Becky with the Good Hands

Shout out to Aaron of Phillips for the above joke and ideal business card scenario, should I ever be in the market to revamp the nickname Becky and/or make whimsical calling cards.

Nothing gets me out of a rut like re-arranging the furniture in my bedroom, or a nice [insert a baseball metaphor that references an easy-to-hit lob] simple appendectomy.

It's truly one of the easiest operations in general surgery. Staple. Staple. Boom. Nothing even has to be sewn back together. A vestigial organ that an intern [or surgical sub-intern, or according to some of the douchiest attendings, a monkey taught to operate] could remove. However, like the infamous mother-of-all-laparoscopic-surgery, the cholecystectomy, at times it is deceptively and unappreciatively difficult.

Giant pockets of pus. Walls of scar tissue. Shit stuck to other indistinguishable shit.  I always go overboard and tell my patients too much about the possibilities for badness - that it might be a cancer, or that it might be so inflamed and adherant to the surrounding intestines that they may need a bowel resection. But that's just how I am - an over-sharer [obviously... I'm a blogger]. Because you don't want to have tell an extremely hard of hearing patient in a shared room starting from whisper to full-on shout that "It's cancer!" "What?""CANCER!" and have that be the first time it's crossed their mind.

When I first started taking attending call as a fellow, I would tell the entire operating room staff (anesthesia, nurse, tech) about how this one could be dicey, how we should have all the extra equipment in the room, on the off-chance that I would need to convert to a big open operation. It was my own personal voodoo - to over-anticipate, to never be caught unprepared for the worst. The by-products of how I had lived my entire surgical residency followed me into my fledgling transition year: imaging every worst case scenario, never sleeping, never straying too far from the house when I was on call *in case* someone needed me, taking every failure personally. You only have to leave the SICU desk once [to take your ABSITE exam] and answer a phone call upon your return about a drain placed through the aorta [...not good...] to feel like you need to be the unsleeping watchdog.

It hasn't gone away entirely, of course. The uptightness. The reflux and probable ulcer disease. The absolute certainty that something could go wrong, until it doesn't. And the feeling of personal responsibility only compounds logarithmically with time. But, after removing what felt like every appendix in the smallest state of the Union by myself, in the middle of the night, at a far-away unfamiliar hospital, I finally chilled a little. Developed my own little routine. Made my own preference card. Started singing in the OR again [unfortunately for everyone else]. Remembered why I was in this silly business after five years of thinking [and often being told] I was the worst. Had various scrub techs and nurses [from friends to travelers] reinforce that maybe I wasn't entirely without grace or skill. Of course, it's really the anatomy and not the hands that dictate the course of the operation, but I internalized a teeny bit of pride in my work. 

Most surgeons groan at a middle-of-the-night appendectomy. I still love it. [I just don't love waiting to get to do it]. Just long enough to feel like a real case, but not so involved that I get hangry or despondent by the end. Someone who comes in sick and in pain, usually feels much better by the next morning. Its also [nerd alert] a fun diagnosis to make by history and various eponymous signs on physical exam [now mostly usurped by the ubiquitous punchline-jumping CT scan]. My ultimate surgery-pride moment was when my taciturn little brother called me [a suspicious event in itself] and as a medical student I diagnosed him over the phone [and then quickly told him which hospital NOT to go to in Atlanta].

It should surprise no one that I love taking pictures in the operating room to show to my patients. Since I can't let them take their appy home with them, the next best thing is a photo to frame or post social media [yes my gallbladder has its own album, much to the chagrin of a certain Dr. C who was appalled that I would deign to pull up facebook in the middle of rounds]. Some cases in lieu of a photograph I sketch a quick chariacature [which pales in comparison to Dr. L's works] to pretend I'm a latter-day Dr. Netter, but alas no one seems to treasure my napkin sketches for their future worth. Nothing beats explaining what is going on in those photos to someone self-professedly "stoned out of their mind".

Most appendectomies are one-and-dones, college kids or adults you examine in the ER, operate on, follow once in your office, then release back into the wild. Rarely you operate on someone you know or work with. Someone who gives you a thumbs up every time they pass you in the hall, whose mom updates you on their new baby and burgeoning career, who makes you feel like you were a small part of their life. That type of saccharine-feel-goody high even I can't pretend I'm too cool for. Literally what keeps me going some days. Literally.

Last night after sitting around for hours trying not to endlessly feast at an all-night belated cinco de mayo taco party, I got the ultimate compliment from anesthesia: "sorry, I thought it would take longer".  In other words a total non-sequitur humble brag based on that one time my mom referred to my hands as having value, and the nod of approval from some particularly hard to impress scrub techs.  I'll take "Becky with the good hands" as opposed to the good hair any day. Besides these bangs are O.O.C. especially after a day in a bouffant [damn whatever administrative body dictated that a flimsy bouffant with a barely-rubber-band could tame this locks better than a securely fashioned boy cap].