First Assist

More years ago than I like to advertise, I was flat on my back in a hospital bed, awaiting surgery for kidney stones. It all began on a typical July 4th weekend in northwestern Colorado, visiting family and fishing in the high country. A delightful lunch of cutthroat trout cooked over an open fire was followed by nausea, vomiting, and abdominal discomfort that puts the P in pain. The local ER doc diagnosed a renal stone and I began seeing a urologist in Denver the next week.

As we say in medicine, my initial treatment was conservative, i.e. reduce calcium intake and drink water or cranberry juice like it's going out of style. At that time the theory was, my kidneys were less adept at eliminating excess calcium, so by flushing them with clear fluids, we'd rinse them of the offending chemical. It was a good theory; the problem was, it didn't entirely work, resulting in my first exposure to surgery coming from the patient's side of the operating table.

I spent this past week, and will spend the next five weeks, on the surgeon's side and believe me, that's a whole lot more fun. Not that I minded being a patient, but the lessons I learned have stuck with me. For instance, there's nothing like being at the mercy of the healthcare system to teach future doctors to pay attention when their patients speak. It's one thing to get report of 522b's requests for morphine and quite another to have been 522b, in severe pain, and have to wait -- in pain -- for the hours to tick away like days before the next round of medications arrives. Thanks to the gravel pit that collected in my left kidney, I know what this is like.

What makes the surgeon's side of the table more enjoyable -- apart from the absence of pain -- even for this incipient psychiatrist, is the fact that you're delving into live anatomy. For all the times you may have laid scalpel to preserved, leathery cadaver flesh, when you insert your fingers into the warm open incision of a living person, you've got to experience a mix of awe and fear. Fear that you'll do something harmful and awe because you're in a position to do so, probing where no one has gone before. It's enough to make the crew of the Enterprise envious.

My week, as do most, began with Monday -- orientation, a meet and greet with the staff, butterflies in the stomch. The next four days were spent in the OR from near dawn to mid-afternoon, when the surgeons head off to do office work and I'm left on my own. This rotation is largely self-directed and I have the freedom to pick and choose the procedures I find most interesting to scrub-in on. Since I'm working in a community hospital, I won't see cardiac or severe trauma cases -- we don't have the ICU facilities for major surgeries like those -- but I'll definitely see the kinds of things most of my future patients will experience and that's what matters. Naturally, I'll scrub-in for all those performed by my primary instructors, but I can also work with any other surgeon who's willing to have a student along for the ride.

It was the latter that led to another first this week, an opportunity to act as First Assist, the individual who stands opposite the surgeon, ready to offer whatever assistance the surgeon requires at the moment. Ordinarily, First Assist is a trained nurse, PA, or another physician. Under the right circumstances, however, it may also be a student. Yesterday the tumblers clicked into place and I was in the right place at the right time.

Now, before this begins to sound "important," in point of fact, I didn't actually participate in the sense I cut this (aside from sutures) or pulled on that (aside from retractors). Still, having an extra set of hands can be helpful and mine were eager to be put to good use. From a student's perspective, you're assisting, even in small ways, and that's always better than observing or merely standing by, all scrubbed up with nowhere to go and nothing to do when you get there.

And the word gets around. You've done the job once, you were attentive and diligent, you didn't screw up, the doctor seemed to enjoy your company; he'll tell other docs and you'll get to do it again. The more often you do, the better you'll get, and sooner or later, someone may hand you a scalpel, which to your inexperience feels like a Bowie Knife, and say, "You make the first cut."

Are my hands ever eager.


(Creative Commons image by Army Medicine via Flickr)