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“You’d be surprised.”

Not long ago a classmate and I were told that there was a patient who needed his chest tube removed. The intern said one of us would do it. Initially I was going to do the pulling. But it really didn’t matter. Neither of us had ever done it.

Before we reached the patient’s room, our intern verbally walked us through the steps we needed to do in order to safely remove the chest tube. After all, you don’t want to be giving instructions at the bedside while the patient is awake and afraid.

It turned out the patient was very afraid. He had just experienced having a chest tube removed a few days ago. For reasons I was not familiar with (as I had never met him before and never looked at his chart), he had required a second chest tube. Now, though, it was time for the second one to come out.

As I bent over the bed cutting off the sutures the patient continued to express his fear. It had been very painful the last time it was done. He also wanted to make sure that we waited long enough for the pain medication to kick in (he had received some IV pain medication from the nurse right before we came in).

I finished cutting the sutures and the patient looked at me and asked if I had ever done this before. For a split second my mind froze. I didn’t want to say no. But it is bad form to lie to a patient. After gathering myself, my answer came out: “You’d be surprised. This is actually fairly common in the hospital.” At this point my classmate chimed in that chest tubes were fairly common and it was pretty routine for them to be taken out.

It worked. The patient seemed to find comfort in the fact that his procedure was simple — and in the process he appeared to move away from the question he initially posed of whether or not the two medical students in his room had ever done the procedure before.

My classmate ended up pulling the chest tube. The patient was actually quite happy about the whole ordeal; it hurt a lot less than the previous one. He even said that he wanted us doing his chest tubes next time he needed one pulled.

The way I answered my patient when he asked if I had ever pulled a chest tube was not something I came up with alone. I actually heard of it from a pediatrics attending physician. She recounted a similar incident that occurred to her while she was in residency. She told us that the patient looked at her and asked her if she had ever done a procedure before. And her answer was, “You’d be surprised how many of these I’ve done.”

By the very nature of medical education, there will always be a patient who is our “first.” Our first intubation, our first blood draw, our first whatever. Sometimes, we have to, as my attending told us, “fake it” until we make it. That’s the only way we can learn.

And for those readers who are not familiar with medical education, this may sound terrifying. But the intern, who had pulled many chest tubes, was by the bed when the time came for the pull. Should something have gone wrong, we were being supervised.

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A Record Day

Before surgery my senior resident muttered something about the surgery being 4-12 hours long. At first I thought it an exaggeration. Then I realized he wouldn’t do that. So I ran away from the OR.

Ok, I didn’t run. But I did walk quickly away; I headed straight for the cafeteria. Because at that point I hadn’t had anything to eat yet.

By the time I came back from breakfast the patient was in the holding room. I found my attending and resident looking over her chart. We then had a few words with her before leaving the holding room. Soon we saw her being wheeled into the OR by the anesthesiologist and the nurse. I followed her in. By now it was 7:50 AM. I was thankful I had taken the time to escape for food.

After the patient got into the room, it took a while before we had everything set to go. The eventual incision time was around 9:17 AM. This, of course, was after all the prep work we had to do beforehand.

Official closing time was about 5:50 PM. I stood for the entire thing. My hands trembled at times as I retracted massive amounts of fat. Throughout the surgery the surgeons kept complaining about the amount of fat she had. Fat really does make a surgery difficult. And I saw first-hand. At one point, I stuck my hand into her abdomen to see how much fat she had. I placed my hand along the entire depth of her subcutaenous fat. About 3/4 of my hand disappeared.

And now I’m home. It’s 7:30 PM. I want to eat. I can’t imagine how hungry I’d feel if I hadn’t eaten breakfast. And I don’t think it’s fair that while the surgery team has to stand there the entire time, the scrub tech and nurses get rotated out for scheduled breaks.

My legs are bitter.

And my stomach, too.

But I’m ok. Only one week left of surgery.

Oh, and I almost forgot. My attending taught me how to suture a JP drain in place! It looks rather ugly, but it works.

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The Details Matter

In clinic today I saw one of Dr. B’s patients. I grabbed the chart, went to see the patient, and came back to present to Dr. B.

After 3 weeks at my site I have managed to avoid seeing any of Dr. B’s patients. Let’s just say that Dr. B is rough around the edges and his vocal chords have a propensity to produce very loud noise when speaking to people. He is also over 60 years old and looks like he could be your grandfather.

Anyways, while presenting my patient to him, I mentioned that my patient had experienced dark red blood in her stool for “months.” The conversation then continued like this:

Dr B: Months? What do you mean months?!? Is it 2 months or 200 months? It matters!

Me: Right (while nodding my head. He is right, after all. I have nothing about which to argue.)

Dr. B: In medicine, the details matter. Are you married?

Me: No

Dr. B: Do you have a girlfriend?

Me: Not at the moment.

Dr. B: Well when you get a girlfriend you ask, “Do you have a lot of money?” She says yes, and then your next question is, “How much?” See? The details matter!

Me: (Nodding my head)

Point taken. The details matter. Got it, coach!

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Words With Patients

Let me set up the scene. I had just met my patient and examined her in her room. She was an older woman. She was an inpatient (meaning she was staying at the hospital). We were discussing a possible trip to the OR that day. I wasn’t sure if she would go that day or if the surgery would have to wait.

Nevertheless, our conversation was pleasant and I felt that we had fairly good rapport. We laughed and smiled throughout the conversation even though she was obviously anxious about surgery. And then this conversation happened:

Me: Well, it was good meeting you. I’ll probably see you later today. If you’re here tomorrow, then I’ll see you then too.
Her: If I’m here? Where would I go?

I sensed the panic in her voice. She sounded like I had just casually mentioned that her future existence was in question.

My only thought was that she could have gone home after surgery since I didn’t think the procedure was too serious. But poor, lady. She was thinking more negatively than I anticipated.

And once again, I was reminded how important communication really is. And seemingly innocent remarks can be understood in a completely different light that it was originally intended.

Oh, and I did clarify what I meant as soon as I heard her reaction. And we laughed again.

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SurgeXperiences 204


Welcome to another edition of surgeXperiences!

SurgeXperiences is a bimonthly blog carnival bringing you stories from the front lines of the operating room. For more information, click here.

This week’s (loose) theme was “My First Time.” So, in order of submission (for the most part), with those closest to the theme first, here are the posts!

Firsts
rlbates, a plastic surgeon from Little Rock, AR, recalls her first surgery rotation during her Junior year that happened to coincide with a record-breaking heatwave in July of 1980.

Captain Atopic writes about his first time being awake in the OR and his first time in a non-English speaking country in a appropriately titled post: My First Surgery.

Jeffrey Leow from Monash Medical Student shares his reactions to the many firsts in surgery in a post with visual aids aplenty and a nifty soundtrack too.

David Gorski over at Science Based Medicine writes about his first encounter with The Orange Man and the lesson that meeting taught him about alternative medicine.

Bongi, over at Other Things Amanzi, writes about his first time performing a splenectomy which, incidentally, was also his first time seeing one: see one, do one, teach one. Bongi also shares a humorous story about teaching a medical student how to do a lymph node biopsy and sending the student in(to) the deep end.

The Scalpel’s Edge features a post about the first time DrCris begins to seriously consider a career as a surgeon.

T vents a bit about the specialty of Anesthesiology after a patient announces to her that she is in a ROAD specialty and that her job is “easy”… which leads her to, in the end, remember the reason she decided on her specialty. The post is titled: Hit the Road, Jack, and Dontcha Come Back No More, No More, No More, No More…” (just kidding, of course).

Over at Nursepractitionerblog’s Weblog is a post titled My most interesting patient that discusses some memorable firsts like changing a bedpan for the first time and the first time giving an IV to a gentleman scheduled to have both legs amputated.

Opinion
Lucia Li, in her first post on The Differential, shares her views on Women in Surgery.

In a post titled Disaster Waiting to Happen, a new blogger from New Delhi writes a short paragraph about his thoughts after surgery at SurgeryLounge. Let’s welcome him to the blogosphere.

Maggie Mahar at HealthBeatBlog.org writes about the Cultural Divide between Surgeons and Physicians.

And related to the last post, rlbates offers her comments on a recent article (A Surgeon’s Outburst) printed in the Boston Globe and the article by Maggie Mahar mentioned above.

DrCris also writes about TURFing and asks, Can’t Surgeons and Physicians Work Together?

Jeffrey Parks offers his take on Diane Suchetka’s Continuing Anti-Doctor Crusade in a post discussing the newly released list of “never events.” MSNBC.com reported on this list last week. Another article at MSNBC.com reported that surgical errors cost $1.5 billion a year.

News
In To Heal the Wounded, Donald McNeil writes about a new textbook for surgeons on the battlefield. An interesting read for those interested in military medicine. The story is found at NYTimes.com.

bookofjoe compares an article from the Scientific American and a study that appeared in the British Medical Joural about what happens when a surgeon sneezes.

Reuters.com carries a story discussing the ethics relating to waiting for death and the quick-harvesting of hearts.

Thanks to everyone who submitted. Thanks for allowing me to host this edition of SurgeXperiences. The next edition of SurgeXperiences will be hosted by DrCris a Scalpel’s Edge.