Case 1

The first thing that struck me was the room. Tiled in aquamarine, with a latticework design of grout, the procedure room struck me more as a YMCA shower than a site for finely tuned medical activity. Shelves lined the walls, crowded with individually packaged sterile equipment. A black portable surgical bed stood in the middle of the room, self important, if not proud. Next to it lay a sterile tray of surgical tools, a rack of dully shining medieval metal and sharp edges. The OR team (as it were) consisted of myself, the attending surgeon, and a single circulating nurse, as this establishment was only for minor surgery. This unassuming room was to be home to my first case on my first day of surgery.

Minor surgery or not, VA policy dictates full sterile procedure, and given the lack of personnel, it was my responsibility to scrub, gown, and glove myself, using the half remembered, half heard instructions from a 3 hour OR orientation. The patient was already in the room, lying on the surgical bed having his arm prepped methodically. A 50 year old vet with a stunning mustache and a slightly bored look on his face, he apathetically took in my relentlessly self-conscious efforts to lacerate my hands into sterility as the nurse lathered his arm in betadyne. He enjoyed my inexperienced efforts to don the uniform of a surgeon, laughing out loud as the nurse patiently helped walk me through the final steps, amused by the gyrations that kept my lanky frame sterile in the cramped space.

The attending finished his note and in moments was scrubbed and fully wrapped. In the meantime, the patient had been fully prepped and draped, and the attending stepped up to the tray, grabbed a syringe of lidocaine/epi, and announced that we were ready to start. The patient was here for a triple lipoma removal from his left arm, and in moments the attending had anesthetized, incised, and dissected the largest fat tumor. In a whirlwind of motion we were left holding a fatty sac and suturing, with my main experience being some supremely impressive retracting (if I do say so myself). I wasn’t really sure what I had learned, except that I don’t faint at the sight of blood. I looked up at the patient, who had been chattering away through the whole thing, looking on in fascination at the bloody mess we were making of his arm.

“Here” the doctor said, handing me a syringe, “you do the next two.”

He plopped the syringe down on my palm. I reflexively grasped it and stared it down, plastic clasped far too firmly in my sterile and double latex clad hand. The patient’s arm remained outstretched, visible bumps calling out for minor medical attention. My own inexperience shouted back that this was almost certainly a bad idea, my entire surgical career to this point having consisted of a single afternoon of suture clinic. As I tried to recall how to sew (no…the surgeons like to call it suture), I tentatively stabbed him, working the needle tip under the skin and injected the sodium channel blocking delight that would keep him blissfully uncaring when I sliced him.

“Minor burn here” I said, willing cheery competence into my voice with every ounce of my frame. I pushed on his arm, poked his skin to see if I had successfully applied the local anesthetic.

“Can’t feel a thing doc,” he said, as I mumbled something almost under my breath about being a medical student, and not a doctor. The attending handed me the scalpel, and for the first time in my life I was seriously about to cut someone. I put the knife to the skin, drawing downward across the protuberant lump I was about to remove. The skin split apart almost eagerly, tiny rivers of blood sliding out as it parted like the skin of a ripe orange.

“OWWWW” yelled the mustachioed man with his arm now wide open. I froze, scalpel in hand, agonized with the knowledge that I must have failed with the anesthesia. I looked up, saw the patient smile, and heard him say “Naw, just fucking with you kid.”

The attending laughed. I didn’t.