The important lesson

         Communication is the center pillar of a successful surgical practice. Long years in medical school and hospital practice make surgeons accustomed to the blood and pus. It is easy to explain the possible complications of a disease to a medical student. But only a surgeon can understand the chance of collateral damages associated with a surgery in a difficult situation.

        Some days ago my professor was called in to gynecology operating room. They had opened a patient for a large ovarian cyst. The patient had history of four abdominal surgeries. The gynecologist made a rent in the rectum while separating the adhesions in the pelvis. There was bowel contents were released to the peritoneal cavity. Considering the nature of injury and comorbidities, my professor advised a covering colostomy after repairing the rent. Now the difficult part was to get things explained to the relatives. They will never understand how difficult it is, to operate in an abdomen with adhesions; they will never realize how easy it is, to get bowel injury while separating adhesions, even with utmost care. But my professor handled the situation very smartly. He met the relatives and explained them, that the tumor was adhered to the rectum. The options left were to leave the part of tumor or remove the tumor completely with a part of rectum, for which a covering colostomy is required. The relatives were happy to agree to do the colostomy.

         This incident is a story about my professor in medical school. He did a thyroid surgery; unfortunately the recurrent laryngeal nerve got damaged on one side. He could identify it on the table itself. He went to the relatives and explained about the patient condition. He said “I was in a difficult situation during the surgery, I had to choose between the life and voice of the patient. I asked God. He told me, life is more important than voice. So I had to do it that way. So patient may have some change in the voice, but thank Him for giving back the life.”

Surgery on a surgeon

            Recently my name was added in the patient name column of our Operation register. It was nothing major, a small corn removal from my foot. But I had the fortune of being operated by my batch mate, my upcoming fellow surgeon. It has been more than two weeks now. The wound was left open. It has almost healed now. The important thing is that it reinforced some principles that have to be kept in mind while operating a patient.

             Done so many surgeries under local infiltrative anesthesia, I was started to have a feel that the procedure is so simple and tension free. But for a patient who has come to the operation theater for the first time and not accustomed to the smell of antiseptic lotions, nothing is a simple. Even a tetanus injection can be a painful procedure both physically and mentally.

            When a person lies on the operating table, he or she is surrendering completely. They believe that the surgeon will do everything to keep the procedure least painful and comfortable. A good surgeon will always respect this and do whatever in his control to make the procedure comfortable for the patient.

             One instance I felt ashamed of myself during this surgery was when I uttered ‘f**k’ when my friend gave the first shot of local anesthesia. I have always shouted at patients who swear while doing procedures under local anesthesia. Most of the time it occurs at the first shot. Even I could not control myself and it was a reflex reaction. I need to improve my manners.

            Once in a while, being back to the other side of table help light up some inside thoughts, some little things that can add more empathy in patient treatment.

PS: Not to mention, I took the next day off due to pain.

"Are you sure"

     This happened yesterday. Our professor who has an experience of more than 25 years in surgical practice was doing a laparoscopic cholecystectomy. As I have mentioned so many times before he is a very friendly person and easily approachable for residents. Now my Junior who is in his second year of residency recently did a laparoscopic training course. There they taught him basic laparoscopy techniques and cholecystectomy on porcine specimens. Our professor dissected the Calot's triangle and clipped the cystic duct. Unlike we usually do he was in a little hurry and didn't mind to explain each step. Then my junior who was really enthusiastic after all that one week training   questioned him, 'Are you sure?!!' (that you are clipping the cystic duct and not the common bile duct!!). Professor started laughing. Even I, who was holding the scope, could not prevent myself shaking the scope due to laughter.

          Surgery and any other medical professions has got this peculiarity. Once we pass the degree, we are legally equal to our teachers. Now this is a reality, but it depends on individuals how he or she assimilates that fact. Even though senior resident has the same educational qualification as the professor, his clinical examination and treatment modality may not be the one the Professor wish. In this profession the thing that matters most is experience. Allthough it may considered class 3 or C evidence in context of evidence based medicine, it is the most important factor.

         It is also another effect of this profession. You are at a position with ten years of experience and then a youngster who just passed out, come and question your decisions. Often you may not have an evidence based explanation for what you do, but based on a 'gut' feeling. Most of the time the youngster believes what he learned in books, but each patient is different and each one needs treatment or surgery, tailored to his or her need which an experienced practitioner can understand.