Issue 7 – Volume 3 – April 2017
by Tahnee Bell
The day of my first surgical scrub-in held a nostalgia reminiscent of the excitement felt as a child on Christmas Eve. However, the experience was not what I had imagined it being; I was not a fly on the wall shadowing the surgical team, being seen and not heard. Instead I had a hand in an incredibly confronting and memorable experience, one that has provided me with a sober understanding of what my career in the medical profession will bring.
My mentor, Dr Jay Bruce, is an anaesthetist and on the day of my scrub-in she had been working in general emergency surgery. I was under the impression that I would witness a simple surgery, such as an appendectomy. Instead, she warned me that today’s surgery was a particularly sensitive case: a 94% chance of morbidity and 33% chance of mortality. The patient was an 82 year old female with multiple comorbidities including dementia, heart, lung and kidney failure who presented with an incarcerated femoral hernia. Surgery was the only option besides turning to palliative care. I sat in as Jay explained the procedure, risks, and possible outcomes to the patient’s family. The family was, as could be expected, very emotional and I found that I was as well. I knew I had to maintain composure while still remaining empathetic - I just never realised how challenging this would be. We left the family to give them some privacy while we prepped for the surgery.
I was shown the multiple drugs to be used and explained the layout of the room. We then went down to the holding area where the details of the patient were checked and rechecked. Here, one of the patient’s daughters was able to say goodbye - this was difficult to watch as all of us quietly understood that this could be her final goodbye. Once in the room I observed how they communicated with the patient and re-assured her of what was going on. I was surprised when Jay asked me to ventilate the patient, I hadn’t expected I would be allowed to be so involved in the procedure. When I held the mask over her face her request for water became muffled, but it was still very clear when she cried out that we were hurting her and to “Please stop.” This was awful to hear, but it was remembering that this whole process was to help her. We may have been seen as the bad guys but it was what we had to accept and continue to provide her care. I attempted to console her, to tell her it was alright and we’d have that glass of water ready for her soon. The registrar Sophie then took over the ventilation, demonstrating the correct technique, before intubating the patient.
I was amazed and so grateful for how supportive the surgical team was to include me and explain what was going on. I was even able to palpate the mass and they made sure I had the best spot to watch the operation. As the surgeon operated she explained everything that was going on; where, why and what she was cutting; what was normal, what was not; how it might occur and how to fix it. I thought I would be queasy but I stood there the whole time mouth open, transfixed. I’m sure the team was laughing at my reaction. Afterwards I did apologise to Jay - it was her I was meant to be watching, but she was glad I took the opportunity to experience every facet of the procedure. Once the hernia was removed we next checked the bowels. The change in mood of the team was obvious - they had expected serious damage but the surgeon explained that it was only bruised, meaning the patient’s prognosis looked much more optimistic than initially predicted. The surgeon closed and it was time for the anaesthetic team to take over again. Slowly, and with some difficulty, we woke the patient. She was disorientated and distressed, so I held her hand as we quickly stabilised and moved her, taking her to the recovery room.
I wasn’t there when the family received the good news. I left with Jay and she couldn’t tell me exactly what the outcome would be, just to hope for the best. Later I contacted her and she told me although the first few days were rocky, she was soon to be discharged.
My first surgery was not what I expected. It was a confronting and sobering realisation of the world I’ll soon be thrust into. Nevertheless, I will cherish the experience and always be grateful for the opportunity Jay and the surgical team gave me, and for the family allowing me to be present in what must have been a very difficult time. After all this: I’ve decided I want to do surgery.
Tahnee Bell is a second year MD student studying at UWA.
