My mother has always had this inexplicable fascination for
surgeons and their art of healing with a scalpel. So it is not surprising that
I often found myself being a victim of her constant banter about what an
amazing life I could lead as a surgeon, and she in turn, as the immensely proud
mother of a young surgeon. But it never pushed me to like surgery more than I
already did.
I vividly remember the very first surgery I observed. I was
in my second year of med school. I had never seen the insides of an OR prior to
that. I knew much less about the OR dress code and discipline. But that did not
dent my enthusiasm even in the slightest of ways. Dressed in bottle green
scrubs, we entered the OR bare foot.
It was a little intimidating at first, even though we were
merely observors. In front of us, lay a 45 year old lady who was about to lose
something that defined her very essence. She was scheduled for a right sided modified
radical mastectomy, having been diagnosed with breast carcinoma. The
psychological trauma of having her breast cut off, would probably leave her
more scarred for life.
With all due respect, my unit chief was a very ordinary
surgeon albeit with a fierce temper that could probably kill the patient before
cancer could consume her. He began the procedure with an elliptical incision
beginning on the inside of the breast. I had never seen so much blood all my
life. Blood stained hands, scrubs, floors. It was mortifying. They kept
suctioning all the blood and it still wouldn’t stop oozing out. I secretly
thought she would bleed to death. The stench of the cautery slowly but
mercilessly eating its way through the human tissue was dizzying and wasn’t
helping. The surgery trudged on for what seemed like forever but lasted a good
2 hours. At the end of it, she was surely short of one breast, but the cancer?
We were not sure. We could only wait and watch. And hope!
As I entered my surgical rotation for the second time in my
final year of med school, I had taken a liking for it which rather surprised
me. My unit chief was not just an extraordinary surgeon, he was also an
extraordinary man. Watching him resect a gangrenous bowel and anastomosing it
in the middle of the night was probably one of the best experiences of my
lifetime. (Yes, just being a witness to it.) Its easy to fall hopelessly in
love with surgery if you ever saw him playing around with vicryl and a needle
holder. Deft and precise, he was everything a budding surgeon hoped to ever be.
Being bold as a surgeon is the greatest gift that can be bestowed upon one. And
he was gifted. In more than one way.
Internship was an altogether different experience. I learnt
slowly, but effectively (hopefully!!) basic surgical skills and techniques. I
got plenty of opportunities to learn and practice with minimal adverse
consequences.
Yet, the event that changed my mind about surgery came after
I finished all my surgical rotations. It was during my brief stint in
Anaesthesia. I was posted in the plastic surgery OT. A 55 year old man was
posted for creation of an Arteriovenous fistula. He was diagnosed with diabetic
nephropathy which meant his uncontrolled sugar levels had started to stunt his
kidney functioning. Without dialysis on a regular basis, he would die very
soon. People on dialysis undergo a procedure which involves creating an AV
fistula called a Cimino fistula. Our body has two separate blood circulation
systems – an arterial system (high pressure system) which contains all the good
blood and oxygen that fuels the tissues of our body; and a venous system (low
pressure system) carrying the bad blood away from the tissues to the heart which
in turn gets filtered in the lungs and returns to the arterial system. It’s a
simple cycle really. By creating an AV fistula, we are essentially connecting a
small artery to a small vein thereby inducing a hyperdynamic circulation in the
body.
The patient was made to lie supine and stretch out his right
arm to find a vein. He was given a local anaesthetic, parts painted and draped.
The plastic surgeon then got down straight to business! He made a small nick in
his forearm and carefully dissected out the underlying tissues. His immense
experience was testimony to him spotting the vein in no time. It was clamped.
He then proceeded to find the artery adjacent to it. It was pulsating and
breathing life, and hence hard to miss. It was clamped. Procedure half done.
Sounds astonishingly simple doesn’t it? There is no way an amateur could do
this procedure without causing some kind of damage to one of the blood vessels,
The whole procedure would be totally futile even if it was only one small
puncture. All along, he beautifully explained the entire procedure step by
step. It was fascinating for an onlooker.
He proceeded to cut the vein and made a tiny nick on one
side of the arterial wall without damaging the rest of it. (This was all of
course done after clamping the vessels and obtaining a bloodless field) All he
had to do was connect one end of the cut
vein to the cut side of the artery by placing sutures anteriorly and posteriorly.
He used 7-0 prolene sutures which are visible to the naked eye only if you have
perfect vision. Procedure completed. He released all the clamps and just like
that, the now conjoint vessels sprang back to life, pulsating and pushing
harder than ever. The operating surgeon let me palpate the vessels after
stitching back the skin together. The mixing of the bloods had caused the blood
flow to become turbulent which I could appreciate as a thrill. On auscultating,
I could hear a low rumbling noise like that of a machine. It only meant one
thing – it was a job beautifully done!
“The night fissured and stars rained down on me. Queen of
the night, I knew love at last.”
