Journey through the OR

Despite being bundled up in scrubs, a surgical gown, gloves and a pair of odd, shoe-covering slippers, I still felt cold. ORs are always kept cool to limit the spread of bacteria, and the sterile cold that surrounded me didn’t seem much warmer than the Wisconsin winter outside the hospital walls. I had decided to spend my Spring break shadowing physicians and surgeons and was about to see my first surgery: a left mastectomy. The patient lay on the table anesthetized and draped in a sterile blue blanket, with just her left breast exposed. The surgeon drew a black circle along the target site and then, with me looking over his shoulder, took up his scalpel and Bovie pen to make the first incision.

A small amount of blood oozed out of the incision. To limit bleeding, the surgeon constantly singed closed the blood vessels that feed tissue with his Bovie pen and the result was the unpleasant smell of burning flesh. The only way for me to avoid the smell was to breathe through my mouth rather than nose, which caused my glasses and face-shield to fog up throughout the operation. Through the fog I saw the surgeon slowly and meticulously work his way around the black circle, exposing cream-colored, lace-like strands of fat, and red and clear strings of muscle, which make up the pecs. After an hour of work the breast came off, exposing a beautiful matrix of muscle, arranged like the strings of a piano—the surgeon would touch the strings with his Bovie pen, and they would twitch and dance in response to the small electric shock.

I stood by the surgeon’s side as he traded his scalpel and pen for the tools required to stitch up the patient’s chest. He chatted with the nurses and me as he methodically closed up the gap, and before long the patient was being taken off anesthesia and wheeled to the recovery room, where we would visit her later in the day. We shed our gloves and gowns and prepared for lunch, but were interrupted with news that another patient would need an emergency appendectomy. Scarcely half an hour later, we began a now familiar ritual. Hands washed, scrubs on, cloaked in gowns and face-shields, we entered another cold, sterile OR, where the patient was already under, draped in blue with her abdomen exposed.

This operation was nothing like the first. Instead of making an incision, the surgeon poked a hole through the patient’s navel and then fed a long tube with a camera on the end—what’s known as a laparoscope—through it. This made it possible for us to see inside the patient’s gut: As the nurse swung the camera from one side to the other we identified the small intestine, pancreas, stomach, liver, gallbladder and finally, appendix. The surgeon then poked two more holes on either side of the abdomen and fed long, claw-like tools through them to work at dislodging the appendix from stomach muscle and fat. After about 45 minutes of constant hacking and cutting, the laparoscope was removed and the surgeon pulled the dislodged appendix out from the navel in a plastic bag. At the time, I thought this was just about the neatest thing I had ever seen!

Afterwards, the surgeon and I went to the clinic to check up on patients he had operated on in the weeks before. A day that began at 5:30 a.m. did not end until about 7:30 p.m. Despite having eaten only an apple and some breakfast bars for the day, I was feeling remarkably energetic and upbeat. I asked the surgeon if this was always the case. He said, “No, there are a lot of days when you feel burnout. That’s why you have to remember that life is about the journey and not the destination. You have to remember to enjoy the journey, and not devote all of your time and energy to, in your case, clearing the various hoops you will have to jump through before becoming a full-blown doctor. And remember, it’s not all smooth sailing when you’re done!”

That was a year ago, and those are words that I will carry with me throughout my medical journey. They apply to other pursuits as well. But the road to becoming a physician is a particularly long and arduous one: pre-med courses, the MCAT, gap and glide years, medical school, boards, residency, boards, fellowship and more boards! It’s easy to get caught up in the hoops and miss the bigger picture, especially when you’re considering specialties as competitive and adrenaline-rich as surgery. Every person will have to strike his or her own balance, but it’s good to go in with a healthy attitude from the start—an attitude that views medicine as a journey to be enjoyed, rather than just experienced. With such an attitude, a gap year is seen as an investment in and bridge to your future practice. And residency, fellowship and boards are stops on the way of a lifelong journey in medicine.

Paul Horak, Trinity ’13, is a Duke pre-med. This column is the eighth installment in a semester-long series of weekly columns written on the pre-med experience at Duke, as well as the diverse ways students can pursue and engage with the field of medicine.