Plastic surgery.

I spent today shadowing one of the hospital's three full-time plastic surgeons. Unfortunately, we weren't in the OR - the morning was taken up with in-office evaluations, follow-up appointments, and small biopsies. The afternoon was spent in a minor procedure room doing more extensive excisions; most of these required both cauterization and multiple stitches to close the wounds, as opposed to the morning biopsies, which only needed gauze and band-aids.

The morning's worst case was definitely an 84-year old man with squamous cell skin cancer. Dr. R had removed a sizable chunk of his nose last week and placed a skin graft over the exposed tissue. He said it was healing well, but it still looked pretty gruesome. The man has more lesions that need to be removed in the OR, but from what I gathered, he had some sort of cardiac event the last time he underwent general anesthesia and Dr. R is reluctant to take him back to the OR because of the new heart problems. Because of the improbability of removing more of his cancer, the nurse said sadly as we left the room, "I don't know what's going to kill him first, his cancer or his heart."

The most difficult procedure to watch was a biopsy performed on a young woman. The mole was on the left side of her nose, near the bridge, and I was somewhat unprepared for how much it bled after Dr. R cut the lesion out. I did have to sit down for a moment and center myself, but I didn't have to leave the room, which is an improvement over some of my previous experiences. We joked afterward about the fact that the woman had worn her full set of eye makeup to the office, which Dr. R said happens more often than not. Common sense is apparently in short supply these days.

The next three biopsies were not as shocking, though I did feel badly for the elderly gentleman who had a confirmed spot of skin cancer on his face. Dr. R cut out a wider margin around this lesion than he did the other patients'. The fact that this man was on blood thinners meant that there was a literal puddle of blood forming around the drapes by the time the sample was completely removed, and the smell of the cauter wafted all the way over to where I was sitting on the other side of the table. Burning human flesh, for those who are interested, smells exactly like burning bacon. I didn't find the smell unbearable, but I imagine it would be much more powerful if there is more tissue involved.

Just as we were getting ready to begin the last case, a woman was sent up from the ER with an abscess on her chin which needed to be drained. The woman's entire lower lip was swollen to three or four times its normal size, and she was clearly in pain from the pressure of the fluid on her facial nerves. The procedure room was quickly prepped and the woman's lip and chin were swabbed with Betadine. Dr. R cut a crosshair-shaped incision in the middle of the abscess and used scissors to open the cut toward the lip, so the final incision looked like an upside-down cross. In spite of myself, I had to grin when the white pus started oozing out of the incision. It was mildly disgusting, but I had the curious sense of satisfaction one gets when one pops a particularly juicy pimple. Actually, that's exactly what the pus looked like - pimple juice - just a rather large amount of it at once. Samples of the pus were sent to the lab to be cultured, the wound was packed and dressed, and the woman was sent off with a prescription for antibiotics. It was a nice ending to the day.

Dr. R's parting advice echoed some of the advice I've already been given, though he did put a somewhat despairing, surgical twist on it: "Find something you can tolerate doing day in and day out. In the end, it's a job. Pick wisely."