The glamor of surgery (Part 1 of an occasional series)

Nonmedical people always seem to have a conception of surgery as being a particularly glamorous profession. So did I to some extent before I entered medical school, although my surgical rotations quickly disabused me of that impression. Somehow, working from 5 AM to 11 PM every day and several hours each day on the weekends, combined with the grunt work that had to be done, just didn't seem as all those medical shows. All one has to do is to spend a night in the emergency room draining perirectal abscesses to know how unglamorous surgery can be. Not that it mattered. Something about surgery hooked me, and even all of the abuse that I endured failed to deter me. I have to wonder how it is now, given the 80 hour work week. That takes away one of the biggest downsides of a surgical residency, the five years of every other or every third night call that I endured, aside from the occasional respite rotating at the VA Hospital, where call was only every fourth night and usually fairly benign.

The "glamor" of surgery was driven home to me in a rather spectacular way one night back when I was a second year resident on the trauma service. It had been a particularly busy weekend night (Friday or Saturday, I don't remember). It was the dark hours between 3 and 6 AM, when things usually shut down (or at least quiet down enough to allow those of us on call to lie down for an hour or two), and we had tucked in the last trauma victim. It's the lowest ebb of the night and a resident's energy. The trauma team and I collapsed in our respective beds in the cramped trauma call room. Blissful sleep seemed moments away.

That is, until the screech of four pagers going off simultaneously ripped through the silence.

We all moaned, and, ever so reluctantly, threw off our covers and trudged down the hall to the trauma bay, looking not unlike the characters in Shaun of the Dead pretending to be zombies, except that we weren't really pretending.

The scene that greeted us was the usual controlled chaos of a multiple trauma, with nurses and ER docs running around doing physicals, drawing blood and inserting IVs, and barking orders. What also greeted me was the horrific smell of body odor mixed with alcohol, through which cut the drunken screeches of two middle-aged men yelling at each other, at the paramedics, and at the doctors and nurses trying to evaluate them.

Yes, the victims were the usual trauma victim variety, but even worse than usual. It was two winos, and the story was actually rather amusing--or would have been if it hadn't been around 4 AM. Apparently, the two of them had been fighting over a bottle of booze on a railroad overpass when, in a mutual death grip on each other and their favored poison, they had both fallen to the gully below, approximately 20 feet, according to the paramedics. Our chief resident ordered the junior residents to split up, each taking one patient. I took the louder and smellier of the two, trying to protect my interns from what would almost certainly be a more annoying patient to take care of.

There he was, strapped securely to the backboard, neck immobilizer in place. The radiology techs had just finished taking the chest and pelvis X-rays and it was time for the C-spine films, which meant it was time for me to suit up and pull. I explained to the patient what I was going to do (pull on his arms to pull his shoulders down and out of the way, so that--hopefully--we could visualize the C7 vertebrae and the top of T1). He actually cooperated, but leaning over this guy only reinforced the obvious: This guy clearly hadn't bathed or showered in many days, if not weeks.

It was now time for the fun part.

Time for the Foley catheter.

I once again tried to explain to the patient what I was going to do, namely put a catheter through his urethra and into his bladder.

"You ain't puttin' no tube in my dick!" he yelled.

I tried to reassure him over and over that it was necessary. No go. He just kept yelling, "You ain't puttin' no tube in my dick!" It's at this point that the experienced resident knows that a doc's gotta do what a doc's gotta do.

Just do it.

So I began. I gloved up, got the head cleaned off with iodine, tested the balloon, and lubed up the catheter. Time to get started. I grabbed the object of the procedure and began.

And got blasted in the face with what had to be the most impressive urine stream I had ever seen in my life.

Maybe he didn't need the tube in his dick after all.

"Ack!" I yelled, jumping back more athletically than I would have thought my skinny body, pasty white like a mole from months without significant exposure to the sun, could move, particularly given the lethargy I had been laboring under until this point. Fortunately, I was wearing protective eyeware and a mask, but, sadly, those masks are designed to protect from blood spatters. They aren't water-tight for a high-velocity, high volume splash right in the face. Gagging, I ripped off the mask before more of the foul liquid soaked through, but too late to prevent the taste of urine from reaching my mouth.

"Go wash your face," my chief resident told me.

No shit, Sherlock, I thought. He didn't have to tell me twice. Fortunately, neither patient was unstable, and their injuries appeared relatively minor; so the team could function without me for a while. I headed for the nearest bathroom and scrubbed my face raw. Even after I was done, I couldn't shake the feeling that I was unclean. Unfortunately, there was no time to go back to the call room to brush my teeth.

I headed back to the trauma bay, cursing myself for not being more careful. I had had some near misses before. It had to be the exhaustion that led me to an intern mistake like that.

I headed back to the trauma bay to finish what I had started. Fortunately, another member of the team had taken care of it for me. Later, he confided in me that he hadn't been particularly gentle about it, although he had taken care to make sure he was nowhere near the line of fire as he put the Foley in.

"Ha, got you good!" A drunken laugh greeted me, as I took over the patient's management again.

Why was it again that I wanted to be a surgeon? I asked myself.

I couldn't provide myself with an answer.

And I never did find out who got the bottle of booze.

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No offence, Orac, but didn't your senior residents ever tell you NOT to point the bloody thing anywhere near yourself?

(Says this senior pathology resident, trying vainly to remember how he actually did do it when he was treating the living... I'm pretty sure I stood back and inclined the shaft towards the patient's own head...)

I have heard of a sleazy man who got an erection out of his member being manhandled by a (not particularly pretty) female resident one night. Her senior resident, who actively despised her, actually felt sorry for her on that occasion. And I sometimes wonder what my old boy would do if some pretty surgical resident handled it. I shudder to think, and pray that I would be in so much distress that getting an erection is the last thing on my mind.

But pissing in the resident's face... that's justification for an assault and battery charge, and if someone did that to one of my juniors, he would be speaking to the police as soon as he was fit to do so, patient or not.

By Justin Moretti (not verified) on 27 Feb 2006 #permalink


Thanks for sharing, and for teaching me a valuable lesson about putting in catheters.

*shudder again*

Justin Moretti says:

And I sometimes wonder what my old boy would do if some pretty surgical resident handled it. I shudder to think, and pray that I would be in so much distress that getting an erection is the last thing on my mind.

Having been in this position once I can say from experience there was nothing remotely sexual about it. It was all very clinical and mercifully quick. Not at all like the movies...the kind I never watch. Someone else may have had a different experience though.

Well, glad I chose engineering rather than med, despite the sneaking suspicion that an MD degree is a better chick-magnet.

But given your speciality, wouldn't the dealing with the tragedy around you be worse than the occasional piss-stream?

By Urinated State… (not verified) on 27 Feb 2006 #permalink

Fortunately as a massage therapist, I rarely have to deal with bum-pee (an odd looking hyphenated word, if I've ever seen one). B.O. is a constant, but only in my past life as a group-home worker with mentally handicapped folks did I have to endure the seemingly endless variety of bodily fluids that drip, drain, flow, and spray from orfices most foul.

Power to you, brother.

Heck, I learned the 'assume it's loaded!' principle in an EMT class, watching an ER doctor examine an infant (male).

I do have to second Kevin's comment - I know that by the end of a 16-hour day, I'm usually dangerous. And that 16-hour day is certainly less stressful and hectic than a surgeon's day.

Following up - thanks for posting a not-quite-glamorous-enough-for-TV surgical experience for us. Hopefully, you'll post more.

What are the reasons for these grueling shifts that residents and other doctors endure? I would never want a life-and-death decision made about me or my family, or any else, by someone addled by hours of work and lack of sleep. I sure as hell wouldn't want to make that kind of decision while exhausted or impaired. Is there a logic to this that people like me are missing?

By J.L. Grimmer (not verified) on 27 Feb 2006 #permalink

"What are the reasons for these grueling shifts that residents and other doctors endure?"

Don't know if this is the true reason, but a doctor explained it to me that we need more hours of junior doctor labor than for senior doctors. If junior doctors didn't work insane hours, you'd either have doctors looking at 40 years of a career of being a target of homeless guy piss-streams or an up-and-out career structure (which would be costly to society, given the cost of training the doctors).

By Urinated State… (not verified) on 28 Feb 2006 #permalink

"Heck, I learned the 'assume it's loaded!' principle in an EMT class, watching an ER doctor examine an infant (male)."

Heck, you learn that the first time you change a diaper on a boy baby.

By Urinated State… (not verified) on 28 Feb 2006 #permalink

Here comes the first-year nursing student to advise the M.D. that disposible plastic face shields are available at most hospitals.

And now, thanks to reading this, you can be sure I'll find me one for my first catheterization.