Tuesday, November 01, 2011
a good surgeon does not imply a good assistant. i personally don't like my assistant to be equally qualified with me. more qualified assistants can sometimes be a nightmare.
one of my role models in the department of surgery was my registrar when i started there. he was just a very nice guy. he was in fact such a decent guy most people wondered what the hell he was doing studying surgery at all. he just didn't seem like the type. but no matter how good an individual he was, he still had to learn how to operate.
the boss believed in teaching us to remove gallbladders the old fashioned way. therefore in his firm there was no such thing as a laparoscopic cholecystectomy. this was good in the sense that we all ended up being very comfortable with open cholecystectomies. however it was bad in the sense that you didn't get that much opportunity to learn the laparoscopic procedure, which is the standard modern procedure throughout the world. so when we moved together to the firm of the older semi-retired prof, ironically my senior would get to do some laparoscopic cholecystectomies. i remember when we got the first one on the list.
"doctor, this patient needs a laparoscopic cholecystectomy and you are going to do it." i watched my senior's face. i knew he had never done one alone before, but i also knew he would not pass up this opportunity.
"thank you prof." he looked a bit worried but he seemed determined not to let the prof know.
"and i will assist you." announced the prof with a broad smile which i'm sure he meant to be reassuring. now my senior looked very worried indeed. the prof was old and hadn't operated for years. in fact i had never seen him scrub into a case at all. i wasn't even sure he could operate any more. the problem was that with the prof there if there was any trouble it was unlikely the prof could help and his presence meant we would not be able to call anyone else that could. we'd just have to soldier through.
the operation started well enough although slowly. even the dissection of the artery and the duct progressed acceptably well. but it was here that the prof's assistance skills started to interfere. i personally suspected that the poor old man was nodding off intermittently. the reason was that every now and then the camera would wander away from the operation field. my poor colleague would be just about to apply a clip to the cystic duct when we would suddenly be given a wonderful view of the stomach or the abdominal wall or some other random organ. obviously everything would come to a grinding halt, with both of us trying to decide how best to tell the mighty prof that he needs to keep the camera on where the surgeon is trying to operate. in the end, neither one of us was brave enough to chastise the prof and we ended up just waiting for him to realise his mistake and return the camera to the correct position. i thought it was comical, mainly because i wasn't operating. i'm sure my poor colleague didn't quite appreciate the humour in it at the time, though.
finally the awkward pause was too long as we admired a pristine view of the colon. my colleague had to say something.
"um, prof, could i ask you to move the camera slightly." slightly wasn't going to be enough, i mused, but i was not about to say anything. if someone was to face the wrath of the prof, it sure as hell wasn't going to be me. yet somehow this request seemed to do the trick. maybe the prof realized his camera work had been suboptimal and he decided to try harder. i suspect that he had had his nap and was no longer tired. whatever the reason the camera settled on the cystic duct and did not move. at last the registrar could clip and cut the duct unimpeded. at last the operation was proceeding at what i considered a reasonable pace. quite soon the registrar was carefully dissecting the gallbladder out of where it was embedded in the liver. but then gradually i realized there was another possible dilemma on the brew.
you see, although the camera position was perfect for the cystic duct, as my colleague dissected the gallbladder loose i realized that the prof was not following his progress with the camera. the dissection progressed across the screen of the monitor and finally moved right out of sight. the dissection progressed beyond the limits of what the prof was looking at and finally it came to a grinding blind halt. again we sat in an awkward silence. it just could not go on like this. maybe bolstered by the success of his last request to the prof to drive the camera better my colleague decided to address the prof again. but this time the prof was awake.
"sorry prof but ..." the prof cut him short.
"doctor you must operate in the middle of the screen, not on the side!"
more and more i came to appreciate the real reason we wore theater masks while operating. they were to hide the fact that we were laughing so often.
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woah, that sounds like a lot of pressure, I doubt I could handle it.
mike, all you need to do is to laugh the pressure off. it helps if you are wearing a mask.
I am currently on my Surgery rotation and I have been fortunate to have had the chance to assist my attending, i.e. work the camera. It seems like a straight forward task, but you really are the surgeon's eyes at that point and you have to think one step ahead so that you follow the surgeon's move. It's given me even more appreciation for everyone in the OR; it's all hands on deck. And you're right about the surgical masks!
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