Okay, time to get some science back into this blog before I lose my street cred.
It’s a long entry, so I warn you ahead of time, but skim as you like.
First off, I’d like to say I’ve re-HIPPA-tized myself before writing this entry. If you are unfamiliar with HIPPA, it’s confidentiality of patient and healthcare-related information. Most importantly, no names or personal information attached to medical notes, procedures, and history.
For a nice brief overview, check out HIPPA on Wiki:
So, I was sewing up a hem on my dad’s sweatpants, and it reminded me of a surgery I got to watch before Thanksgiving break. I had the pleasure to observe for three months at the Orthopaedics unit in CHOP, one of the best pediatrics hospitals in the country. The chief surgeon was nice enough to let me scrub into surgery, and his ever lovely academic admin was more than happy to let me fill out the paperwork to do so.
I don’t even know where to begin with this. It was just very surreal. I never thought this moment would ever come. It sounds dramatic, but I feel as though I haven’t had many big “pre-med/pre-pa” experiences. So I’ll just tell it as the ever so excited and overly enthusiastic student that I am.
Step 1: SCRUB ACCESS
First thing was first, I got scrub access! After getting an ID to access the Women’s Locker room, I sprinted to the “scrub vending machine,” as I dubbed it. So apparently, each ID keeps track of how many scrubs you have taken out and returned, based on the number of times it’s been swiped for access to the machine. You scan the card, and use a code to select whatever size combo you want. I got a small top and medium bottom — BIG MISTAKE. I was swimming in my pants. How easily amuse I am by hospital mechanics.
Next, I had to put on my hair net, mask, and shoe covers! I have suited up for biopharm production floors before, but it’s really different. In biopharm, it was all keeping your entire being as uncontaminated from the outside world as possible. Airlock doors, alcohol sprays, and restricted sterile areas were the norm just to go inside the production site! It’s hard to explain, but the protocol for suiting up for observing this surgery was less strict and uptight, though still precautious to prevent infections. I felt weird not needing to don a pair of goggles.
Step 2: MISSING SUGERY
When I finally was all suited up and ready, I wandered around looking for the OR room I was supposed to observe in. Apparently, by the time I found it, I had missed a HUGE moment. The following conversation ensued between the operating doctors (still on fellowships) and nurses in the room with me (not verbatim).
*I pop my head in the door* Hello?
*Operating on young girl* “Hi, and you are…?”
“Oops sorry. I’m observing Doctor *insert name here* I came in to watch a surgery.”
“Do you want to be a doctor? ”
“I’m not quite sure. I’m doing these observances to see if the health field is really for me.”
“Well, you just missed the most unusual thing I’ve probably ever seen. Maybe it’s a good thing you missed it. You probably wouldn’t want to be a doctor then. It was like Scarface. Blood everywhere. On the floor. It was just gushing. It wouldn’t stop.”
*The rest of the surgery team continues with more witty banter while closing the patient up*
Apparently, they were trying to remove a giant mass of tissue growth on the girl’s arm, but it had gotten so big that it had developed its own blood supply. So in the process of excising the tissue, a vessel was hit.
You would imagine my disappointment when I realized that I missed the surgery I was supposed to watch, especially as they cleaned up the room and wheeled the patient away. It was kind of depressing. I was sent to the nurses’s lounge until the next surgery was up. An hour had passed and I had gotten sick of watching Rachel Ray, I popped back in to the OR room. Luckily, a patient had just gotten medicated and was due for surgery. I got to talk to a few of the fellows and nurses who were really encouraging to ask questions. It was fun talking to them.
Step 3: PREP WORK
Although I ended up missing my Evolution Bio class (completely unplanned), I got to watch an entire surgery from start to finish, instead of just running in the middle of one.
I saw the X-ray of the patient. They pointed out to me that by her right ankle, the patient had a soft tissue mass that needed to be taken out. What is typically done is in the middle of the surgery, a small sample of the tissue mass is taken to Pathology to figure out if it is a benign or malignant growth. Depending on the results it would determine how much of the tissue would be left in. The tissue mass in this case was so tiny, that they ended up scraping it out in its entirety.
I always find the one of the most fascinating parts of science to be the prep work. I think seeing protocols in action is always fun and a good way to see if the protocols are effective or need to be changed. Plus, by watching prep work you can gauge what they expect will be needed or will happen during a surgery based on what is laid out on the table. Vaguely I remember saline washes, pre-threaded needles, A TON of surgery scissors, a variety of shapes and sizes of scalpel blades, and a scalpel that actually heated up (its like a SUPER DISSECTION KIT). And packages of gauze piled high. Watching the surgeons who actually do the operations suit up was also very interesting. Unlike those simply observing, the operating surgeons are covered from head to toe, and need another person to double glove them, probably to prevent any infections when opening up an incision.
How they prepare the patient before surgery is pretty enlightening as well. First, thing they buckle the patient down. This patient in this case had particularly good reflexes and kept moving (not a good thing). For this patient, they were operating on her ankle, so they had to also find ways to prop and angle her leg in a stable way. One side of the sheet is the anesthesiologist (who was my most favorite person in the room). The other side is where the actual cutting happens. They then covered the patient with like a giant paper sheet. The only thing not covered was the head (exposed to the anesthesiologist) and the part the right ankle (exposed to the surgeons). I was standing from the surgeons point of view, and there were times during the surgery I forgot they were operating on a girl because of how covered she was.
Step 4: THE ACTUAL OBSERVANCE OF SURGERY
Now, the moment of truth: could I handle watching someone cut into a living human being? The initial incision was what I personally dreaded the most; I feared I would have fainted at the sight actual cutting into flesh on what seemed to be a normal person. At this point I had only dissected a plethora of animals (In their entirety: sharks twice, mink, pigeon, pig, squid, lamprey. Countless animal parts, like cow eye, sheep lung, Prepared human bodies: plasticized, cut into histological slides, photographs. Watched surgery on tv, ect.) But I had never been in a room where it had happened.
Luckily, as most things in life, things were not as bad as they seem.
First, the doctor had marked up the girls leg with a black marker: one thin line. When the chief surgeon gave a phone call to proceed, the doc on fellowship began the cutting. The one thing that caught me off guard was the smell when he used the heated scalpel. The smell of burnt flesh is not always too pleasant, but it wasn’t overbearing. He continued to cut in with a normal scalpel and small scissors. Along the way, he would stuff gauze into the girl’s leg to soak up any fluids.
It took a while to find the tiny tissue mass. The chief surgeon finally came to the operating room, and he looked like he was going to dig in a mine: full helmet set, magnifying glasses on top of his glasses, and a flashlight. I was surprised he even closely remembered who I was, but he did and I was glad. When he peered into the operating site, he practically located the mass within a mere few minutes. It was attached to a nerve. Another great quote from the fellow doc that day:
Here nerve, where are you? I usually try to avoid you, but today I want to fiiiiiiind youuuu.
At that point they knew where to target, and scraped it all up for the OR nurse to bring to Pathology. Satisfied, the chief surgeon left and the remaining fellow doctors closed up the girl’s incision. This for me was also one of my favorite parts. They used pre-threaded needles of different thicknesses and a pair of scissors (used like a pair of tweezers to pull the needle through the skin) to sew up the cut site. They started with a thicker thread and sparse stitches. Along the way, they injected some fluid along the cut site, I guess to keep it hydrated. They continued with thinner thread and more closely spaced stitches as they went from deep to more superficial parts of the skin. They also used the heated scalpel to fuse some parts together internally, from what it looked like (they had to cut and separate small amounts of connective tissue between the muscles to get to the nerve). It was really amazing who precise and beautifully they sutured it up.
Finally, it was time to bandage the cut up and clean up time! It was like the girl was never operated on after a few minutes. They even remembered to put back on her socks for her because they didn’t want her to get cold! They removed tape from her eyes, all the sheets that covered her, various items to prop up her leg, the buckle that held her to the operating table ect. The doctors got her back on her bed. She was taken off the anesthesia and oxygen carefully. Then, doctors even woke her up, told her the time and said her surgery was over.
Step 5: Revelation
After the whole thing was done and I returned back to “Christal the normal bio student,” I walked out of the hospital and bought a cupcake for Naomi (I think it was for a Sickle Cell Anemia in Children fundraiser). For the first time, in a very long time, I realized how much I found medicine fascinating. I’m always yelling about my love for science these days, but MEDICINE. I loved being in that operating room and watching these people use their knowledge to stop whatever bad thing was in their patient.
That is one major difference between medical and non-medical settings. Medicine is so RAW. Working in labs, I’m always concered about sterile technique and having precise ways of doing things, but in medicine, it’s a whole different ball game. To put it bluntly, these surgeons were sticking their hands in this girl’s leg and feeling out what was wrong. Granted they had years upon years of training and experience and so much more intelligent than I will ever be, but medicine is literally a hands on career.
Like what my friend John (who happens to be a Geology major) said to me when I saw him for dinner last week:
…in school they teach you all the rules, but in the field there are only exceptions to the rules.
And it’s so true! These doctors were faced with a case that was rather unusual. They used all their formal training to figure out how to approach the matter, even if it wasn’t a “textbook” case. They had the knowledge, but the brilliant part is when they realized how to apply that knowledge. And not to mention how nicely they handled the patient after the surgery. It’s so beautiful! There are no words I could write here for you to understand how amazed I am and how I felt after this surgery. But I guess that’s just how you know you want to make a career out of something.
I hope to observe more docs & PAs before I graduate with my undergrad Bio degree and get more patient care experience as well, but it just felt really good, like a rekindling of faith, that even if college has been challenging for me academically, it doesn’t mean I’m not good enough to go into a health profession. Deep down inside, past the disappointed O-chem grades and frustration with physics and countless other classes I fought to hold my ground with, the initial desire and want to help people via science is still there. The initial need and passion to pursue a career path working in hospitals and clinics still burns strong, even if it is quietly.
I wish I could figure out a way to make that feeling into a personal statement eloquently enough.
As for a summary of the procedure it can be said like this:
- Procedure was not as crazy or scary as predicted. The surgery environment was actually not as hectic or stressful as I thought it would be (everyone was so damn chill & calm; it was awesome).
- Prep work and waiting for the patient takes the longest time.
- Being a surgeon takes a lot of brains, steady hands, and a sharp sense of humor.
- I may still be slightly squeamish (just slightly) when I watch horror movie gore, but as for actual human blood and guts, I seem to fare well, at least for this observation.
- I want to be a part of an operating team one day