The Curious Scalpel

Today I took a giant step forward in my training. I had been watching, and even assisting with surgical cases in the operating room for years already, but today I actually did a case. I performed surgery. Open reduction, internal fixation. Case went smoothly, and boy was it a great feeling. I was coached through it, and supervised the entire time, but that didn't detract from the experience at all. In fact, it was exactly as I imagined it would be. Incision. This was the first complete skin incision that I personally made on my own in the OR. I took a half second to acknowledge that before announcing "incision", and then promptly diving right in. Dissected down to bone, carefully avoiding surrounding neurovascular structures. And then there it was. Hematoma. Fracture. Boom. Just like in the textbooks. So there's a fracture. Reduce it. Put a lag screw across the fracture site. Now a plate. X-ray to confirm. Cotton test. Syndesmotic screw. Bang. Done. Close it ...

... one will be built for you. And mine currently seems to be "the negotiator." My colleagues are under the impression that I am able to "handle difficult patients" (and maybe that I enjoy it).  No comment.  But if it's true, i t's because of a principle that I'm extremely grateful to have learned in medical school (but really resented at the time) called open-ended questioning, which really helps with conflict resolution. The idea is simple. Ask an open ended question first, like the go-to in my current hospital... "What's up?" After that, the patient is usually exasperated enough to just tell you what's on their mind. If not, it could be because sometimes people don't want to share, or actually don't even realize, what is their PRIMARY concern - whether it's their illness or their dinner or their job, mother, etc. In those cases, you might have to have an actual conversation and listen until the real issue ...

So far in intern year, I've met some interesting people: -There was the guy who wanted to leave against our medical advice, and said he didn't care what happened to his body as long as he could leave the hospital to have a drink. And whom we had no choice but to let leave, since he technically had the capacity to make his own decisions. It was a frustrating thing, to pour so much effort into trying to get him better only to hear him say "thanks, but no thanks," and simply disappear. Maybe I'm weak, but I really can't handle that kind of thing with any regularity, and if I'm going to be fixing people, it should be people who actually WANT to get better. I already knew this, but it just keeps getting reinforced. -Then there was the lady who was "crazy," but perhaps not as crazy as everyone thought. Sure, she was floridly psychotic. Sure, she talked about strange jackets, speaking in tapes, and being from another planet, and was completely disor...