day (even though I'm sure it was painfully obvious) so that when I passed out, they'd be understanding. The surgeon was a tall man with an Irish accent who everyone called Colin. He didn't even introduce himself to me. He just said, "Is this the medical student?" Allow me to introduce myself: I am The Medical Student. That's what they call me. Actually, I sort of liked being anonymous. I already had a mask. All I needed was a cape.
I asked the scrub nurse what to do. She pointed to a draped area on the patient's body: "Put your hands there. They'll be safe there." I obeyed.
I had no idea what to do for the first half hour. I just kept my hands in The Safe Place so they wouldn't get contaminated. The surgeon Colin handed me the suction and let me suction off the bovie fumes (bovie = little electric cutting device). When he finished cutting, the scrub nurse said, "Do you want the medical student to keep holding the suction?"
"Yeah, " Colin said. "It'll give her something to do. " I don't think surgeons can talk directly to The Medical Student. I think we're too many levels apart on the hierarchy and some kind of translator is needed. Like if a man needed to talk to a beetle.
So anyway, I stood there and watched, gripping my little suction hose. To my surprise, I didn't feel faint at all. It didn't seem real… it was more like dissecting the cadaver in anatomy class. The whole body was covered except for the small area where they were dissecting out the carotid. And they were cutting through the tissue like the person was already dead. If I didn't think about it too much, it really was no big deal.
Then things started to go wrong. The shunt fell out and the incision site filled with blood. "This is one of my ten worst carotid endarterectomies, " Colin declared. He then started cursing and yelling, which I later found out that he did a lot, and made the nurses shut off the music. Let me tell you, if you go in for a surgery and there's music, and then when you wake up, someone has shut it off, that's Bad.
"Get on the other side of the table! " Colin yelled at me. I carefully tried to navigate around wires and cords while keeping sterile. "Why aren't you helping the medical student? " Colin yelled at the scrub nurse. Then he actually reached across the table, grabbed me by my gown, and yanked me where he wanted me. Oh, Colin.
In my new position, I was responsible for holding the retractor. I was pleased by this development, because that's what the medical students always do on TV. However, I quickly became overwhelmed by this crushing responsibility. What if I let go of the retractor and the patient died? I gripped the retractor so tightly that my fingers turned white and tingly.
Then things really started going wrong. After Colin stitched up the artery, it started popping tiny little leaks. The blood was squirting out like from a crack in a dam. What we needed was a teeny little Dutch boy to seal it off with his finger. All the while, Colin was cursing loudly. Each time the blood started squirting, I got hit like he was aiming for me. By the end, there was blood all over my hands and gown. There was even blood on my bare neck.
But miraculously, the surgery finished up successfully, lasting three hours total. "This was my third worst carotid endarterectomy ever, " was Colin's final official ranking. He looked me over, "Hey, the medical student got more blood on her than we did. "
The Medical Student bows, then snaps her cape and flies off into the night. And by that, I mean I ate a stale bagel in the locker room and returned to the OR for a five hour removal of an infected aortic graft.
Sara Weiner is an attending physician in physical medicine and rehabilitation.
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