Thursday Born

The everyday life of a psychiatry resident (who was born on a Thursday).

Archive for August 1st, 2011

Adventures With Laparoscopy

with 2 comments

Friday morning. Post call. Maybe four hours of sleep? Not sure yet if I’m going head down to the OR to watch a surgery before I’m supposed to leave by noon, being post-call and all. Rounds finally over, Intern gets a call asking for someone to go scrub into a surgery to drive the laparoscopic camera. Everyone with legit responsibility is busy figuring out why one of our patients has an Oxygen saturation of 50% (this is bad) so I get sent down. Never driven the camera before but I figure, hey, it’s good to try new things, and this is a routine procedure that’s supposed to be done by 11:30am. I hadn’t eaten since 9pm the night before, but eh, I’m not all that hungry now and this won’t take long.

Ah, how wrong I was.

It was stressful enough struggling to figure out how to use the camera on the fly. We’d had a workshop teaching us how to use them, but this was a different model, or I hadn’t paid enough attention, and I couldn’t figure out how best to hold it and it took me a while to get used to using the levers to look up, down, left and right instead of always moving the entire thing. So I’m trying, the doctor keeps correcting me verbally, and also by sharply taking over the camera.

And then we see blood. I mean, we were seeing blood before. We were inside the patient’s abdomen, bloated with carbon dioxide so we had room to work in, and we were cutting free his bowels that had fused all over the place due to his chronic disease. But no, we were seeing a lot of blood. Flowing blood. Not the slow welling up of blood when you cut a minor vessel, and not quite the torrential gushing of cutting a major vessel, but it was steady and rapid and while no one panicked, it was clear that this was a Problem.

My parents came to visit this weekend (which was wonderful, btw!), and we went out to dinner with a few of my friends. At some point it came up how I was a calm, easy baby, and my friends mentioned that they call me zen and wise because of how mellow I am.

And so I didn’t visibly freak out. I didn’t panic and ask for someone else to take over the camera, not that there was anyone else anyway. I suppose the circulating nurse could have scrubbed in and stepped in for me, but I would have needed to keep my cool until they were ready, because every second was important. Inside my mind was screaming with frantic thoughts. Was it my fault? Was I driving the camera so badly that they couldn’t see a vessel and cut it? What if I’m doing a bad job right now and wasting time so they can’t find the vessel and clamp it off? I desperately wanted them to switch the surgery from laparascopic to open, but they hadn’t thought they’d need any blood and they would if they switched to open, and the blood they’d called for as soon as this happened hadn’t arrived yet.

I don’t know how long this went on for. At least twenty minutes. Perhaps a half hour. Maybe longer. I kept driving the camera for fifteen more minutes until one of the other residents showed up and asked me if I wanted a break. My “Yes!” was perhaps a bit too desperate and enthusiastic.

They told me I did a great job for my first time. And that considering what happened, I’d done an excellent job. I’m not sure it was obvious, given the mask I was wearing, that even as I was laughing and saying that I was fine and didn’t take the harsh commands and reprimands personally, I was holding back tears. Tears of relief? Tears from the stress? I’m not sure. I kept them away successfully.

The adrenaline eventually subsided, and I stayed through till the end of the surgery, even though it ended past 2pm. I had come after they’d already started, so I hadn’t seen the patient yet as a person, only as draped body with  a square foot of disinfected skin exposed to my eyes. I saw inside him, saw through him in ways I hope I never get to see through my loved ones, before I got to see his face, and two days before I got to see him properly awake and alert on rounds Sunday morning.

It’s my bedtime now, so I apologize for not editing this, but I wanted to make sure I write about it before it fades.

Written by Aba

August 1, 2011 at 8:49 pm

Posted in Uncategorized

%d bloggers like this: