Notes from a Medical Student:

With Cold Steel

The water runs down my arms and onto the floor as my back goes against the door, pushes open, and I enter. Don't touch anything, don't knock anything, just don't do anything stupid, I tell myself. The gown then comes over my arms and my hands dive into the plastic gloves.

Under the watchful eye of the surgeon, the first cut is too shallow, and so I have to make another. The abscess I'm cutting into has an induration thicker than three of my fingers. The bacterial cocktail bursts forth, and the cleaning and packing follow. I pull the gown off, strip the gloves off, and realize how bad my heels hurt, something I hadn't even noticed for the past hour. The resident sits down and starts writing orders. I assist in the dressing and finally the transport of the patient into post-op. As I leave I see the scalpel sitting on the tray with just a drop of blood on it. "The way to heal is with cold steel."

You see, that's just one of the sayings you'll hear. "A chance to cut is a chance to cure…Surgeons separate their patients from disease." All types of physicians are proud of what they do…surgeons are no different. So you start to pick up the quirks of the resident you're following; you're doing what they do because you have no idea what to do. You watch, you do, you teach…or so the teaching model goes.

Transition from the first two years to the last two years isn't as smooth as I'd like it though. Surgery is well known as the boot camp of 3rd year clerkships and so I've been hitting myself on the head wondering what possessed me to choose it as my first rotation. To tell you the truth I have no idea, no real rhyme or reason. Now, as I transition from 10 hours of steady study to 14 hours of constant surgery, I find myself lost again. So most 3rd years, in my opinion, have to get used to the idea that you are starting over again. Despite coming so far in the last two years, you open the door into the wards and realize there's an entire world of knowledge you haven't even touched yet.

As the scrub brush darts back and forth on my arm, I keep counting as best I can. I rinse and push my back on the door. Don't touch anything, don't knock anything, don't do anything stupid, as my mantra goes. So it begins, a bypass and transposition of several vessels in a nice lady's chest. It's a fascinating clinical presentation and an intricate story, with exciting twists and turns. For this procedure, however, I'll do nothing but watch, all gowned up and nowhere to go.

So I stand there watching, hands in front of me folded. I feel like an altar boy again, giving homage to whoever invented the electrocautery or the Metzenbaum scissors. As I stand there, the resident turns and asks me an anatomy question. "What's this…what's that?" It's a form of questioning called "pimping." So you try to know as much as you can before you even pick up a scrub brush. Problem is, for every right answer, the ante goes up. The questions get more and more complicated until you pretty much have no idea what they are even talking about. But it sticks…well most of the time.

At 4 a.m. I start to feel the burn in my feet from being upright all this time. My back is in spasms and I've been holding this retractor in the same position for the past 20 minutes. The young man in front of me, lying down with a tube in every natural and man-made orifice, had a scuffle which ended in two things: a police report and a hole in his back. The attending physician points out the anatomy to me as we go through. We trace the path of the bullet, through the liver and into the peritoneal cavity. Suction, look, suction, look, suction…you get the idea. As we close him, the attending allows me to staple the incision shut. Whenever a medical student does such a procedure, we get very excited and very nervous at about the same time. However, at this time of the night, I'm mostly excited about anything that has a flat surface on which to lie down.

A week later I'm rounding with the residents and seeing how the patients are doing. It's during this time that I've learned one immutable fact: the body can take more abuse than you think. It can be, as I've heard it so aptly described, "forgiving." So as I walk into the patients' room to ask them how they are doing today, I'm smiling for two reasons. First, I'm actually starting to understand some of this; I'm actually getting the hang of it. And, secondly, just like the Dr. Scholl commercial, "I'm gellin."