Tuesday, January 02, 2007

Flashback: General Surgery

I started this blog after I had finished my general surgery rotation, so for the two fold purpose of preserving another story, and providing entertainment whilst waiting for my next rotation to start, I offer: my first day on general surgery.

I knew I was probably in trouble on this rotation. The middle four weeks of my surgery experience were to be spent on a general surgery team, the non-laproscopic surgical oncology one. Later on, the one shining light of a resident in the whole malignant program would call our team the "kings of maximally invasive surgery" but that was still waiting. But I knew I was in trouble because I had been at a large hospital staff meeting at which some awards had been given out, and the surgeon who was to be my chief had gotten one of the big ones. He never smiled, through the whole process. What kind of a guy is lauded in front of most of his peers and never smiles? A surgeon, I guess. I counted myself lucky that I had four weeks of surgery already, and knew the basics of scrubbing in and such.

Day one of general surgery then, worried me. When I came in the first day, I knew we had two thyroidectomies scheduled, because I had checked the schedule before leaving the previous day. (I wasn't usually that OCD on surgery. That showed my nervousness) And I was a little relieved that my best friend from my class was on the same team. As we came in to the scrubstation, Dr. Neversmile looked at us, asked our names, and said to my classmate "You. You're the med student on this case." Then he told the chief resident to page him when the patient was ready, and left the OR. During that first surgery, I became more and more concerned. Surgeons (and some other docs) like to "pimp" medical students, by asking them harder and harder questions about the surgery they are performing (if they are nice) or whatever comes into their head (if they are mean), usually with the intent of belittling the medical student. Supposedly, pimping is meant to be educational, but usually it just scares the med student into reading in his off time. Anyway, Dr. Neversmile was asking some ridiculously difficult questions, and my classmate was not doing well. Once or twice, when he didn't merely shrug and ask another question, he would look over at me and ask the question my friend had missed. Both of us came out of that surgery shaken. I was more worried because I had to bear the brunt of the questions for round two.

The second surgery began much like the first, technique-wise. In a thyroid surgery, the medical student stands at the head of the patient, reaching around the head on both sides to hold retractors to expose the gland. It is difficult to see anything unless you lean partways over the patient's head, and this gets dangerously close to invading the surgeon's space. My classmate had been told repeatedly to move his head back, which demand would invariably be followed by a completely unfair question like "which artery is this?" And "I can't see it" is not an acceptable answer. So the good doctor started his incision, and as he was placing the retractors, took the time to look at me and ask "who was Charles Martel?"

At this point, I was nervous enough not to think that this question might have anything to do with surgery. Having had more than a little history in my education, I quickly answered "he was Charlemagne's grandfather, steward of the royal house of France, and commander of the army that held the Muslim invaders back at Tours in, I think, 723 AD."

Dr. Neversmile, who had looked back at his work, stopped. Looking up at me, he said "do you know what that was?"

"No sir."

"That, Nathan, was an afflatus. Do you know what an afflatus is?"

"No sir."

"It is a flash of divine communication of knowledge, as if the person was breathed upon by an angel. Do you know any angels?"

"No sir."

"Anyway, that was brilliant, but not the answer I wanted. Charles Martel was actually a sea captain who was the first person to have his thyroid removed, and who died because his parathyroids were removed as well. Here, let me show you something..."

And that was it. From that point on, Dr. Neversmile was nice to me, in his own way. He still made me hold a retractor on a liver case for 4 solid hours, he still asked ridiculously difficult questions, and he still never smiled, but he actually taught me from that point on, and when we did thyroid cases, he let me peer over the patient's head and see what was going on. I actually came out of the rotation having learned something besides the fact that I never wanted to see the inside of an OR again. Thank God for that afflatus.

*As a side note, I was actually wrong about the date of Martel's victory. It was in 732 AD. It didn't seem to matter. Also, the picture of Martel the sea captain is from American Journal of Surgical Pathology. 20(9):1123-1144, September 1996.


Anonymous said...

wow --- mind-boggling. Hats off to you for keeping your head, surviving, and even thriving. And to your excellent liberal (in the classic sense) education.


Thainamu said...

My baby begins his surgery rotation today. He said he will spend the day sewing up a pig's foot, and then tomorrow goes on from there. I hope he gets somebody nicer to work with than you did. Yikes!

So to say "That was an afflatus" was an insult, I guess. He assumes you needed divine help rather than you smart enough on your own.

Ibid said...

Charles-the-Hammer. His grandson, in becoming King of France and Germany, essentially started World War I, according to... random French dinner table conversation. You should try it sometime; they would probably be impressed-- which is hard to do.

Nathan said...

TMU - Thanks. I owe a large part of that to public libraries across this country.

thainamu - I was just glad he wasn't mean. Everyone is condescending to the med student, so I didn't notice that.

ibid - excellent, I'll have to. Actually, the chief resident, who was also in that case with me, followed up by asking me "what was Charles' nickname?" wanting me to answer "The Hammer." I didn't have the heart (or maybe chutzpah) to answer "Martel actually means "hammer" in Old French, I believe." That would have been pressing my luck, I think.

Ibid said...

How in the world do you know Old French? (or would this just be an educated guess-- je veux dire, est-ce que tu comprends "marteau"?)

Nathan said...

I don't actually know Old French. However, the book I read about Martel in (whenever that was, a while ago) mentioned that was the translation of his name. In fact, je ne comprends pas le fran├žais. I took Russian and Latin.

Ibid said...

Do you find this improves bedside manner? As Seneca said, "non quaerit aeger medicum eloquentum."

Nathan said...

Indeed. But part of the reason I decided on internal medicine rather than pediatrics was the fact that my patients can usually understand things more learnedly. They may not speak Russian or Latin (and I certainly don't do more than scrape by in the latter) but eloquence is not always out of place with them.

Actually I like Eddie Izzard's take on learning Latin: "...it's quite useful when you're say, queuing at a petrol station at three o'clock in the morning, and there's a load of murderers behind you. You can just say 'AMA, AMAS, AMAT, AMAMUS, AMATIS, AMANT!!' and they'll say '^@#$% Hell, he knows Latin! Run!'

*as if to prove my inexpert command of Latin, I had to edit this comment to correct the spelling on this, most basic conjugation. Twice.

zhoen said...

Now, see, from the nurse pov there, I think they just entertain themselves with the med students. I get the impression that it matters little if you actually come up with the answers to the hard ones at all. If you don't contaminate, and hold for good exposure, you're golden. Med students are often preferred to residents, because they don't slow down the work. Make a joke, and all is really well. Seriously, you should see what they do to the interns and residents and fellows when they don't know what they really should.

There are some good, pleasant surgeons out there. Honestly. I worked with two yesterday.

T. Oates said...

It is too bad that you did not know Charles Austrasil Martell because Dr. Neversmile had it all wrong. Charles was the first patient in the USA diagnosed with primary hyperparathyroidism. He did not die from thyroid surgery. He had 7 different parathyroid surgeries until finally it was determined that he had a mediastinal parathyroid adenoma. When that was removed he did indeed have hypoparathyroidism, even though some of the tumor was transplanted under his skin. He lost over a foot of height during his lifetime due to his hyperpara and was called "the vanishing man".

T. Oates

Nathan said...

I learn something every day. Thanks, T. Oates.

Anonymous said...


just signed up and wanted to say hello while I read through the posts

hopefully this is just what im looking for, looks like i have a lot to read.

Anonymous said...

pretty cool stuff here thank you!!!!!!!

Anonymous said...


Anonymous said...

Thanks for another awesome post. Keep up the good work.