Residency Diary: My Second Year: September and October 2016
As the summer rolled into September at Gillette (our pediatric specialty hospital), surgical volume dropped off considerably. Perhaps parents didn't want their kids undergoing major elective surgery at the start of the new school year. So for one week in early September, my surgery schedule consisted entirely of hardware removal procedures. Initially disappointed that I wouldn't observe some of the more-technical procedures that Gillette is known for, I quickly discovered that hardware removals are perfect opportunities for a developing second-year resident. They let me get my hands on the surgical instruments, and grow more comfortable using the various tools.
So on Tuesday morning, I sat, scalpel in hand, at the proximal femur of a young girl. The attending was at my side, directing me on how to make the approach down to the femoral plate we were trying to remove. Layer by layer, the attending helped me choose which instruments to use and how to approach each tissue plane until we were down to the plate. I easily removed the screws and scraped away some bony overgrowth around the plate so that the hardware came out without difficulty. Mission accomplished, it was time to close.
We reversed course now, retracing our steps and closing each layer we had come across. We lingered on the fascia, making sure the seal was watertight. We finished with a running monacryl suture, the two sides of the chasm coming together to kiss at the top of the gentle peak signifying the reconciliation of the opposing ends of the incision. We began to place steristrips across the wound when the leg began to ooze, dislodging some of the strips. I cut some more strips to replace the ones that had come loose and laid them on the incision, which held nicely.
“Those are too long,” the attending pointed out. I examined the strips, which were poking out awkwardly beyond the edges of the colinear strips on the incision. Indeed, I cut them longer than the ones the scrub tech had cut earlier.
As I replaced the steristrips with ones that were better sized, the attending explained that the incision is the only thing the patient sees. The patient often has little idea about the technical aspects that go on deep to the barrier of the skin. He takes it on good faith that the surgeon is doing her best work and doing what is in his best interest. The incision becomes the visual representation of the surgery we performed. As we finished applying the dressing, I stood with a surgeon who was capable of doing complex and creative pediatric surgery, but who had stayed until the very end of a hardware removal to ensure all the steristrips were cut to the same size.
There are no small operations.
Friday, September 2016
Back on call one Friday afternoon, I walked into Acute Orthopaedic Clinic (ACOR). The nurse quickly shuttled me into a room.
She told me I would want to see Addison (names changed here and throughout).
“She's operative,” she said.
I walked into the room to see a young girl with her arm in a sling. She had slipped backwards when building a tent, landing hard on her outstretched arm.
A couple hours later, she was asleep in the operating room; I sat at the edge of the operating table, her fractured elbow resting comfortably in my gloves.
The c-arm blinked to life, revealing a Type 2 supracondylar fracture. With the attending's help, we reduced the fracture, and flexed the forearm up, holding the reduction in place.