Tuesday, September 23, 2008

Oral Exam and a Lucky Break

I spent the weekend studying for my oral exam, which was supposed to be this afternoon at 2:30. My attending let me out of evening rounds early yesterday so that I could study, and she told me not to scrub in this morning either. So I was feeling pretty relaxed because I had so much time, and I even slept in this morning. Then I got a page at 10:30 saying that my examiner wanted to move the oral three hours earlier, in one hour. Crap! That call made me finally start feeling a little stressed, because now I wouldn't be able to get through the whole review in time.

I was cursing myself for not getting up earlier, but it turned out ok. Even though I struggled a little with the first question, I got it in the end with some prompting. The second one I knew cold, and the doc couldn't find anything wrong with my answer to that one. It was kind of hard to concentrate during the exam because his telephone and pager kept going off every other minute. He is a transplant surgeon, and an organ (a liver) was possibly going to arrive this afternoon. First the organ was coming, then it wasn't, then it was again, and finally he told his assistant to contact the patient and get the team and OR set up. He made a comment about all the calls, and I felt bold enough after doing well on the second question to ask him if I could scrub in. He said it would be ok, and to page his assistant in a few hours to find out where and when the surgery would be. Then he said I had passed, and I left to go have lunch. The thought also occurred to me that I shouldn't have asked him to let me scrub for the transplant before checking with my attending. Fortunately, she was excited that I had passed the exam and enthusiastic about me getting the chance to see a transplant, so I didn't get into any trouble for not asking first.

The operation was long and laborious. This time, I was mostly watching and retracting (although I did get to do a little bovieing), but it was totally worth it. It took the team a few hours to remove the patient's old liver. That liver was shrunken, hard, a sort of sickly greenish color, and knobbly all over. (The patient had really bad cirrhosis.) In contrast, the new liver was large, brownish and glistening. Its surface was smooth, and it felt soft and spongy to the touch. Putting in the new liver took several hours also, because all of the hepatic blood vessels had to be anastomosed (connected). Once they were all connected, the surgeon opened the clamps, and blood began to perfuse the new liver. First, the tissue closest to the hepatic artery turned pinkish, and then slowly that pinkish color began to spread like a wave all throughout the organ until the whole thing turned pink. It was so amazingly alive compared to the old liver. Everything had gone well. We scrubbed out at 8:30 while the residents finished suturing.

Tonight I am on call, but I'm not doing too much. I'm tired and not really in the mood to stay up all night. Fortunately, I am here with the same cool resident again, and he didn't mind that I showed up three hours late for call. He also told me it's ok if I leave, and I think I will do that in another hour or two. All in all, this was a pretty awesome day. I don't want to live a surgeon's lifestyle, but I can definitely understand why surgery is so appealing to a lot of people.

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