Saturday, December 01, 2007

Endocrine Surgery

It was an interesting week at work. I spent a week working with our endocrine surgeons. It was a great experience, and extremely high-yield and educational. Although endocrinologists are not surgeons (duh!) we send so many of our patients to surgery that it helps to actually see what we put our patients through. After all, there is only so much you can learn of a procedure by reading.
The operating room is an interesting setting. This certainly brings back memories of medical school. After all, the last time I scrubbed in for surgery was in 2001, when working with Dr. Preshaw (not counting the bronchoscopy I observed in internship). I've always been fascinated by the sequence of events that happen in there, even before the first incision is made. You scrub in (and unlike Nip/Tuck you put your own mask on and BEFORE you scrub). Then, hands always above your elbows so that the water drips away, you go in. The scrub nurse hands you a towel. Then your gown. You stick both arms in, another nurse ties the ties in the back. Scrub nurse shows you your left glove; you stick your hand in, then your right hand. Next you hand her the ties in the front, make a 360-degree anti-clockwise turn and grab the tie she's holding, and finish by tying that to the other one on your left waist.
It's a dance, really. Everyone goes through the sequence. And finishes with that turn.
And then you make sure you don't screw up and contaminate your sterile field.
As a medical student, I remembered the scrub nurse admonishing me:
You touched your mask! Your hands are below your elbow! Don't touch his back!
I learnt then, if she says you're contaminate, you're contaminated. Just don't argue- regown and reglove. Everything is so clean in there, you probably could eat off the floor.
I got to see several minimally invasive parathyroidectomies, subtotal thyroidectomies, a Roux-en-Y gastric bypass surgery, a distal pancreatectomy for NIPHS, a laparoscopic resection of a pheochromocytoma, and a transphenoidal resection of a pituitary adenoma.
I gotta say, despite the ongoing medical-surgical rivalry and jokes, my hat's off really to these guys. It takes a lot of dedication to train, and then to work as a surgeon. Maybe I'm just getting old, but just standing and holding the retractors was killing my back! It also takes a certain kind of personality, confidence, to go into one's body cavity almost so cavalierly, cut out the diseases part, then suture things back up. Or so actually go into part of the brain, through a small opening you've created via the nasal cavity. I mean, is this like Star Trek stuff or what??
You also see the different personalities. The neurosurgeon who loves Led Zepellin, and makes his OR staff listen to it blaring over the speakers on YouTube, or the soft-spoken kindly surgeon who suddenly lets one out on the radiologist who's slow in performing the intraoperative ultrasound of the pancreas, or that surgeon who's singing Christmas carols in the OR.
I remember as a medical student, I was in awe of the lanky Scottish surgeon I was working under. He had the most vile sense of humor, but we got along great and he tried to talk me into surgery. But, my love for physiology (and probably laziness) got the better of me, and I chose medicine instead (no regrets so far).
I got to see a different perspective this week. And when I saw that patient with acromegaly at clinic yesterday, I was able to better describe what surgery I'll be sending her for on Monday.