Internship is about six weeks in—actually a month and a half—and I have already rotated through vascular intervention, spine surgery, trauma orthopedics, and now breast and thyroid. I had intended to keep a weekly internship diary, but my energy has been evaporating like alcohol since I started. Even on days when I do almost nothing, I end up exhausted. I recently came across the term low-energy people, and maybe I have entered my low-energy phase.
The routine is straightforward: show up for morning handover, follow the rounds, and then my attending usually tells me to go read. That was true in vascular intervention, spine, and trauma ortho. Now and then I watched a procedure, changed a dressing, or ran an ECG. Back at the dorm I slept, woke up, read a little, attended an evening live class, and finished the day with mahjong with my roommates. Today was the Lantern Festival, though I did not get to eat tangyuan until after midnight on March 4. In my hometown, the New Year is not really over until the Lantern Festival, so I suppose a new phase is beginning. I hope it goes smoothly.
The first time at the table
During clinical rotations at Zhujiang Hospital in the second half of my third year and the first half of my fourth, I watched quite a few operations. But I was always in disposable viewing clothes, far from the table. After I moved to Xiaolan Hospital, I followed cases in vascular intervention and trauma orthopedics, but still in scrubs, watching from the periphery.
Today was different. For the first time, I put on a sterile gown and stood at the operating table.
The patient was a man with right-sided thyroid cancer on ultrasound, TI-RADS 4c, scheduled for a right total thyroidectomy. There is a saying that if you had to pick one cancer to get, you would pick thyroid cancer. For a malignancy, it has an unusually good prognosis, and most cases can be cured.
The day before surgery, my attending, an associate chief physician, discussed the imaging with the department director. It looked as if the tumor might be invading the trachea a little, which would make the operation more difficult, so the director was asked to supervise. The next day, when my attending told me to come along to the OR, I assumed it would be like before: scrubs, standing outside the sterile field. Instead, someone had prepared gloves that fit me and a surgical gown.
And just like that, I was at the table, nervous. I had heard classmates say that students usually just hold retractors and suction blood—nothing too difficult, more like being a human tool. If that had been all, I probably would not have written a whole piece about it.
I watched my attending cut along the skin crease of the neck, then divide the subcutaneous tissue and separate the strap muscles. I held the suction, retracted this way and that, and tried to keep the field clear. The electrocautery buzzed and hissed. It really did smell like roasting meat. I had always assumed that was an exaggeration, but it smelled exactly like grilled pork belly. Under the surgical light, the smoke particles looked almost layered.
Once the thyroid was exposed, they found the recurrent laryngeal nerve and the parathyroid glands without trouble and began dissecting the gland. I listened to the director and my attending chat while they worked. Soon the diseased thyroid and lymph nodes came out. They irrigated, closed the wound, sutured the muscle, and sutured the subcutaneous tissue. In between, I got to try the electrocautery for coagulation a few times. Then my attending handed me the needle and the needle holder.
My internal monologue: Me? I am going to do the final intradermal suture on this patient?
My attending's eyes said: Yes, you.
Intradermal suturing means the suture runs horizontally through the dermis or the subcutaneous fat layer. By pulling evenly, it makes the wound edges sit together naturally and avoids needle marks on the epidermis. It is used for clean incisions with well-matched edges and no tension, especially in areas where appearance matters.
So I sewed, more or less properly. It was bumpy, but I felt it looked decent—better than someone clumsy like me should have managed. My attending praised it so warmly that I almost believed I had been born with surgeon hands. Maybe intradermal suturing is not that hard after all. (Cue the overconfidence.)
After the operation, I ate the surgical meal, went back to the dorm, and crashed.
I am writing this to mark the first operation I have actually taken part in.
A few more thoughts
The teachers in breast and thyroid are especially nice—kind and gentle. There is more to do than in some other departments, but I do not feel much pressure. I have also saved up a pile of movies and shows, so perhaps a short review is coming.
My future direction will probably still be medical oncology and research. But after today, I have started to wonder whether my hands are not as useless as I thought. (I am trying to be wary of mysterious confidence and the power of I reckon.)
Happy Lantern Festival.