Surgery In A Nut-Sack-Shell

-->

The world of surgery was a whirlwind of awesome and shit.  Sometimes it was pure awesome. Sometimes it was pure shit.  Sometimes it was awesome shit. 

I would leave my apartment at 4:00am, walk 5 blocks to the subway, arrive at 5:15am, and walk 8mins to the hospital.  We had lecture at 5:30am given by the Godfather of surgery – sure, he was partially deaf, had an 87-year-old-man limp in his gait, and yelled at the group for being dumbasses from time-to-time, but damn…he was sharp.  Beyond brilliant. 

630am morning rounds would begin with all the students (I think there were around 20 of us), interns, and residents.  For an hour-and-a-half, the huge effing flock of us would go floor to floor, room-to-room, discussing the management of every patient surgery had.  Students had the additional job of being in charge of wound changes on patients, and it is this wound-change duty where I had my first taste of the surgery rotation.  Day 1. 6:31am.  First patient room in the CCU.  Fornier Gangrene – which is a fancy way of saying: flesh-eating disease of the perineum (the area between ones’ legs). Are you reading this and crossing your legs in protection of your perineum?  You should be. 

There is no way to describe the smell of this kind of wound.  It overwhelms you as you walk into the room.  Keep in mind I literally have no clue what I’m doing and really have not seen any “true wounds” in my life.  So I follow into the room and take notice of what the interns and residents are doing and just blindly do as they do.  Gown up. Gloves on. Grab onto patient’s hips and start rolling him.  ‘oh my gosh. We are rolling him over. What the hell is going on here!?! Holy sweet baby Jesus what is that smell!!?! Oh Lord. Oh no. WHAT THE FRACK STACK! This man has no flesh on his ass left! Welp. His inner thighs are gone too.  Oh wow.  That’s an edematous scrotum there.’

My approximate inner thought process as I am half draped over this man’s hips, holding them up as the rest of the team pulls out all the packing material and bandages from this man’s ass/perineum.  An added treat to this flesh eating disease’s ravenous appetite is the fact that essentially all the tissue surrounding the rectum has been debrided away – so it’s like a dangling rectum now – and there’s no bowel control in the slightest.  In simple terms, every morning we had to partake in this huge process there was always a pile of diarrhea.  Whaaaaat. A great way to start the day.

Not only will I never forget this man for the sheer fact of the extent of/location of his gangrene, but he also was the first case I scrubbed in for in surgery.  He came in a few days before I started with a few odd looking spots on his scrotum… this RAPIDLY turned into a surgical emergency of necrotizing fasciitis. He was taken into the OR for debridement, after which he was at risk for renal failure due to so much muscle tissue necrosis.  He was on his way for dialysis when he coded for 45mins.  Now he is ‘alive’ but with ‘minimal brain activity’.  His family refused to look at his wound, and refused to let go.  At the end of my first week in surgery, I went into the OR for this man’s: suprapubic catheter (pee out the belly into a bag), colostomy (poop out the belly into a bag), and more debridement.

 The debridement part:

·      Legs in stirrups.  In lithotomy position.

·      Bed raised as high as it can possibly go

·      Legs raised as high as they will go

·      It’s just me and the chief resident up close and personal.  Chief resident pulls out the rectal tube previously inserted and we both jump back as liquid shit sprays – super soaker style. 

·      As chief resident cuts away more and more and more necrotic tissue I have to stand beside him, cupping this patients freely exposed testicles.  That’s right. There was literally no scrotum left.  It was a tragic case of not-so-eazy-breezy-city.

And that about sums up the first surgical case I ever scrubbed in on.

I have a few more stories left to tell.
If I happened to tell one to you in the moment back when it happened and you found it particularly entertaining or fascinating.  Or just ridiculous.  Email me and remind me of it!

Miss you all! More than you know!

xoxo