I have a few questions, inspired by my morbid curiosity:
What was it like, the first time that you made an incision? Were you freaked out? Scared that you would cut too deep or anything?
Did you practice a number of procedures on cadavers before you ever did surgery on a live patient?
On a less morbid note, did you study at all the history of surgical procedures?
I am not a surgeon, but I dont think there are too many on this board. And I have done surgery on people, as long as we’re calling surgery any kind of cutting into a person, and not necessarily removal of organs and such.
I wasn’t scared that I would cause harm or cut the wrong thing or too deep or something. I was just nervous that I would do it correctly and fast enough. I had pleanty of practice on a small number of procedures. No practice on cadavers though.
I think they build up to it so it isn’t so bad. I did hundreds of animal surgeries when I was in grad school. I found it fascinating at first and then very routine and a little boring. It was just another exacting procedure. Woodworking or car repair would have been similar.
I also took several medical school classes including neuroanatomy. We were exposed to a lot of stuff and yet me and all the medical students in the class looked at it like any demanding task that didn’t happen to involve dead people and their brains. It wasn’t difficult to do at all. Within a couple of exposures, you are desensitized to it (assuming you are the type that would go to those schools).
I work emergency in a small town. So I do lots of minor surgery since people need care and it’s a long hike to the closest orthopedic or plastic surgeon (for example).
I do stuff like put in chest tubes, cut away skin cancer, knock people out and reduce/cast fractures and dislocations, cut hemmorhoids, deliver babies and sew up afterwards, re-attach amputated fingers, drain knees and rectal abcesses (yecch!), stitch cuts – even deep ones which cut a medium blood vessel or leave the lip hanging off the face. I help out in harder surgeries too. I’m not about to touch your heart or brain; I would hesitate to do an appendix or C-section given any other alternative.
Most med students practice and learn anatomy on cadavers. Most clerks get to sew up chicken legs and spare ribs before working on people. As a clerk or intern, you watch a lot of surgery being done and get to do more in a graduated fashion under strict supervision.
Some students pass out the first time they see surgery. They get over the nausea factor quickly if they learn anatomy on cadavers (“We have an exam, anyone see the bucket of forearms?” I friend of mine fell into the container with cut heads and does not remember the incident fondly.)
Doing minor surgery is not particularly gross, nowhere near as much as the stuff you’ve seen by the time you get to this point. So no, this does not seem gross to most medical folk (a few find it gross and they stay away from certain specialties).
Most students must learn some history of medicine. Surgeons are especially keen on this since it is a good substitute for learning about other forms of culture. 
What Dr_Paprika said reflects my experience and level of surgical practice too, for the most part (tho I gave up the baby delivering and surgical assisting and digit reattachment). We practiced on live pigs back in med school before slashing away on human patients. I don’t really recall being grossed out by anything since the first year of medical school.
I remember my first blood draw far better than my first surgery.
I guess I spend a lot of time taking things out of peoples’s eyes, skin and finger/toenails, too.
I remember my first slit lamp (eye) exam. I was a clerk who begged the resident to let me see a patient by myself after following him around all week. He finally agreed. My first patient was a 350 pound trucker who had a chunk of metal in his eye. I told him I needed to use the slit lamp to take a look at it. He told me that this was a bad idea since he had sensitive eyes. I told him to sit down since I would have to see it to take it out. Instead, he promptly passed out, hitting the floor with a gigantic thud. My resident ran in the room, horrified. “What the hell did you do to this guy?”
I was a medic in the Air Force before going to nursing school. I did minor stuff too, caught a baby or two. (side note to my physician friends here: Doctors don’t deliver babies, Mothers deliver babies. Doctors just make sure they don’t fall on the floor 
) I was never freaked. But I was young, dumb and had no idea what damage I could conceivably do.
Even in nursing school, I was a “cowboy.” I watched every surgery I could beg my way into. It never occured to me that I might be put off by any of it.
Then, after entering the real world, I had to assist with a simple cutdown. That’s a procedure where the doctor exposes a vein to put in a long term IV. I had to hold the patient’s arm still. I was half lying on the bed, my face just inches from the surgical area I was wearing a mask and was partially covered by the surgical drape. When the doc stuck a pair of Kelly clamps deep into the incision, and spread them open, tearing the flesh to expose the blood vessel, I nearly fainted. It was the sound. I was stuck, and I had a responsibility, so I couldn’t opt out. I got over it, but I can still hear it. Seeing it was never a problem… But that sound…
You get used to all of it. If you don’t, you get out.
Oh, and QtM, I taught countless studs to draw blood and start IVs.
What do you call a med student holding a Jelco? ** An IV catheter with a prick at both ends.**
Veterinary POV here. A large portion of my practice is surgical. Spays, neuters, tumors, GI foreign bodies, orthopedics, eyes, even an occasional cardiac case.
My first experience was as an undergrad; I worked in a neurophysiology lab on Hermissenda crassicornis, a marine nudibranch. My job involved dissecting out the central nervous system (alive!), then recording from the photoreceptor cells.
In veterinary school, beagles are purchased from a licensed dealer. Each dog has several survival surgeries, then eventually a non-survival surgery. My first dog spay took the better part of a day. The same surgery today takes me under 20 minutes.
Feel sorry for the dogs though. Howcome they don’t get them from the pound? I would think it would be more ethical to get dogs on death row as practice tools for vets than to breed them.
One of the reasons is consistancy in the animal. If you’re trying to learn how to, say, spay a dog, you don’t want it to have unexpected tumors, or find out after cutting it open that it was already spayed.
And although not a doctor or vet or even an urse, I did perform surgery on a pig in college for an advacned physiology class. We were learning about the heart, so we did things like inject epinephrine and acetylcholine, stopped the heart and then did internal compressiosn to get it back up agaion, etc…, Needles to say, poor little Porky didn’t live. But then again, how good al ife could he have had with his heart being subjected to that much trama, as well as having his vagus nerve severed?
All in all it was fun and a good learning experience, and I even ate prok chops for dinner that night (and no, not from ther pig I killed.)
PETA and their ilk. When I was in school, there was interest in using dogs from a shelter that were going to be euthanized anyway, however animal rights groups protested. heh.
You Army used to use dogs. And, I believe, the dogs were obtained from the pound. However, because of issues already mentioned like quality and PETA, the Army had problems with quantity.
Now they have contracts with sheep breeders and they only purchase - I shit you not - “medically approved” sheep. I have no idea what would make these sheep more worthy of becoming practice patients than any others, but I think it’s just a way to make them cost more.
The government likes to overspend. And if you can call something “certified”, “official” or “approved”, the Army will buy it for twice as much :rolleyes:
Wow… it’s late. 3am on Saturday morning for me… can I try that first sentence again?
It should be:
The Army used to use dogs. I believe they were even obtained from the pound. However, they had problems with both quality and quantity. The pounds could not ensure a consistant supply of the amount needed.
Though PETA has held protests in the past, the treatment of the animals is supervised by an Army Vet and 3rd Party observers/inspectors.
Sure, the mother delivers the baby.
But if something went wrong, and this hasn’t happened to me yet, who is the first person you would blame? The mother?
Try William A. Nolen’s book The Making of a Surgeon. IIRC, it’s set in the mid-1960s, so techniques are probably (!) outdated, but I’ll bet that his accounts of first-time this and that still apply. His description of his very first appendectomy is, um, interesting. Let’s just say that he didn’t do very well. (Luckily, the patient survived his bumbling.)
Surgeon here.
The first invasive things I did in residency were central line placements, in which a large, long IV is placed in a large vein, either in the neck or under the collarbone. While this did not involve any major skin incisions, it did involve the blind jabbing of a long (~4 inch) needle through muscle while trying to avoid lung and arteries by feel; and the patients were often conscious. The fear here was mostly of causing pain. From there I moved ‘up’ to lancing abscesses in the ER and OR. From there, I moved on to middle-of-the-night appendectomies and hernia cases, thence to opening/closing the chest/abdomen for major cases, and then to various operations on the abdominal contents themselves. The order in which you are introduced to things varies depending on your rotation schedule as a resident. I’m sure that I don’t need to emphasize that the operative experience of surgery residents as seen on ‘ER’ or ‘Scrubs’ is wildly inaccurate.
One thing that really struck me when I started making big incisions is that there is a learned skill to making a clean cut that is perpendicular to the skin, rather than skyving through it at an angle. The former is easy to sew up nicely, while the latter can be very difficult to close. You also have to learn the rules for holding the scalpel properly (different blades require different grips) as well as for the other instruments.
I practiced suturing and tying knots in my free moments, usually on the leg of my scrubs. Our residency program started out with some primitive laparoscopic instrument trainers involving boxes with periscope-type mirrors and quickly progressed to computerized force-feedback trainers programmed for many routine operations.
As far as the history of surgery goes, we were taught multiple ways of doing the same procedure, some of which were ‘traditional’ or ‘historical’. For example, 90+ percent of modern groin hernia repairs are done by inserting a plastic mesh into the abdominal wall defect to close it up. Before the mesh repair, there were many, many different ways to close these defects, each named after the surgeon who developed them (e.g. Shouldice repair, McVay, Ferguson, Halstead, etc). It is worth knowing these ‘obsolete’ techniques because you never know when a situation might crop up in which the ‘modern’ approach may not be possible for some reason. While it might not be of much value for an internist to know how a Civil-War era physician ground up his calomel to make a blue draught, it is still worthwhile for a surgeon to know how he amputated a leg in under two minutes.
While I don’t remember the first time I put a knife to living human flesh, I do remember the first ‘real’ operation that I did as an intern, but mostly because of the bizarre circumstances surrounding it.
brossa, first of all, Welcome! Okay, I know you’ve been a member for a while, but you don’t post much.
Obviously, you aren’t aware of the rule that says when you post something like
You don’t stop there! We love bizarre! Remember, we’re fighting ignorance here. We may need this information. Anyway, its good to have another medically educated voice here.
I’m a medical student.
Due to laws in this country, you can’t practice surgery on cadavers, or live animals, and most don’t practice surgery on dead animals either. Here, they don’t let you actually cut anyone until you’re at least an SHO, which is 2 or 3 years after graduation. but you can do simple things (lines, drains, sutures, assisting in theatre) well before that.
I’ve assisted in theatre a lot (holding clamps, retractors, etc.) and none of that is particularly scary, just very tiring, as you have to keep everything in exactly the same place for hours on end.
I’ve assisted at hernia repairs, hysterectomies, large bowel resections etc. At time that means that I have been elbow deep in someone’s adbomen, but it’s not weird.
Putting in cannulas and taking blood is scarier…you only get 2 goes, and the person is conscious!
Suturing is pretty difficult to do well, but our medical school makes you sign off on several kinds of suture in your 4th year. That means you have to have a line of at least 8 perfect stitches in the fake skin to be passed, so you practice pretty hard until you get it. They test simple interrupted, simple continuous, vertical mattress, horizontal mattress and sub-cuticular stitches. One of my least favourite exams, because you have to spend hours and hours doing the same thing over and over until you get it right, and it’s not exactly thrilling.
Once you have those signed off you can go and stitch people up in the Emergency department, the interns are usually really grateful to have a med student about to do the suturing on simple cases because it means they have less work to do!
My first suturing patient was a guy who had fallen through a plate glass window and sliced a flap off his upper arm… I got to close it with the last 3 sutures. Since then I’ve done a lot of scalp lacerations and a few foot lacerations, nothing where the scar is going to be too visible.
Trust me, after 18 months spent dissecting a cadaver preseved in formaldehyde (we can dissect them, we can’t experiment on them), cutting up live people can only be an improvement.
Very interesting stuff, thanks to all who contributed. Like picunurse I’m also curious about the “bizarre circumstances”.