Simple Procedures

the main operating theater

The steady beep of a pulse echoes through the halls, the odor of bleach and water fills the nostrils. Pink crocs rest on my feet. Blue scrubs cover my legs. An oversize green shirt envelops my shoulders. A green net holds back the few stubborn pieces of hair away from my face. Only my eyes peer out curiously through a blue sterile surgical mask. My feet make the few anxious steps through the swinging doors, a new rush of sounds, smells, and sights rush into my senses.

Today was my fourth day of getting the chance to observe procedures in the operating theater. I haven’t seen anything rare or exotic, but even though the cases I’ve witness may be considered normal or routine in the hospital they are such a rare sight in my eyes. Each day is a little nerve racking and thrilling at the same time. Who knows what my eyes will get to witness in the next hours.

I stood back on the side of the operating table, peering intently at the side of a woman’s head as a scalpel and fingers of a surgeon do their job. She walked into the hospital today with the knowledge of having cysts removed from her neck. She is now in a deep dream world, unaware of the knife, scissors and fingers cutting and gently moving around all the layers of veins and muscles. The first cyst rested below the ear, and was removed quickly. The second cyst was closer to the front of the head, but kept escaping the grasp of the surgeon. As I stood watching, shifting weight on my feet, and trying to stay focused on the small openings into the neck I heard the words that a lot of people in medicine long for, “Do you want to scrub in.” What kind of question is that? Of course I jumped at the chance and the next thing I know I am scrubbing my hands, getting tied into a sterile gown and slipping on sterile gloves. I edged my way closer to the table and was handed a tool. My job (which does not sound very glamorous or exciting) was to hold back the skin at the top of the incision, pulling it up towards the mouth. No, I didn’t get to do any cutting or anything super significant, but with my small amount training and capabilities I was jumping inside to just be a part of it all. I was actually assisting in a surgery! Something that I would have to be in med school or working as a theater nurse to even come close to do in America. It made the somewhat mundane surgery extremely interesting and fun. We were able to successfully remove the second cysts and after a little pain and healing the woman will be as a good as new.

The room smelled of burning flesh and bleach. I slipped my surgical mask up over my nose to cover some of the smells. I stepped through the swinging door and entered the second operating theater. A older man is looking up at the ceiling, listening to the surgeon and nurse chatter back and forth and the clinking of metal tools. As I walk closer I see something I’ve only seen in first aid books, or random medical books. This man is a preacher out in Zomba (an hour drive from Blantyre), he came in several weeks ago with severe infection on his left leg. A healing incision lies on the inside of the leg. A open about wound, about 3 inches wide, runs from the top of his foot, across his ankle and half way up his shin. When he first came in, the doctors told him he will most likely lose his leg, since the infection was too far through it. The surgeon decided he would open it and see how much he could save. The infection was able to be scrapped clean from both the incision and wound. The incision had enough skin around it to just sew it back up, however the wound was too wide for any hope that stitches would solve the problem. This is now his second procedure, today the main task was to scrap the dead skin away and prepare the flesh for a skin graft. The surgeon looked at me and told me that what they are doing is pretty simple, “you just scrap until you get bleeding, and that’s your healthy flesh.” The bottom part and top part of the wound was starting to heal nicely and only had a few layers of dead skin removed before blood appeared. However the middle took a lot longer to complete the debriment. So many layers had to be removed to reach the healthy flesh that the surgeon had to deliver disappointing news. The skin graft couldn’t happen today, another week would have to past before they would try again. You could tell the man’s spirits fell and he struggled to understand why it could not happen. Unfortunately since so many layers of tissue had to be removed the wound became too deep for a skin graft to take. The blood vessels were cauterized and the wound was dressed. Next week hopefully it will be healed and fleshy enough to complete the skin graft.

I have had the opportunity of being able to witness and help in a total of about 20 procedures, so far. From the simple removal of an abscess, to c-setions, removal of a ovarian cysts, endoscopies, cistoscopies, head trauma, and getting to collect the tissue for a biopsy on section of the esophagus. I don’t think I have the discipline to become a surgeon, but being able to see these procedures has strongly secured that my career choice is exactly what I want to be doing the rest of my life.