Never in my wildest dreams did I think that I would get to see and do some of the things I get to do on this rotation. On my first day with them, I was able to intubate a patient and first assist during the majority of a coronary artery bypass. By the end of the first week, one of the PA's was letting me try my hand at harvesting the graft! Most surgical things have seemed to come quickly to me, harvesting is a little tricky to learn as time is a factor to have the graft harvested and prepped by the time the surgeon is ready for it, (which limits some teaching moments). Nevertheless, the two times I have been able to try my hand at it, I have already seen much improvement since the first day I touched the scope. Fortunately, I have been with this team already for two weeks back in my general surgery rotation which allowed me to jump right in where I left off. They let me close the small leg wound by myself and let me help close the chest at the end of the case. One of the surgeons even let me sew on the heart! My little prolene knot is in a patients heart right now! How cool is that?! (its the small things that bring the biggest joy).
Not only have I grown by finally finding the right types of gloves that work best for me (thanks to the scrub tech, Billy), or what shoes are most comfortable during longer cases, but I have genuinely noted some personal growth in many of the surgical procedures. Originally, closing the wound was a daunting task, but now I look forward to it at the end of the case because each time, my closures are looking better and better (and I'm getting a tiny bit faster too).
Some small take-home points from the first few weeks:
The Power of Observation:
IN THE OR: For once my overly observant nature is actually very useful. Instead of noting what color shoes or tie someone is wearing, I turned my attention to survey the surgical field. When the surgeon is focused on sewing the graft, his suture could easily get caught on any of the nearby equipment (that he cannot see because of his magnifying loops he has on), it is our job to make sure it doesn't. Think about how small some of these vessels are, the simplest tug can tear it at any point. Basically, if something doesn't look right, speak up, ask questions when needed because it is for the patient's safety and well-being the majority of the time.
FOR ANY PROCEDURE: In addition to assisting, when learning how to perform any procedures, it is worth while to pay extremely close attention when shown how to do something the first time. For example, if learning how to place a chest tube, don't just watch the tube and where its being placed; note the specific way they find the rib, the way to make the incision, how they open the incision, the way they hold instruments, and how much pressure at which they have to push to advance the tube in. All of these things are small in comparison to the steps noted in "how to perform" procedures; however, they allow you to be fully focused, engaged, and observant which will create a better foundation for the memory on performing these procedures again on your own. I find that the most I can observe from the first time I watch a procedure to the first time I attempt it on my own, the better my attempt will be and the fewer questions I will need to ask. After all, our goal is to be proficient in whatever we practice.
The surgeons each have a slightly different way of performing the same procedure. That being said, as the PAs we need to know each of the different ways they liked everything done. Essentially, its a game of chess, where we need to be a step and a half ahead of the surgeon to know what they want to do next, what can go wrong, and what we need to do if it does. The same PA who taught me this also said that we "need to be one step behind as well" to fully grasp everything going on in the field and allow for the smoothest operation. After being with these surgeons for a few weeks now, I am starting to remember the little differences between surgeons already.
Being Meticulous is Often a Good Thing:
Often, I have been told that I am too focused on the details; well, in this area when we are working in milimeters, precision is key and worth the time. Often, I ask my preceptors what they think of the wounds I have closed, the drains I have secured, even they proper way to hold and cut left handed with scissors because habits can form form the first few times you practice something. I would rather learn and train the right way than have to fix bad habits later. In the end, the extra time taken to make sure everything is done correctly, will benefit the patient in the long run, and prevent complications.