Under the Knife

13 06 2012

It’s time for that rotation—the one I had more or less been dreading since the year began.  It’s a notoriously stressful rotation, with a reputation for infinitesimally long hours, demanding residents, obnoxious scrub techs, and attendings who accept nothing less than perfection.

Since beginning the rotation, I am happy to report that I have not encountered a single one of the aforementioned issues.

In short, so far, I am enjoying the rotation.  My assignment for this month is working on the burn/wound care/plastic surgery team, and it’s fantastic.  Not only are the hours great, but it’s a very low-key environment and I’ve been learning quite a bit.  It’s actually perfect because I have absolutely no intention of being a surgeon, but I will see burns and pressure sores and a variety of other wounds in the future.

While I haven’t seen a cholecystectomy or appendectomy yet (which I am perfectly okay with), the surgeries I’ve been able to see are more plastic surgery related.  Turns out I’m much more interested in the superficial surgeries than the ones involving what many of the surgical attendings refer to as “chitlins.”

As far as interesting cases go, I’ve seen many so far.  Most of them involve men with far too little common sense playing with fire and gasoline.  On my first night on the service, two young men were admitted with burns up their torsos, arms, and faces from starting brush fires with gasoline.  Another man, whom I saw one afternoon in clinic 2 months after his injury, nearly lost both legs to infection from 3rd degree burns that made his legs from the knees down look like he was wearing a pair of thick, blackened, bubble-wrapped stockings (I saw pictures.  Not pretty).  He’d been wearing coveralls from work, covered in oil, rolled up at the ankles, and decided to take a nap in front of a bonfire.

My first day, I saw more pressure sores than I ever had on internal medicine.  One woman had such a drastic sore that her spine was clearly seen at the base of the wound when the gauze was removed.  I also saw a woman who’d had an infection after a hernia repair, and her incision became so infected that all of her fat around the incision just necrosed (died and fell apart).  This lady is pretty hefty (BMI over 65), and her wound, when it fell open, measured 26 cm x 32 cm x 12 cm deep.  The amazing thing, that’s all in the fat!  Her abdominal cavity—the peritoneum and ‘chitlins’—were totally unharmed.  The wound was huge, and, to be truthful, smelled awful.

My most dramatic case so far was a woman who, a while back, was attacked, doused with an accelerant and set on fire.  She’s got some pretty dramatic scars, and unfortunately for her, burn scars like to contract in on themselves. The only way to free up that skin and get some flexibility back is with a scalpel, so her surgery was all about slicing open the contracted scars and then putting skin grafts into the open spaces.  It was very cool to watch, and very satisfying to know that the surgeons could help to restore at least some of her quality of life.  The best part of this surgery was that I was allowed to help, to cut open a contracture, use the Bovie (electrocautery) to stop the bleeding vessels, staple in the graft, and suture one of the wounds at the end.  It was AWESOME to actually do more than suction and hold retractors.

That being said, I know now all of my peers are having the same positive experience as I am.  Most of the time, they look dead on their feet after only a week.  Their schedules are more demanding, and they’ve been allowed to do very little in the OR on the whole.  I don’t know how I got so lucky with this rotation, but I am planning to take full advantage of a good situation J

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One response

13 06 2012
Anonymous

I love your blog! thanks for writing it 🙂

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