“Do. Not. Move.” There will be many defining moments during my time in medical school. This instance was one of those moments.
I had the opportunity to shadow a world renown cardiac surgeon and work one-on-one with his staffed fellow as one of my selectives.
Selectives
The Mayo Clinic Alix School of Medicine explains, “As part of Year 1 and Year 2 curriculum, selectives are dedicated 1-2 week curriculum blocks that enable students to experience the self-directed approach behind the design of the medical curriculum, emphasizing personal responsibility for the learning experience.”
A few of my past selectives in medical school thus far have included Bounce Day, a community-wide emergency preparedness event, and an ambulance ride-along.
As part of this particular selective, I actively observed a cardiac surgeon for the week. Observed, because I’m not a board certified surgeon. Actively, because I was expected to learn, contribute, and participate in every step.
The Mayo Clinic is a teaching hospital. The goal is to lead, transform, and heal.
“We focus on clinical training that redefines medical education. Our faculty members will know you by name and you’ll be surrounded by learning opportunities that you won’t find anywhere else. Our students don’t have to wait to make an impact in health care. They start here.”
I definitely have not had to wait to make an impact in health care.
This selective was all hands on. I scrubbed into multiple open heart surgeries, felt a beating heart, rounded on patients, observed the technical aspects of cardiac by-pass, learned to place chest tubes, practiced a subcuticular running stitch and even got to help close up a patient with that very same stitch.
Master the Basics
Day one. I met the fellow I would be working with for the next week. He made it abundantly clear that he wanted me to learn a lot during our time together, for which I was grateful.
From the moment of the first incision, the icing began.
Icing is constant questioning of things you should know as a resident that they ask over and over and over again. What does this drug do? What is the next step in this procedure?
I was unable to answer most of his questions correctly.
He soon realized I was limited in my knowledge and capabilities. He finally asked me, “What do you know how to do?”
I think the fellow thought I was a first-year resident and was sorely disappointed by my meager answers. I had previously explained via email of my education level. So, I clarified again explaining that I was only a first-year medical student with biochemistry, histology, and anatomy under my belt.
Once we were both on the same page, he asked me different questions tailored to my knowledge. It felt good to finally be applying things like biochemistry and anatomy in the direct care of patients.
However, I’ll never forget what the fellow told me when I went to change out of my scrubs. I was recounting to him the things I had learned and what I thought I should work on to be of better assistance to him in future surgeries.
He said, “Blade, today I asked you to run, but you can’t even crawl. You will never be able to help me in the capacity I need you to until you learn and master the basics.”
Ouch.
My first initial reaction was, “Man, I suck.” But I realized I had only been doing this medical school thing for four months. I had only been working on surgery skills for no more than eight hours! Surgery takes a lifetime to master.
To the fellow’s credit, he wanted me to learn and be better. I wanted the same. So, I asked, “What can I do this week to start mastering the basics?”
That’s when he sent me home with my first homework assignment.
Look up the mechanism of protamine sulfate and heparin. Learn about the procedures known as an unroofing of an anomalous coronary artery and a septal myectomy. Understand the pathology and clinical presentations of hypertrophic obstructive cardiomyopathy. And practice the subcuticular running stitch.
Overwhelmed yet?
I did my homework that night and returned the next day ready to learn.
Life is Fragile
Day two went smoother. I answered all his questions correctly during the surgery because my anatomy course was fresh on my mind. After eight hours of shadowing the fellow, I was again sent home with more homework.
Day three was the day I will never forget.
We rounded on patients at 6 a.m. before heading down to the OR by 7:30 a.m. We were prepping for a straight forward procedure when the fellow bolted out of the OR unannounced. I’m usually adverse to cardio workouts, but I had to run to keep up with him.
We arrived in the ICU to respond to a patient we had rounded on that morning. When I met this individual, they were doing great. But when we arrived in the ICU, things had taken a turn for the worse.
After some tests and an echo, it was determined that emergency surgery would need to be performed as part of their heart was lacking blood flow.
We were in the OR minutes later.
I didn’t scrub in right away because they needed to open the chest quickly and prepare the patient. I found a place on the edge of the OR where I could observe the room and stay out of the way.
Everyone had a job except for me. Which left me with nothing to do but watch the patient.
Nurses hovered around the patient prepping their body for surgery. It was a solemn moment as the patient, yet to be asleep because of the urgency of the situation, cried out in fear. Their body shook partially because of that fear and partially because the OR is kept fairly cold.
I caught a small glimpse of the hell they must be going through.
The patient knew very little about anyone in the room, but their life was in the surgery team’s hands.
Finally, the patient was put under general anesthesia.
That moment for the first time in my life, the delicate balance of life and death became real. Being a doctor is not just “cool” or “a career choice”. It is a responsibility and a trust.
A Simple Instruction
It was amazing to watch the team. It was a well-oiled machine. The only reason the patient recovered in the end was because everyone was confident and competent in their job.
Eventually, I got to scrub in once things settled down. But things didn’t get less intense.
A few hours into the procedure, the world renown surgeon entered the OR to do a by-pass to fix the lack of blood flow. The area the surgeon needed to work on was in a difficult spot. In order to repair the heart properly, it needed to be lifted and rotated a few degrees.
The surgeon did so and then placed a probe under the heart, balancing it in the chest cavity.
The surgeon then looked at me, grabbed my hands, placed them on the probe, and said, “Do. Not. Move.”
I nodded. Got it. I can do that.
Little did I realized I would have to do that for the next 35 minutes.
As the surgeon worked, at times his hands rested on mine. I told him I could adjust my hands to give him more room to work. But he quietly and forcefully reminded me, “Do. Not. Move.”
The procedure he was preforming was quite technical and moving my hands just a little bit could have destroyed what he was doing. As small as my job may have seemed, it could have ultimately determined the outcome of the surgery.
My back was aching. My hands were cramping. I definitely broke out in a sweat. I silently prayed asking God for assistance so that I could help this patient.
Despite my shaking muscles, thanks to God, I did what the surgeon told me to do. I didn’t move.
I was so focused on not moving, that at one point the surgeon said, “11-millimeter blade to me.”
In which I responded, “What?”
He clarified saying, “You are Blade. I need a blade.”
He chuckled and continued working.
Eventually the procedure concluded, and the patient was taken back to the ICU.
Book Learning vs Clinical Skills
Day four was a clinical day. We met with patients and scheduled their surgeries.
Day five was all hands on. Under the direction and supervision of the fellow, I cauterized bleeding vessels, placed chest tubes, and to top it off, I helped close the surgical incision site on a patient.
That was quite the experience…
I realized the book learning we do in medical school doesn’t insure good medical practice. Practicing paired with book learning does.
I felt confident with my subcuticular running stich on a rubber pad, but stitching skin back together was vastly different. Surgical skills take a lot of practice.
It’s important as a physician to know what is happening and then do what needs to be done.
Day five was a stark difference from day one. In a short week, I learned basic skills and was able to apply them.
It was the first moment I felt like a real doctor. The nurses and fellow even called me Dr. Blade during the procedure, which was cool moment in my training.
Final Thoughts
Surgery has always been on table when it comes to choosing a medical specialty. I now have a little more understanding of what it is going to take if I am going to do so.
I can see why surgeons are so stressed. Life hangs in the balance the moment that incision is made.
I was captivated, fascinated, yet humbled at every turn.
Until someone’s life depends on it, you will never know the true weight of what it means to be a physician.
This is a collaborative post written by Blade and Kristi Hargiss.
