Thursday, August 7, 2008

My First Surgery Rotation

JeffreyMD will be hosting SurgeXperiences on August 17, 2008. It will be his first time hosting. His suggested theme is "my first time". Though this could cover a wide range of firsts, I think he intends for it to be related to surgery.

My first clinical rotation in medical school as a third year student was surgery. My first six week rotation started in July 1980. The local weather guys have been referring to that summer as the year of the hottest July on record in Arkansas.

1980 - A record forty-two consecutive days of 100 degree heat finally came to an end at the Dallas-Fort Worth Airport. July 1980 proved to be the hottest month of record with a mean temperature of 92 degrees. There was just one day of rain in July, and there was no measurable rain in August. There were 18 more days of 100 degree heat in August, and four in September. Hot weather that summer contributed to the deaths of 1200 people nationally, and losses from the heat across the country were estimated at twenty billion dollars. (David Ludlum) (The Weather Channel)

I don't recall the outside heat that summer. We got to the hospital while it was dark out and got home after dark, so we missed the worst of the heat. I am sure I did my share of complaining, but I loved surgery. I was on the vascular service at the VA hospital. I was lucky enough to have good residents (Dr John Kendrick, Dr Michael Stairs, Dr. Robert Lambert), smart and skilled and who didn't mind teaching us. It was "peace time" so most of what we saw at the VA were guys with peripheral vascular disease (PVD) and/or diabetics who needed wound care or amputations. We junior medical students "took" call by sleeping in the hospital. It was our responsibility to draw blood, put in IV's, do H&P's on any admits, do dressing changes, chase down lab, and scrub in on the surgeries our patients had.

The first surgery I ever scrubbed in on was a late night BK (below knee) amputation of a diabetic gangrenous foot. I think the two male residents expected me to get faint or nauseated and have to leave. I didn't and even managed to do the surgical prep without contaminating anything. They actually taught me about amputation levels that night, and showed me how I would need to do the dressing changes and wrapping of the stump as it healed to get it ready for a prosthetic.

It was also on that service that I first learned how to debride wounds. A lot of wound debridement was done at the bedside during dressing changes. There is one man I remember so well. He had PVD and still smoked. His right leg was amputated at the hip. The wound was had not healed, and I had to do dressing changes 2-3 times each day, debriding non-viable tissue each time. He had been there a long time. My chief resident showed me how to do the dressing and debridement. When it was my turn to do the job alone, the gentleman (that is what he was) actually tried to make things easier for me. I think I cried (just wet eyes, maybe a tear or two down the cheek) my way through the first one, but he and I made it. He sang to me while I debrided his wound. He sang "Ramona". I will never forget him.

3 comments:

mark's tails said...

Love the post Ramona, having a VA was one of my prerequisites when I looked for training programs. Definitely a lot of PVD.

ditzydoctor said...

:) that's a really sweet song. i'm glad you got through!!

Bruce said...

What a great story! Worth writing about.

A few years ago, a new secretary was transcribing a dictation about a patient who had undergone a below knee amputation. Of course the note came back for signature with the patient having a history of a prior "baloney amputation."

Thanks for a great post!