07 October 2010


On scrubbing

I have recently spent several weeks on surgical services within ob/gyn. It's been much more interesting and fun than I expected, however there were a few surgeries where the fellow or the attending told me *not* to scrub in. I was still in the OR, observing the surgery, being asked questions and being taught, but somehow, it's not the same. When you're scrubbed in two things happen: you have a much higher chance of participating in some way and you feel like part of the team.

The first point - participating - is exciting. Throwing stitches, retracting, using electrocautery and various scopes are skills that are difficult to learn well without practice. Truthfully, it makes the surgery a little less boring as well and keeps your attention on what is going on and not on what the anesthetist is doing, what time the clock reads, or the conversations of the circulating nurses. More importantly, it is usually impossible to get a good view of what is being done below the incision if you're not part of the sterile field. This means your ability to learn anatomy and technique are compromised when you're not scrubbed.

The second point - feeling like part of the team - is important in encouraging the morale of the medical student, something surgical fields traditionally struggle with. In general, as a medical student I aim to be useful or, at minimum, not be a drag on my team. Getting told not to scrub is like being put on time-out. Either you've done something wrong or there is no possible way in which you can contribute - not even to hold the skin open. Talk about feeling small and unwanted.

It takes very little to make a medical student feel good and we spend most of our time feeling tired, understudied and unhelpful. It takes time to teach us and we're aware of that. Residents and attendings frequently go home later when they spend time including and teaching us and we're grateful when they do. But it takes no extra time to let us scrub and observe from within the sterile field, so c'mon, throw us a friggin bone here.

06 October 2010

subcuticular stitches

When closing the skin after abdominal surgery, one has two options: staples or subcuticular stitches. Staples are quicker, but subcuticular stitches leave a prettier scar. Subcuticular stitches are also one of the few things a medical student may be allowed to do in the OR causing an interesting phenomenon: the surgeons are artists within the body. They do an amazing job and while you may feel better, you will likely not be able to see their work. On the other hand, the medical student's skin stitches will be on display for you and others for the rest of your life. The least experienced person in the room is doing the most aesthetically relevant portion of the procedure (under supervision, of course).

I was recently allowed to do the subcuticular stitches on a women after her abdominal sacrocolpopexy and right-salpinooopherectomy. I am slow at them, but I do a decent enough job. The following morning when I went to pre-round on the patient, she told me she married her husband while he was in medical school. She looked straight at me and asked, "did they let you close?" I nodded. She replied "let's get this dressing off and see if you're any good." I convinced her to wait until the resident joined us for work rounds and he took the dressing off. As he peeled it off, she peered at her abdomen. "I approve." The resident looked puzzled and I was beaming. Excellent start to the day.