On Surgery
“I’m about to cauterize this man’s scrotum.”
There’s a perfectly logical explanation for this, I assure you. In order to get there, let’s go back to the beginning. Yes, I’m still on my antidepressant. No, I haven’t gone over the edge despite popular opinion. Yes, I do have a dark sense of humor that I keep in check because it sometimes scares people. Now that I’ve addressed these pertinent questions, let’s proceed, shall we?
After two months of clinical clerkship at our university hospital, I was both curious and apprehensive about starting our first major rotation that was surgery in a government hospital. I had heard and received endorsements regarding the workload and work environment that should be expected. However, I decided to discover the reality of the situation myself before forming the truth I should believe in. On the first day of this new rotation, I arrived at the hospital an hour and fifteen minutes early for my duty shift. I had to wait at the cafeteria, which hadn’t opened its food stalls yet, before I was assigned at 7 AM to the Surgery Intensive Care Unit (SICU).
Surgery is the field of medicine that deals with the treatment of disease through surgical intervention. It can be defined in a straightforward manner but a lot of work also goes into pre- and post-operative care. My first day as a clerk for this department involved monitoring and referring two patients every hour for the next 24 hours. The first patient was a case of subdural hematoma while the second was a case of acute abdomen secondary to ruptured viscus. Both patients were in critical condition and required hands-on care which allowed me to apply skills I had learned in theory. Aside from monitoring the vital signs, I also had to record and refer the first patient’s score in the Glasgow Coma Scale (GCS) to measure the level of consciousness and assisted in wound care. Inserting a nasogastric tube (NGT) twice in the recalcitrant second patient who kept pulling it out was also a highlight for that day.
Such was the pattern for the days and weeks that came after as I was assigned to other surgery wards, both service and pay. Each practiced skill felt like a small achievement; the dreaded IV line insertion, the strangely satisfying venipuncture or phlebotomy, the fascinating draw of blood for the measurement of arterial blood gas (ABG), and the insertion of an indwelling foley catheter (IFC) for both male and female patients. However, I also judged myself harshly for my initial incompetence in these matters and had to repeatedly remind myself that everyone starts out as a novice. Experience is a great teacher and this was made more evident when I was assigned to the emergency room. An action packed 24 hours without sleep, a patient who went into code, and my swollen ankles forced me to overcome my doubts. Little did I know then how important that day would be two weeks later as I worked in another government hospital. I had to accompany a patient in an ambulance to a different hospital and carry out endorsements.
When an opportunity to learn presents itself, grab it. My first pre-duty shift offered me the chance to assist in a hydrocoelectomy. I’m ever grateful for the patience of two urology residents who guided me through this procedure from scrubbing in, then allowing me the use of a cautery pen during surgery, and performing basic suturing. I’m also grateful to the anesthetized patient whose scrotum we operated on. See how all this comes full circle? I promised a logical explanation, didn’t I? All the succeeding surgeries I assisted in only served to excite and intrigue me, even the emergency appendectomy at 3 AM and almost an episode of syncope. I experienced the latter once again the following month, during a vein stripping procedure, rotating in the surgery department of our university hospital. It was worth it, though I hope I won’t ever need to internally debate with myself again whether to collapse forward or backward.
