EPTSurgery is a specialty where the highs and lows of emotion you feel are both primitive and magnified. What do I mean by this? It's a given that the interventions are usually direct and immediate, and that the patient is usually very grateful. The tactile nature of even the simple procedures are satisfying in an immediate way. The friction between your instruments and surgical gloves, gripping the loaded needle driver in one hand with pickups in the off-hand, puncturing the skin with the suture, tying the surgical knots - enjoyable and rewarding on a simple level in comparison to, say, putting in orders or writing notes. (By the way, surgeons do also put in orders and write notes. They just do them much faster, partly because they are really managing only a limited number of pre/postop things.) One of my friends got to cut out the gallbladder during a lap chole. Another had to do CPR on a hemorrhaging patient in the OR (much less happy story). It's stuff like this that makes me understand why people go into surgery, despite the horrible hours.
On the other hand, a difficult surgery is frustrating on that same level. Imagine trying to tie your shoes with chopsticks while looking through a microscope. Even the best surgeons have days where they are a bit off: The orientation of the surgical field is confusing; his grip on the tissue slips repeatedly; there is lots of bleeding; sutures break; steps have to be retraced; the patient has the body habitus of a hippo; etc etc. And everyone is the OR is watching and waiting for you.
When things are going well in the OR, everyone's happy. The attending is having a good day, moving through difficult technical stuff with facility. With the time he's saved, the attending lets the resident practice a little more, providing tips and encouragement. The resident lets the student practice some new suturing techniques during closing. The nurses are in a good mood because things are moving along and everyone's organized. Even the anesthesiologist cracks a joke or two. That's a pretty nice environment to work in, right?
I've had the fortune of working with mostly very good-natured attendings. But there is also no shortage of stories from any medical student about working with the stereotypical God-complex asshole attending who has the entire OR feeling uncomfortable and belittled. The hierarchy is extremely clear in the OR, for better or for worse.
I spent two weeks in the Burns ICU while on the rotation. First off, some free unsolicited advice: Don't chase people around bonfires at 5 am. Don't hold your kids while changing the gas in the generator. Don't become a fireman. Don't let your 3 year old try to grab a hot bowl of ramen from a tall counter. Don't use your foot to start a trash fire. And for godsakes, DO NOT SMOKE while you are wearing a nasal cannula hooked up to a flowing oxygen tank.
Yes, I saw all these things.
I felt enormously sorry for every single patient I saw in the ED that was going to be admitted. They had no clue what they were in for in the next few weeks. A superficial second degree burn is the most common and easily treated of people that get admitted. The good news is that they usually won't need a skin graft, which is reserved for 3rd degree and some deep 2nd degree burns. The bad news is that 2nd degree means your nerves are intact and firing away the pain signals like 200/200 stimmed marines.
Burn wounds need to be cleaned almost every day. For most patients, this means The Tub. The Tub is a large rectangular metallic container in which burn patients soak while the nurses/doctors take down the previous day's dressings and scrub scrub scrub. I have heard the Tub also referred to as the "metal grave." Basically, all the necrotic tissue (a very distinct smell, to say the least), has to be scraped away to prevent infection and visualize the healthy tissue underneath. Imagine getting a nasty sunburn on your belly, then accidentally scraping it with a carrot peeler, and then pouring lemon juice, salt, and habanero sauce all over it. From the screams of agony that accompanied every day I helped with the Tub, that description is an insulting mockery of what it actually feels like. I've seen muscle-bound men reduced to choking out pathetic whimpers, begging for pain medication every 30 seconds. It is in essence being skinned alive every day for however long it takes.
The hands, arms, armpits are all extremely sensitive areas which are, unfortunately among the most commonly burned areas.
I scrubbed in for several skin grafts as well. Much easier on the conscience to scrape when the patient's off in lala land. They keep it quite warm in the OR, as burn patients lose heat at a high rate. I used a potato-peeler type tool to debride the necrotic tissue, and I got a chance to handle the "skinner" machine on the donor sites.
Decent amount of psychiatric stuff going on also. Burns are traumatic. Flames are easy things to visualize when you close your eyes. I'm guessing anticipating having to go to the Tub everyday doesn't help either. Definitely not for the weak of heart.
