Scrubs Finale

All good things must come to an end. Including surgical terms.

As a student I never liked surgery. Having failed anatomy 3 times as a student (I really should have spent more time studying instead of working in a pizza shop) it was a re-enactment of the embaressment I felt at not being able to describe the course of the brachial artery or the relationships of the hypothenar muscles of the hand. In clinical years surgery did not offer much to the lazy med student (ie me) Relegated to stand in the corner, we were occassionally lifted from obscurity to hold a retractor in some yoga like position for hours on end with no view of the actual operation being undertaken. My surgical mentors as a student were larger than life characters with ego's that had their own reputations.

Prof was one of them. A man whose stature was fitting for his ego. An old school surgeon from the mother country who despaired of the declining quality of medical education being offered up in the colonies. He would carry around a giant blow-up hammer and a water pistol with which he would punish his students for the most minor transgressions. We all feared going to his tutorials. We would be grilled about bizarre Xrays only to find out later they were not of humans but of sheep! He would berate us for being 'space cadets' and threaten to send us out to Wagga Wagga to work. One of my friends refused to go to Prof's tutorials for fear of embaressment or dismemberment. A surgeon to be feared, a man larger than life.

However despite his abrasive manner, he was a brilliant surgeon. A man dedicated to his craft and to excellence in everything he (and his junior doctors and students) he would take on the cases no one else would. Those patients relegated to the 'inoperable' category would be given a chance (however slim) on his list. He would operate for 24 hours straight and then come to teach us despite his lack of sleep.

I will always remember him telling us about his experiences as a student. When he was in our position he was asked by his mentor to look outside the window.
"What do you see on the lawn son?"
"Sparrows sir"
"That's right my boy, sparrows.... not bloody albatrosses!"

Point of the story: common things occur commonly in medicine... don't go looking for rare/obscure diagnoses all the time (life is not like House)

Many years later I find myself donning a pair of scrubs for the last time. Finding a nice pair of green tie scrubs, making sure the knot is firm (so my pants don't fall down mid-operation) grabbing a hair cover bandana and tying the ninja-like face mask loosely. Washing my hands 3 times ever so carefully, first with the scrubbing/nail brush and then twice working from the hands down in a meticuluous manner, making sure to not touch anything and to let the water run proximally down the arms. Backing into the door with arms raised like holy objects and gloving and gowning in a familiar theatre.

The pinging of the anaesthetic machines, the smell of the antiseptic prep, the sound and smell of diathermy burning through vessels. The bizzare names of retractors and forceps. The psychic nature of the scrub nurses who hand the surgeon his tools. The banter between the surgeon and anesthetist about their shares/kids/cattle*

It's a welcome haven from the incessant paging of the ward, an opportunity to 'do' something practical and see immediate results. A chance to 'fix' something with your hands and use your muscles.

During the past few weeks I've moved my way up so that in my last few weeks I was allowed by the bosses to apply the skin grafts to the wounds and staple them on. Then I was allowed to close the wound after a fem-pop bypass and stitch everything in place.

Then to put the icing on the cake, it finally came... the King of all vascular operations... a leaking abdominal aortic aneurysm. Statistically 50% of people with a leaking AAA don't come out of hospital alive. AAAs are ticking time bombs... and when they start leaking you know that the final countdown has begun. The boss let me scrub in and 30 minutes later we were covered in blood and securing the aorta and distal arteries. A simple graft was placed in the lumen and 1 hour later the patient was alive and in recovery. Someone who could have been dead that night would now live to fight another day.

It's humbling and amazing stuff! In the past few years surgery has let me pull babies out of abdomens, transplant kidneys, reimplant infant ureters, remove multiple appendices/gall bladders and do emergency bowel resections at 3am (just to name a few). There's an adrenaline high that comes from cutting people open, fixing up their insides and putting them back together again.

But now, I have gone to theatre for the last time. I've finished all my surgical terms and it's time to move on...

Good bye surgery... and thanks for the memories!

* we had a very interesting discussion about the prices of stud bulls whilst repairing a hernia the other day... very intriguing