Anesthesiology.

I survived my first day on the OR! I'm very relieved, as I was extremely nervous last night as I packed my tote bag with my sneakers and other OR necessities.

The doc I was supposed to shadow wasn't in, so they stuck me with Dr. L, the same guy I worked with in the pain clinic a few weeks ago. That was fine by me.

There's a reason why anesthesiology is such a hot field these days: the anesthesiologists don't do anything. The nurse anesthetists are the ones who remain in the room with the patient throughout the procedure; the anesthesiologist comes in at the beginning to supervise the intubation, and may stop by once or twice if it's a long case, but otherwise he or she spends most of the surgery time outside the OR.

Anyway, the first three cases were laproscopic procedures, which was nice because I could see everything clearly on the video screens. The first procedure was a middle-aged guy who had a pleural effusion and possibly cancerous lesions growing inside his chest wall and on his diaphragm. The surgeon and the resident cut two ports in the man's left side and drained the effusion, then biopsied the lesions. Fluid and tissue samples were sent to the lab for analysis. They then used a rasp to irritate the man's chest cavity, and then sprayed talcum powder in the cavity to prevent the fluid from returning. The entire procedure took only 20 minutes; putting the guy to sleep and waking him up probably took longer than the surgery itself.

The second case was similar, except it was a young woman (34, if I recall) who had a massive, noxious yellow-green pleural effusion (3 liters!) and a volleyball-sized mass sitting on her lungs and creeping toward her aorta. The docs took biopsy samples of the mass and we ran those down to the path lab while the patient was left open on the table. Path said that the mass was probably Hodgkin's lymphoma, which was actually a good diagnosis considering the placement and size of the mass - at least HL has a better prognosis than some of the more nasty lung or renal cell cancers.

The third case was a little old lady (84) who had complained of shortness of breath. Her internsists and pulmonologists hadn't been able to pinpoint a cause, so the surgery was more exploratory than anything else. The surgeons drained a small pleural effusion but didn't find any masses in the cavity. They did notice that the pericardium was slightly bluish and suspected that there might be fluid in there as well, so they cut a small incision and a gush of fluid poured out. They didn't change the collection chamber before suctioning the pericardial fluid out, but I estimated it must've been at least half a liter. No wonder the poor woman was short of breath!

The fourth case had actually been going on for a few hours before I arrived, but it was also quite interesting. I walked in at the point where the patient (male, upper middle-aged) was lying on his back with his entire abdominal cavity open. The surgeons apparently had spent the past three hours removing various lesions and connective tissue from the small intestine and colon so they could differentiate the tissues for the main procedure. After clearing the field, they removed most of his rectum and a large part of his descending colon, then stitched the loose ends of his colon together and cut an ileostomy site on his right side. By this point they had been in surgery for over five hours and everyone in the room was feeling a bit loopy. Finally, after going over the entire bowel again and cutting out any remaining lesions, they sewed the ileostomy site and the main incision down the middle of his belly. They didn't close the wound entirely, and left the man's old ileostomy site mostly open as well, with only a few stitches in the deepest tissues. It was a fascinating case because of the complexity of the illness and the number of instruments they surgeons used (the nurses were counting 60+ pairs of scissors when we wheeled the patient out to recovery), and I'm almost sorry I didn't get to see it from the beginning.

Overall, it was a great day and though I'm exhausted from standing still for so long, it was definitely worth the pain. I am so much more confident now that I've seen some pretty gruesome things; it's hard to be squeamish about things like skin biopsies when you've watched a surgeon mush a guy's small intestine around in his hands, right?

I'm definitely looking forward to my next OR day.