Tuesday, September 13, 2011

Tiny Holes and Testicles

So I knew, going in, that medicine wasn't glamorous. But sure, I love it anyway.

M.C has been giving me any opportunities he can to unleash me on patients and attempt my (now feeble after two years of atrophy) suturing skills. I learned a new tie last week and had a chance to suture up some trocar incisions. The piercing gazes of the O.R staff can be enough to make any steady hand tremble and I was kicking myself for not being smoother when he handed the needle driver over to me. It was only a few tiny knots in a couple minute incisions but I could feel the sweat starting to trickle while I worked it out.

Then yesterday he let me attempt hand-tying for the first time. Of course the anesthetist had to come out from behind the drapes to watch the show and the scrub nurse faintly jerked her head every time I made a mistake, but M.C let me persevere until I got it right. I just hoped that my damp scrub top at the end was from my nervousness and not from the hydrocoele fluid that I'd been sprayed with earlier in the procedure. I figured out quite quickly that practicing tying knots with a shoe string around a toilet paper roll is no substitute for scrotum and sutures. Go figure.

And speaking of testicles...I thought I saw plenty of man-bits when I was nursing...but oh no. Of course seeing testicles isn't anything new, but having to figure out what is wrong when someone comes in with a swollen one is something completely different. I find myself sometimes getting caught up in trying to visualize the structures under the skin while I am palpating the problem. I think the last thing you want as a male patient is a woman staring off into space, blank expression, ball in hand. Rolling.

So I am going to try and become a little faster and more methodical with that exam. Like everything else.

Only 2 weeks of surgery left, and then I am off to ponder sodium levels and sliding scales for the next 9 weeks start my general medicine rotation.

Theater tomorrow!


OMDG said...

See if you can snag some leftover suture from one of the cases you're on. thinner suture is more difficult. Maybe the scrub nurse will help you out on this. And then practice tying knots (one and two handed) wearing baggy ass craptastic latex gloves. It will make a huge difference, and you'll be tying like a pro in no time.

Albinoblackbear said...

I like the idea of the baggy gloves!!!

I have been hording the unused but opened sutures from the O.R...just trying to find a good material to practice on.

Solitary Diner (Also Known as The Frugalish Physician) said...

Some of my surgically minded friends practice on fruit (bananas, oranges). Not sure that the consistency is all that similar to real tissue, but maybe the awkward angles are similar?

You seem thrilled to be starting medicine! Don't forget the sleep deprivation...that's another key aspect of it.

OMDG said...

They had us use pigs feet on our EM rotation. You just cut an incision and sew it back up. Maybe you can get some at the supermarket? And then use them in a yummy pigs feet-suture soup?

Also, why no love for internal med? For me it was interesting to see all these diseases that you read about happen in real life -- just like the book says! And there are all these glorious lists and checkboxes, not to mention the differential....

Anonymous said...

Exactly as OMDG said - practice practice practice. I used dental floss (I couldn't grift any sutures from the OR) and practiced on a desk handle. And yes, gloves will help you get the technique right. Also, just learn the one hand tie - as my staff said, the one hand tie is a better knot and knowing the two hand adds nothing.

And with respect to internal medicine, I found that though it was interesting to see some of the esoteric diseases, for every one of those you came across you would see five "failure to cope" or "weakness".

Grumpy, M.D. said...

That's the problem of Tobie being in North America. No one to practice testicular palpation on.