Have you seen the little piggies?
My first week of the surgery clerkship was orientation. They gave us an intro to the trauma room and the OR, told us how to scrub, the basics of note-writing, etc. The second to last day, we had a suture lab; they taught us how to put in stitches and tie knots. They used pigs feet. Now, I've done this before. Usually, it's the kind of pigs feet that come from a butcher in Chinatown - they're thick-skinned and still hoofed, but they've been cleaned up; they're ready to put in a soup. This time, though, the pigs feet smelled startlingly like barn. They were still hairy, and still had some grit between their little piggy toes. I wondered where they got them. Some sort of medical supply company, where they get the rats? But would they sell us just the feet? I think I got my answer today.
There was only one surgery scheduled for today, and it wasn't my turn, so I followed the residents. They had a lab, and I tagged along. It was abdominal surgery practice. On pigs. Living, breathing pigs. Well, sort of breathing. They were tied down, anesthetized, and intubated - so they weren't breathing on their own. They were on a ventilator. It took me a few minutes to decide that they were, in fact, still living. That they were pigs on respirators. Periodically, a young woman would come around with a stethoscope and listen to their little piggy hearts and lungs. It seemed so twisted - we were performing unnecessary surgeries on these poor critters for our own benefit, and they would be killed before they woke up. It seemed so sad to see them strapped down to the tables, with tubes coming out of them. On the other hand, the surgeries the residents were doing looked pretty interesting.
I watched for a while, and when one of the residents needed to leave, I was allowed to assist. I cut knots on sutures and held things in place. I tried to clean up oozing gastric juices with gauze pads and fumbled with suction. Later, the resident I was working with let me play with some of the toys. Surgeons have great toys. They let me use the cautery, which uses electrical current to burn the flesh, thereby cutting through it, and also stopping bleeding.
The resident decided to do a colectomy (taking out part of the colon), but had to separate some of the loops of bowel in order to do it. I used the cautery to cut through the tissue that held the sections of colon together. The resident would hold out a piece, with his fingers under it, and I would have to cut along his fingers. Even though he showed me that it didn't hurt, I was afraid of burning him, so I moved quickly.
Apparently, moving quickly is bad. Bad bad bad. Remember how I said the cautery stops bleeding? Not if you don't leave the tool in place long enough. Piggy bled. A lot. The abdomen filled up with blood, and it began to pool under the intestines that were splayed out on the operating table. The resident cauterized some of the blood vessels. For the bigger ones, he would grab the tissue with the forceps, and I would touch the tool to the forceps; electrical current would flow from one to the other, and down to the vessel, burning it closed. The tissue kind of smokes and pops if you hold it there too long - you are burning it, afterall. You can smell the burning flesh. We eventually got it under control, but it became more clear to me why we had pigs strapped down to the operating tables. The mistake I made was common for beginners, and the consequences potentially dire.
Besides the colectomy, we did a splenectomy, a pyloroplasty, and a gastric bypass. When it was time to clean up, the resident took the time to show me around the abdomen - the kidneys, adrenal glands, ovaries, uterus, bladder, liver, gallbladder, and aorta (the spleen was already gone). Then, he had me cut into the diaphragm, hoping to get a peek at the heart. We couldn't see it: it was further up than he expected. Instead, he had me reach in through the hole and put my hand around the still-beating heart. I can't describe how cool it was. You can feel how strong it is, how purposeful. Even after all our meddling, all the bleeding I caused, piggy was very much alive. I paused there for a minute, feeling the heart expand and contract under my hand. Where else could I get experience like this?
After we pulled off our operating gowns, caps, and gloves, I cleaned the splatter of blood from my glasses and went to lunch.
this is really good stuff and i'm a vegetarian! uh. do you like house?