The Day of Surgery: The Knife

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I call in, “Hey, sorry, the kids are sick, had a crazy morning, I’m running a tad late”
The charge nurse hangs up, “Guess you still only go 60 in your Audi R8”
Get to the hospital and exchange my suit for scrubs
Run through the case in my head, remind myself of necessary post-op drugs
I find the patient in Pre-op Bed 6. She’s a bundle of nerves
I calm her but don’t downplay the reverence that her case deserves

I review risks, benefits, alternatives, and obtain her consent
I remind her that a cure for her cancer remains my intent
Dr. Chan is anesthesia, I let out an audible sigh
He’s well-trained, experienced, British, but not my favorite guy
I won’t make a complaint, he’s competent when it comes to administering gas
Controversial political views, but never had an issue with skill in the past

Head to the OR to teach residents and explain the operative plan
“The cancer is on the rarer side here, but more common in Japan”
We review the parts of the digestive tract and ensure the students know biology
I quiz them on relevant and irrelevant anatomy and physiology
Like Socrates, it’s part of my job to be pedagogical
I crush the residents preconceived thoughts with primary knowledge of the pathological

Anesthesia gets the art line, central line, and an IV in just two sticks
He takes great care with which of her many diminutive vessels he picks
The nurses situate the patient during our discourse on the disease
I walk over and give her hand one last reassuring squeeze
The residents make sure the SCD’s are on before induction
Check the sterile instruments, cautery devices, and Cell Saver with suction

The case was smooth, minimal bleeding, frozens negative, went by without a hitch
The residents close rectus, Scarpa’s, and place a subcuticular stitch
The patient starts to buck as they try to close
We ask anesthesia for just a few more minutes to keep the patient in repose
Dressings are on and the patient wakes quickly
Extubation goes swimmingly, nothing too tricky

I let the patient know everything went just fine
She’ll be back in post-op with her mom in no time
I grab a cup of coffee and head to my station
As quick as I can, complete my dictation
Run by post-op to check on the patient
Her pain is controlled. On to the next cancer ablation

Dr. Joshua J. Goldman is a graduate of Integrated Plastic and Reconstructive Surgery (PRS) at the University of Nevada, Las Vegas School of Medicine and is currently an Integrated Craniomaxillofacial and Microsurgery Fellow at Beaumont Hospital, Royal Oak. His professional interests include healthcare advocacy, device innovation, digital marketing, ethics, medical education, and physician wellness. You can follow him on Instagram at @GoldStandardPlasticSurgery. He is a 2018–19 Doximity Author.

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