Saturday, December 3, 2011

No Claims to Courage

Well, as of yesterday, surgery is over. I passed my exam, packed my bags, and said adios to the little two story house on the banks of Long Pond in central Maine, that has been home away from home since mid-October. Thursday marked my last shift on the surgical unit and it felt wistful, saying goodbye to people who've become coworkers as much as teachers these past six weeks.

Technically speaking, my instructors have been surgeons: general surgeons, urologists, obstetrician/gynecologists, orthopedists, and neurosurgeons. Quite a range when you consider the size and scope of the hospital. But the nurses and surgical techs were teachers, too, and good ones. And I ought not forget the anesthesiologists and nurse anesthetists. Together, they taught me how to behave as a member of a surgical team.

It has to be difficult, being regular staff and having a newbie walk through your doors eight times a year. Friday, one leaves and Monday, another shows up. Friday's guy has finally figured out how to find the bathroom without having to be shown and Monday's doesn't know what a bathroom is yet. It's not quite that bad, but you get the idea. There's a constant flow of change. Students are a "complete unknown," as Dylan put it, rolling stones gathering as much moss as they can before rolling on.

When I began this rotation, it was with the understanding that a community hospital wasn't exactly the best place to learn about surgery if I wished to become a surgeon. Opportunities for observing and participating were, of necessity, directed toward the ordinary or the mundane. I suppose that's true, but I gained a great deal in spite of the presumed limitations. One of my pastoral mentors reminded me, as I was leaving for seminary, "You can learn something from every preacher, so pay close attention." That advice holds true for rotations and this one was no different.

For instance, I learned how to intubate, i.e. insert a plastic tube into the mouth of an anesthetized patient, past the epiglottis, locate the vocal folds, and slide the tube between them, ensuring an adequate airway during surgery or at other times when a patient needs ventilatory support to breathe. I learned how to place a laryngeal mask airway tube when intubation wasn't necessary. And I learned how to start an IV line. All good tools to stow in my doctor's bag alongside the reflex hammer and stethoscope.

I learned how to take a leap of faith, not once but twice, by incising a patient's belly with a knife sharp enough to cut just by looking too closely at the blade. I also learned the cost of hesitation. Surgical time is billed to the tune of twenty-five bucks a minute. With a mere 60 seconds constituting each minute, one second wasted in unnecessary indecision is accompanied by the sound of 42 cents clinking down the drain. Standing alongside my patient I had 84 cents max to decide whether I had the guts for this kind of work or not. You wouldn't think faith could be thus quantified, would you?

I think my father would have enjoyed talking about this rotation. He knew some experiences have to be lived to understand, but he'd encourage me to try, anyway. Just the effort, sometimes, takes us places we'd never visit otherwise. Incising a half inch long swath into a belly that had held children cut deeply into my own fears. Of what, I'm not sure, but I came out of the surgical suite feeling braver than when I went in. e.e. cumings wrote, "
It takes courage to grow up and turn out to be who you really are." While I make no claims to courage, I do think I managed to do some growing up the last few weeks and I have a lot of people to thank for it.

(Photo of Long Pond at sunset copyright 2o11 by the author. Like a Rolling Stone, words and music by Bob Dylan, copyright 1965)

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