Any surgeons out there?

Factual Questions
21

OK, I can’t fathom the logic behind that… you can’t practice surgery on cadavers or live animals… so your first time is on a live human being? Um… OK…

My goodness, here in the US there are weekend seminars for surgeons that use cadaver parts. Different strokes and all that, I suppose…

Aw, c’mon! What’s scary about that? It doesn’t hurt you a bit to put those in!

(No, really, having been a patient in the past I appreciate medical personnel who go to some effort to avoid causing me unnecessary pain. Keep up the good work and all)

Some of us do a similar thing for fun. We call it “sewing” or “needlework”. But you’re right, it’s not thrilling. At least I don’t have to worry about my projects twitching or complaining later. :slight_smile:

22

Hmmm. Okay, the ‘bizarre circumstances’. Okay; so I don’t violate the spirit of HIPAA, I’ll change some details in the Strange Case of Ms. P_____.

Ms. P_____, an aromatherapist entering early middle age, was clearly embarrassed at her surgery clinic appointment. Stylishly dressed and coiffed, elaborately made up, and fully tanned in February, she clearly invested a great deal of effort in her appearance. She told me that she was engaged to be married, and that she was concerned with the, uhm, aesthetic condition of certain parts of her body. Her fiance had not yet had occasion to see the parts in question, and she was adamant that we do something, as her ‘deformity (was) too horrible to contemplate’ (bonus points if you get that reference). Despite our assurances that she did not, in fact, have a deformity, and that all her parts were functional and within the range of normal, she insisted that something be done. Our attending surgeon was apparently in an odd mood that day, because he normally would have turned this sort of request down flat, but instead he said something to the effect of ‘yeah, I think we can do that. In fact, we can do it here in the office under local right now. Dr brossa, have you ever done one of these? I’ll walk you through it.’

At any rate, I’m soon performing an intimate cosmetic surgical procedure under local anesthetic, through a 4" hole in a sterile paper drape, sweating like craaaazy, entering a dissociative state as Ms P_____ chats with her boss on her cell phone, trying to reschedule her 4:00 client because her doctor’s appointment is running long. At the end, we bandage things up and set up a followup appointment for one week.

So, can you identify the question that we neglected to ask, that haunts me still?

That’s right, we didn’t ask when the wedding was going to be! Seven days later, she returns to clinic, nearly frantic, and shows us the surgical site, which was puffy and all the colors of the rainbow from fading bruises, as we would expect it to be at this point. Then she drops the bomb that her wedding is in THREE DAYS, and how can she ever…what will her husband think… oh God…
Man, it still makes me shudder. At least we used absorbable sutures, so no big knots were showing.

23

brossa :eek: Oh My! Vanity is a hard master. Thanks for sharing. “I’ll walk you through it” :dubious: Just another way of saying “See it, do it, teach it.”

irishgirl, Did you catch my earlier post about med students and IV catheters? :smiley: Of course, I didn’t mean you!

May I paraphrase the definitions of various specialties? OK, I will.
The Internist knows everything, but does nothing.
The Surgeon knows nothing but does everything.
The Pathologist knows everything and does everything, but a day too late.
Have a wonderful day every one! :cool:

M

24

Yep, we just practice on people.

You’ll have seen it done a few times first and there is senior help basically standing beside you and telling you what to do, but you just go ahead and do it.
If a surgeon hasn’t seen a new procedure done, they’ll go and watch someone else do one, assist at a couple and then do it themselves.
We have different laws relating to the use of cadavers and stricter laws about animals for research purposes. It doesn’t seem to make a difference though, surgeons in the UK and Europe have comparable audit data on safety, effectiveness and complication rates.

Joke:
What’s the definition of a double-blind trial?
Two orthopaedic surgeons trying to read an ECG.
Broomstick, I actually like needlework as a hobby ( I’m currently in the middle of embroidering a wedding sampler) but doing a line of stitches over and over and over again, making sure each one is the perfect tension and size, and then having to take them out and start again, just when you’ve got it right, is not my idea of fun!

25

hijack:

A surgeon can be wrong, but not uncertain.
If you can’t cut it out, you’re just waiting for it to get better.
Where there is pus, let there be steel.
Don’t let the abdominal wall stand between you and a diagnosis.

/hijack

26

Wow, fascinating stuff! Thanks so much for the replies. I think my main concern would be causing excessive pain or injury (“whoops! Sorry about that lung!”) , not being grossed out. I’ve seen and handled body parts from an anatomy lab and I work in my capacity as an illustrator and art director for a major hospital, so I’m familiar with lots of “gross” things and they generally don’t bother me.

27

Ah, the question that you neglect to ask!

I’ll never forget the guy who came into the ER with a massive hemorrhoid, desparate that something be done. He said he was in good health, no medications, lots of pain. Had a massive external thrombosed pile. Cut it open and brought instant relief. Gave him the usual advice that we don’t normally stitch these, come back if sudden increase in bleeding, yada, yada.

He came back two hours later. “It’s still bleeding. I might not have mentioned that I have a condition called ITP.” I stitched it up. His platelet count was 4 (normal is above 150). Oops! :smack:

28

Damn, I hate when they do that. PITA!

Once I had a guy complaining of a painful boil on his abdomen. It was getting ready to come to a head. Said he’d had 'em before, and just wanted it taken care of! I ask for significant medical condition, he says nope, zip, none, nada!

I get the area prepped in our little treatment area, close in on it with surgical steel, and casually ask “No history of bowel diseases, right?”. He replies “oh, I’ve got Crohn’s disease”.

Screech to a stop! That was not a boil localized above the abdominal wall, that was a fistula leading directly to his bowel. I had come within seconds of opening his bowel in our ambulatory clinic!

Gaah!

29

Pffttt! You think you fancy doctors have it hard! What about us unemployed shlubs that do nothing but read the SDMB all day and have to choose what threads to respond to? I have chosen poorly. = ))

30

Much like the salient fact the patient forgot to tell you. We had a guy come in to the ER because he’d dry swallowed an asprin and it was still stuck. He pointed to his chest, about mid sternum.
“Say ahh” Nothing, no redness, no swelling, but the man is in obvious pain, and is having some respiratory issues.* And* he’s sitting ramrod straight, any movement makes he cry out .
After waaay too long we got an x-ray. He had a table knife in his mediastinum “Oh yeah, I tried to get the asprin out with that, but it didn’t work.”
OMG. Some people are too stupid to be wasting my air.

31

Well, I’m not surprised, but what about the depiction is inaccurate?

32

It was so much easier to operate on a live human being than to dissect a cadaver as we did for a year in med school.

In surgery on a living person the tissues are soft and not rigid and hard as in a cadaver. My first procedure I believe was an appendectomy. I wasn’t afraid of cutting too deep because when a surgeon starts out, he/she generally has a more senior resident or a staff member on the other side of the pt. to guide the novice surgeon through.

And we did read in detail the anatomy involved and the operative procedures. Like anything else, the surgeons’s abilities get better as he does more and more procedures.

33

Thanks to the OP and all the contributors to this thread. I’m facsinated! If you please, medical Dopers, more stories of patients who have done incredibly stupid things to their bodies! More gore! More hilarity!

When I was entering college, I had my heart set on becoming a mortician. See, I was drawn to all things medical, but I had a fear of hurting or damaging (!) a patient in any capacity… so I figured I’d just work on dead folk. Thank og I ended up working at a reference lab before I seriously ventured into those waters. I’ve dealt with enough bodily fluids (and solids) to last a lifetime.

My hat is off to all our nurses, docs and vets who encounter belly-churning stuff on a daily (or even occasional) basis.

34

Umm, re-attaching fingers is minor surgery? I can see rejoining the bone needing only the surgical equivalent of duct tape or staples. To reconnect the major blood vessels would just be stitches and surperglue. But, repairing all the muscles, ligaments, and especially the nerves is minor surgery?

35

WAGing, but I would think reconnecting the blood supply is the thing to do first, which as you mentioned isn’t that difficult, relatively speaking. Once the finger is in no danger of dying, the other stuff can be repaired as needed.

36

If you are not a surgeon, what job do you have that requires cutting into people, although not removing anything??

37

Doing surgery on hands can be very difficult and precise – if a lot of blood vessels and nerves were involved, or a substantial piece of the thumb, I’d be on the horn with a plastic surgeon or hand clinic. But most amputations one sees in practice are “the end of the finger with some sort of saw that had the guard off”. Some of these are partial amputations with some blood supply intact, some are complete amputations. These last cases often boil down to: reattach the finger as best you can and see what happens. I’ve saved quite a few.

38

There was the patient who tried to commit suicide by baking 50 year old lead-based rat poision into a custard tart and eating it. Her abdominal x-ray looked like a typical barium film and it took many, many litres of clean prep to shift the stuff.

There was the guy with the rectal foreign body who left it there for 3 days before deciding to come into hospital.

There was the guy who was blue-lighted into the Emergency department for an attempted suicide when it turned out that “I ate the rest of the bottle” meant that he had 2 of the tablets in question.

There are the patients who smoke while wearing oxygen, and the guy who nebulised brandy.

There is the reason why the Genito-urinary Infectious Diseases unit (the GUIDE unit, or HIVE, as it’s affectionately know to its staff- for HIV etc) in one of the major Dublin hospitals has such high security. A patient was stabbed to death in his bed by his drug dealer (most of our HIV patients are IVDUs).

Oh, and a couple of weeks ago the surgical firm I was attached to performed an emergency rosary-ectomy…yep, some guy swallowed a rosary (another interesting x-ray)!