The Scalpel’s Edge: Internal Medicine and Surgery

Summertime. The sun is shining, the grass is green, everyone’s cooking out…and I’m in the OR, bundled up in surgical scrubs, with only my eyes visible behind a plastic face shield.

I can’t complain though. Surgery has been a great rotation; I have learned so much, and I’ve been able to do quite a lot. I just finished this past week, and I start my elective rotation Monday, but while I have a little time in between, I wanted to go ahead and get it all down!

Before I do that, however, I must include a shout-out to the people who went to the AAPA Conference in New Orleans, especially the Challenge Bowl team, who made it onto the stage! Congratulations guys!!

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For more about the conference, here’s a great article in Enet news written by Professor Thurnes.

https://www.elon.edu/e-net/Article/163093

In surgery, my day started around 7am; by that time I had already looked at the OR schedule the night before to get a general idea of what surgeries I was going to see, and once I obtained permission from the surgeon to participate, I would scrub in. I got to see a variety of surgeries, from cataracts to gastric bypass and even a leg amputation! In many cases, when the patient was admitted to the hospital for recovery, I would go talk to the patient and examine them to find out how they were doing. I would also spend one day a week in clinic, where the surgeon would talk to patients preparing to undergo surgery, as well as follow up with patients who had already had surgery.

My role in the OR was a very minor one—I mostly held retractors or provided suction—and I was thrilled to do even that much, but every once in a while I would be handed a scalpel or suture and told “Start here.” It was terrifying and exhilarating all at once. During this rotation I was frequently reminded of a wonderful essay by Dr. Richard Selzer called “The Knife,” which imbues the scalpel with a life of its own:

Even now, after so many times, I still marvel at its power—cold, gleaming, silent. More, I am still struck with a kind of dread that it is I in whose hand the blade travels, that my hand is its vehicle, that yet again this terrible steel-bellied thing and I have conspired for a most unnatural purpose, the laying open of the body of a human being

Taking the scalpel in my hand did feel a little like holding a living thing, like when you’re on a school field trip at the nature center and the guide drapes a snake around your shoulders. You immediately feel the weight of responsibility, and you respect the capability of the instrument you’re holding, which must be handled with care.

Weird Al

Before my surgery rotation, I was in Internal Medicine at a hospital in Elkin, which was also a great experience! In the morning I would go see the patients my preceptor had assigned me, then report back to him. Once morning rounds were finished, I would write notes on all the patients I had seen, and if there were patients being admitted from the ER, my preceptor would send me over to examine them. It was a great opportunity to see the entire course of a patient’s hospital visit. My preceptor would discuss each case with me so I would understand the thought process behind each treatment and lab test a patient received, as well as how to determine when a patient was ready to be discharged.

This rotation really challenged me to flex my problem-solving muscles. While I was not writing orders or prescriptions for these patients, I was still quizzed by my preceptor on the disease processes, treatments, and potential complications that we encountered. On a typical day, we might be discussing a patient in the ICU being treated for C. diff who is acidotic, and my preceptor would turn to me and say “Name some of the causes for metabolic acidosis.” If I didn’t know, I would go look it up, at which point I would discover that the patient probably got C. diff as a result of antibiotic treatment for a bacterial infection. From there, I would deduce that the diarrhea caused by the C. diff created a deficiency in bicarbonate, which made the patient acidotic.

If there was one thing I learned on this rotation, it was that patients never have just one problem, and often treating one condition can create another. A hospitalist has to be equal parts detective, healer, counselor, and diplomat, coordinating the care a patient is receiving from nurses, specialists, and PCPs, and keeping the patient and family members informed.

It’s so hard to believe we are halfway through clinical rotations! My next rotation is an oncology elective, and I am excited to find out what challenges it will bring!

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