Surgery

For a month now I've pulled a puffy cap on and boot covers that come halfway up my legs. I've dutifully changed from my tie and dress slacks, shedding my short white coat in favor of fading blue scrub pants and double scrub shirts to combat the 65-degree temperature of the operating room. Goggles and green duckbilled surgical masks come last on the days when I don't sport 15 pounds of lead to protect myself from the x-rays that are used to monitor the location of pins and screws, foreign objects, and needles. Each day that I scrub my hands endlessly, meticulously smothering each and every finger web, cuticle, and third of my forearm with soapy suds, I'm amazed that dressing up like an astronaut leaving the atmosphere and intentionally hurting my patients helps them heal.

The operating room is a special place of great privilege. Only surgeons open patients' abdomens to search for their diseased kidney. No one else is trusted to care for others by removing chunks of disease from their sides. Our essential but almost comical preoperative ritual is designed to limit infections and insure our own safety as we care for others. Somehow, surgery seems a strange sort of caring. We inflict injury on others because the surgeon and his or her patients fear the consequences of letting a tumor grow, allowing an infected appendix to burst, or to insure the healthy birth of a baby boy or girl to proud parents. We challenge the body to heal not the original disease process but rather the insult that we inflict on patients. I'm learning to make cuts straight and true, sew knots tightly with five knots and sometimes more, and do my best to cut out not only diseased, malignant tissue but also enough good tissue surrounding the bad to guarantee that cancer has been completely removed.

By ending my third year of medical school with my surgical clerkship, I must admit that I was afraid that expectations would be high. Residents would expect me to be able to perform independently and efficiently. I worried attending physicians would expect me to answer their barrage of questions astutely and accurately. I find myself transforming into a senior medical student rather meekly, terrified I'll soon have to finally answer the question "What are you going to be when you grow up?" with more than a smile, shrug, and the response, "a doctor." I'm so thankful to be performing clinical duties instead of pouring over physiology textbooks, I've had little time to reflect on the amazing change that's taken place in my life and my professional career. I'd much rather concern myself with learning sterile technique and memorizing the treatment of testicular cancer than be faced with the reality of the fact that I'll soon be faced with the responsibility of internship and residency.

It wasn't eleven months ago that I quaked at the thought of seeing two patients in less that an hour-and-a-half. Now I can calmly assess four patients in a little over an hour, produce concise notes on my exam, and propose an occasionally reasonable plan of care for those patients. Soon I'll need to care for 9 in the same time period, but at least comparatively I'm improving. I still find myself lacking confidence in my verbal presentations of my findings and ability to compose a differential diagnosis. I still can vividly picture the faces and names of the patients with diseases I'll forever associate with their stories, their symptoms and presentations. I remember the looks on the faces of the moms and dads as I held their baby in my hands, the first person to ever show them their new son. It's hard to believe that in less than a year I'll be responsible for lives, in the same way that the surgeons I admire take the lives of patients in their hands and heal them.

I can't get over the things I've learned over the last eleven months, the faces and illnesses I'll always connect them with, and I'm struck by the irony that good surgeons, the best surgeons do their best to injure you well enough that you'll become well again.

Andrew Jacques ('05)