The First Cut

They say the first cut is the deepest. For me, this was definitely not the case.

It is a typical tuesday afternoon and I am preparing for my 3rd case of the day when the intern I am working with informs me that he needs to leave for clinic. It will be just me and the Attending for this next one.

I report to the OR, feeling a little nervous and not sure how this Attending will react to a 3rd year medical student being the only one around to help. I grab my gloves and am helping position the patient on the table when he arrives.

“Good afternoon Dr. Lamberton,” he chimes, “will you be helping me out on this one?”

“Yes sir, it looks like it’s just you and me today.” I brace myself for his response.

“Well that sounds just fine.” He smiles and motions for us to go scrub.

We re-enter the room and drape the patient in the usual fashion. I’ve never been to the ballet, but I have been to the operating room, and when you watch this choreographed dance, it feels pretty similar.

“Alright now Dr. Lamberton is going to read the time out.” my Attending’s voice thunders.

I look up from the suction I’m securing to the drape, surprised, and make my way to where the scrub nurse is holding the patient’s chart. My voice is only mildly shaking as I muster my most commanding tone.

“This is patient _________________, MRN ________________ born ___________________. Consented for a ___________________ under general anesthesia.”

I look to anesthesia and they take over, the rest of the team following in suit. I’m grinning behind my mask as I step back to my place across from my Attending. He nods to me with a fatherly-like approval. We work together to mark our incision site. The scrub tech hands me a lap-sponge in addition to my suction so I can keep the field dry for the Attending while he makes the incision.

“Please hand the scalpel to Dr. Lamberton.”

I drop the suction I’m gripping (almost off the sterile field) and try to maintain my calm as the scrub tech hands me the scalpel.

This is it, I’m thinking as I place the scalpel on the skin, This is my moment. I’m a surgeon now.

With all the concentration and focus pinned on the tip of the blade, I begin to carve my masterpiece. Commanding my hands not to shake as I bring the knife along the 5 cm of marker that directed where my incision would go. I reach the end of the line, removing the blade from the skin. I turn to hand the scalpel back to the scrub tech and as I’m preparing to state the words I had heard so many times before – my Attending clears his throat.

“Why don’t you try that again.”

I look down at my work of art only to discover, to my horror, that I had barely cut through the dermis. Sheepishly, I take another stab at it. I see my attending nodding his head slightly as he grabs the Bovie and continues the surgery.

My great moment wasn’t as graceful as I had dreamt it would be – but when are they ever? For me, some of the most influential moments in my life have been ones that occurred completely on accident. You can’t plan for moments of growth and progress, you can only capture the opportunity placed in front of you.

This story isn’t about me capturing a moment. While it’s certainly cool that I got to make the first cut (and a moment I won’t soon forget), the real amazing thing to me was the opportunity that was placed in front of my Attending that afternoon. He was burdened with the load of an inexperienced assistant, and instead of complaining or ignoring me and my tightly clenched suction, he elevated me to a position in which I did not belong and gave me the tools to inhabit such a place.

That’s the beauty in really teaching someone – it’s not about asking the hardest pimping questions or assigning the latest articles to read. Those are great tools in assessing someone’s preparedness and self-directed learning process, but to truly teach means lifting the student from where they were so that they can take in the view from where you are.

I was blessed with such a teacher that afternoon, and I hope that one day I can strive to be a surgeon who raises up those around me in the same way he did with me.

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