On Monday, I had a half-day of surgeries and a half-day of clinic. The VA is huge and each specialty has a regular unit and its own clinic. After morning rounds, the residents and med students and myself (minus Natalie b/c she doesn’t eat the cafeteria food) would eat breakfast. After breakfast, everyone goes back to the office or up to the units to either check on their patients or put orders into the computers. Around 10:00 a.m., I observed my first surgery—a BKA or below the knee amputation on a man I’ll call Peter Pan–with Natalie, Doug, and Dr. Rivera. (I think it was those three, but my memory is rusty as to who was present.) Each surgery has at least 5 people—one attending physician, one or two resident physicians, one or two medical students, an anesthesiologist (or nurse anesthetist), scrub nurse, and floating nurse. The nurses prep the room by getting the patient in there, knocking him out with the anesthesia, covering him in a brown iodine solution, setting up the tray by putting down blue cloths everywhere, counting all of the instruments, etc. The prep work can take a long time depending on what kind of surgery it is. Finally, once the room is prepared and everyone is scrubbed in, surgery can begin. Because I was only observing, I wore green scrubs, a blue shower cap, blue footies, and a mask over my face. The physicians and nurses wear all of that plus they have a blue sterile coat that wraps around them and special blue sterile gloves. They wash their hands outside the OR and then walk in with everything but the outer coat and gloves, which they put on inside. Each person helps the other tie the coat and the gloves are usually laid out on the sterile tray or held out to him or her by the nurse or other doctor. I may be getting the steps wrong but this is the basic process.
For the BKA, I was scared but still excited. I’m trying to remember all of the steps but this was a surprisingly bloodless surgery so it wasn’t as bad as I thought it would be. The surgeons wrap this tight white bandage around the leg to push all of the blood up. The idea is to have as little blood as possible b/c this makes it easier to cut. Then, they made an incision and began the process of cleaning out the muscle, tissue, ligaments, etc. before they got out the big saws. At one point, they got this buzzing instrument that literally burns through flesh. It’s white and has a small hook on the end of it and if the scalpels and other tools weren’t appropriate, they used this. When they first started cutting, I have to admit I was a little disgusted, but I was fascinated at the same time. It’s hard to describe what you look like on the inside. You just have to see it for yourself. There’s a lot of fat (white) and muscle (red) and ligaments (yellow?) and just a lot of junk. Because I haven’t had anatomy since high school, I wasn’t sure what they were cutting except that I knew it was in the leg. What bothered me more than the sight was the smell, especially when they used the burning knife tool! I hate that thing. A small caveat: I have a highly developed sense of smell and smells really bother me. Towards the end of the surgery, they used this long tool called a “Gigli saw” which is a thin saw with handles on either end. Doug was the one who actually sawed through the bone. The sound of the bone snapping would probably disturb most people, but it didn’t bother me. Unfortunately, I missed the end of the surgery b/c Natalie got paged and I followed her out so I missed them cut off the leg and drop it in a special bag. I think that would have been very disturbing to see.
I think at this point, I managed to grab some lunch before we went off to the clinic, or we went to the clinic first and then I went and got lunch. Just observing the BKA made me so hungry! Of course, I am hungry all the time and was surprised that watching surgery did not diminish my appetite. (If you know me, you know that nothing diminishes my appetite!)
At the clinic, we saw a variety of patients who I guess you would call either “pre-operative” or “post-operative.” I spent a lot of time with Mr. Orvis Hat. I forgot his name, but he had on a really cool hat and a cane. I forgot his medical complaint but all I remember was the fact that he had a big hole his pants. (At least he was wearing underwear.) A post-op man came in and I got to remove his staples! That was so much fun, but when I put the staple remover on him, he jumped in the air and yelled “ouch that hurt” and scared me half to death. Natalie started laughing b/c he was just playing. They both had a good laugh at my expense. I think the staple removal was the highlight of the day b/c I got to do something. Actually, over the whole week, the BKA was my favorite surgery. We checked up on Mr. Pan later in the week, and it was just amazing. Even though we chopped off his leg, he was eternally grateful and thanked us profusely. He said he couldn’t believe how good he felt without his leg.
I also got to see some “MOPs” on Monday. “MOPs” are “minor office procedures,” which at the VA means that Natalie or one of the other residents will remove skin lesions. Natalie calls them “skin ditzels.” I saw a lot of these over the course of the week. I think the first patient had them on his neck and arm, and when Natalie put in that anesthetic, I felt that man’s pain b/c the same thing happened to me. (I had some kind of cyst removed on my arm not too long ago and it wasn’t a fun experience. I was lucky compared to the vets though b/c my cyst was so far gone, I just needed the surgeon to clean it out. I didn’t even need stitches.) Finally, after the clinic and surgeries, we had evening rounds.
Throughout the day, everyone is checking on their patients between surgeries and writing up notes. Also, the residents have to dictate each case into the phone directly after surgery before they forget what happens. The medical students run around all day checking on patients, writing up notes, and doing surgeries. It’s all very labor intensive.
I will post Tuesday soon.
Just observing the BKA made me so hungry!
OMG I am ROFLOL, Stacy, you’ve got it, girl! “Civilians” would NOT understand this sentiment at all, but it was my observation that nothing deterred the nurses, doctors, med students from thinking about food. You may not know it but you just passed an important test.