Tuesday, 22 May 2007

• fun in the OR, fear of the uncirced

  Had a great time in the OR last week when I scrubbed in on a case with an attending who turned out to be a classical music buff.  Unbeknownst to him, the snot-nosed conservatory-trained MS3 retractor-holder across from him has 22+ years of classical piano playing under her belt and wrote dry and bore-you-to-tears tutorial papers on brahms and schumann at oxford. 
  
  As the iPod speakers blared 80s music, my attending turns to me and says: "I'm going to play Brahms in the next operation.  Do you know why?"  (Ah, gotta love the "read-my-mind" questions).
  
  Me: "Uh...no.  Cause you like it?!"
  
  A: "Well, what's the next case?"
  
  Me: "A gastrectomy."
  
  A: "Yeah, and who was Brahms' best friend?"
  
  Me (thinking WTF I can't believe I'm getting pimped on classical music on my freaking surgery rotation.  But whatever, if this were a jeopardy category, I would dominate): "Schumann."
  
  A: "How can that be?  He tried to steal his wife."
  
  Me: "Not true" (I know, I've got chutzpah) "Brahms admired Clara, he didn't want to get with her."
  
  A: "Hahahaha.  You're funny.  But wrong.  Brahms had another friend.  Again, what's the procedure we're doing next?"
  
  Me (not getting the orthogonal line of questioning): "Uh...a Billroth I or Billroth II?" 
  
  A: "Exactly.  Billroth was Brahms' best friend!"
  
  Me: "REALLY!?"
  
  Go figure.  Billroth the surgeon was apparently a music fiend.  The thing about being pimped by surgeons is that the more questions you answer correctly, the more insane questions they'll throw at you just to see you fall flat on your face.  If you answer wrongly, then God help you. 
  
  But I must have gotten on his good side and made him think I was mildly competent (knowing all the brahms/schumann stuff surely made up for not knowing the posterior border of the foramen of winslow...grrr) cause during the gastrectomy, he said: "You get to pick the brahms symphony that we'll listen to during this case."  I picked the fourth, the e minor, and he had the scrub tech play it on the iPod for me. 
  
  High five for that.  That's right, if it's classical we're hearing, I get first choice baby. 
  
  I am just dripping with pretension, aren't it? Apologies.  I just wanted to prove it to y'all that my liberal arts background comes in handy occasionally. 
  
  **
  
  Dude.
  
  If I have to put a foley catheter in ONE MORE uncircumcised penis, I am going to scream.
  
  Okay.  Last week, I put a foley in an uncircumcised hoohahballooblahblah and was completely mortified and confused since it brought back bad memories of my first practice GU exam on this patient a year ago.  Last year, as we were preparing for our clerkships, this paid volunteer had students do a genital exam on him and he was UNCIRCUMCISED and I spent at least 5-10 minutes trying to move back the foreskin to expose the head (dude, I had never seen an uncirced THING before and had NO CLUE what to do) and having an attending bark at me "HARDER!  Pull HARDER!  Keep pulling it up!" and then getting exasperated and subsequently pushing me aside and moving the foreskin himself.  Gah.  I was literally sitting there pulling wrinkly foreskin back and forth with both hands and getting nowhere.  It was awesomely bad. 
  
  So last week I kept quiet and just followed directions when the scrub tech and my chief resident talked me through putting a foley in the uncirced patient.  Once again on Friday, when I had to foley another patient (they're all under anesthesia already, don't worry), as they uncovered him, I couldn't hide my visceral reaction this time and blurted out: "OMG.  Is he...uncircumcised?!" 
  
  NOT AGAIN.  What is UP with this mutant population?  My chief laughed at me and said "oh, Domi, you've done this before, just remember to pull back the skin to its original position after you expose the head." 
  
  AAAAAAAAAAAAH.
  
  I hate this!  Do you people know how difficult it is to put a foley in an UNCIRCED MAN!?  To take your oversized-gloved NONDOMINANT hand (just ONE hand, cause my right hand is in the sterile field dammit) and grip firmly and pull back wrinkly flaccid foreskin?!  My GOD.  The scrub tech kept saying "Oh honey, you gotta grab harder, REALLY hard, pull it back, harder...you won't hurt it..."  GAH.  Foreskin is WEIRD and YUCKY and I felt I was giving this anesthetized dude a very unpleasant handjob with all the back-and-forth-ness of trying to pull back that damn piece of UNNECESSARY flesh. 
  
  AAAAAAAAAAAAH.  I am so over this.  But now my whole team is making fun of me and my R3 says she's going to scope out all pre-op uncirced patients so I can do foleys on ALL OF THEM. 
  
  Not.  Funny. 
  
  **
  
  I am also so over trying to appear "cute" in my scrubs.    I'm resigned to looking like a dorky smurf in oversized clothing.  I've been too focused on trying to appear minimally competent and I find myself spending more time trying to read and know as much as I can.   But I have to say that I found a way to make my hair look pretty post-op.    I put it up in a bun during the operation and when I walk out wheeling the patient to the PACU, I undo the bun, shake my head, and these lovely curls roll down my back.  This is wavy greatness that I can't ever replicate with a curling iron.  It's lame, but it puts me in a good mood until I realize I am so famished I could eat 5 steaks.  R says I have hypoglycemia-induced rage, and I agree with her assessment.   
  
  **
  
  I like the OR, but I'm not madly in love with it.  Surgery is an odd profession - I feel, for better or worse, if one chooses to be a surgeon, everything in life from that point on will always be second to the OR and to one's career: every relationship, family members, and possibly one's emotional and personal well-being.  This goes for both men and women.  
  
  In particular regard to women, I'm not going to play the holier-than-thou judgment game that the NYT likes to fuel when they showcase upper-middle-class Ivy League graduates who snag wealthy husbands whose 6-7-figure incomes allow them to stay home with their kids and feel superior to working moms because they're "home and THERE for the children."    Please, that's bullshit.  I think there are and will be women who make great surgeons and doting moms even if they require nannies for childcare.  I think (or want to believe) that there ought to be men out there who are great surgeons and are also kind and devoted husbands and fathers (stop laughing, work with me here ).  I just feel that the life and sacrifices required to be a surgeon aren't for me, and the choices that would come up if I became one are not ones I want to make.  I want to be a good doctor, but I don't have the desire to have my profession occupy every corner of my life.   
  
  It sounds silly, but I imagine if I were in the latter years of a surgery residency or fellowship or whatever, and if I were post-partum then and still breastfeeding: what if I needed to scrub out to pump my breasts?  It would be most awkward.  And painful.  Heh.  These are the things I think about; I know it's weird.
  

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