Discovering the novelty in surgery

Today I committed perhaps my worst error since beginning to practice my surgical technique on rats for my new research project.  After inserting the chest tube (helps create negative pressure so the lungs can expand and rodent can begin to breathe on its own after terminating anesthesia) through the second intercostal space and into the thoracic cavity, I pushed one millimeter too far and ended up puncturing the left lung.  There wasn’t any noticeable bleeding at first, so I proceeded to suture the rib cage closed.  I realized what I had done when the noise of the ventilator became more pronounced and I found myself cauterizing the surrounding tissue more and more to prevent excessive bleeding.

5-27 JO

Me, slightly frustrated post-op

This is one of the worst things that can happen in survival rodent surgery.  Lung tissue is extremely spongy and difficult to repair.  And if left unnoticed and unrepaired, the rat could experience a pneumothorax (collapsed lung) as a result of the air that builds up in the pleural space.  This situation can happen in humans too but occurs much more rarely, since the surgeon is working with a team that monitors the entire procedure and retracts the other organs to prevent this sort of damage.  It’s also extremely more difficult to visualize the tiny rat anatomy. 😛

Excuses aside…I messed up.  And I actually got pretty upset with myself afterwards. 😦  I hadn’t predicted that I could make this mistake, since I hadn’t made one like this before.  This rat’s anatomy was unique: it had massive lungs.  I couldn’t control for its genetic makeup to this extent.  Just as I can’t always predict whether I should make the initial incision at the third or fourth intercostal space in order to best visualize the heart.  You just can’t tell until you open up the chest.  Or just as I can’t prevent a minor vessel from bursting as I am cutting through muscle.  You can’t see and avoid a vessel with a half-millimeter diameter.

Usually this sort of uncertainty makes me entirely uncomfortable.  I dislike accepting that outcomes are “out of my hands.”  I am (a touch) 🙂 too controlling, but I’d like to think that I am self-reliant and meticulous as a result.  However, I’m learning that although I can improve my skills tremendously through sheer repetition, I also need to develop artistry.  Yes, I am a novice at what I’m doing, so I should definitely secure the fundamentals first.  But I can’t forego anticipating any mishaps and thinking creatively to prepare before the start of any surgery.  I should always keep extra suture and gauze at an arm’s length. 🙂

I initially fell in love with surgery because it’s hands-on, results-oriented, and self-dependent.  Yet after my reflection on today’s work, I’m even more enamored by the challenge in learning to appreciate the beauty of anatomical variability with my own eyes and hands.  Although I’m nervous to be forced outside of my comfort zone in an extremely intense environment on a daily basis, I don’t think striving to realize a dream that makes me feel “safe” would be fulfilling in the slightest.  Surgery falls at the far end of the risk-return spectrum: high risk, high reward, and the chance to change someone’s entire world for the better.  I am so awe-inspired by the people who have made this seemingly impossible work into a profession!  Having just begun my in vivo research, I am only wading into an ocean of opportunities in the field, and I am thrilled to begin shadowing a surgical service in less than two weeks.  Send me prayers (and Starbucks gift cards) so I can manage to wake up early enough!

xoxo, Jackie O.



One thought on “Discovering the novelty in surgery

  1. Rishi, MD says:

    Such insight about the role for mistakes and overcoming them with resilience! And at your level in training… incredible. Not surprised one bit though. 🙂

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