As the end of week 2 is approaching, I’m pretty happy with how this rotation is going so far. Because this is an ortho rotation in a hospital, there are many OR cases and less time is spent in a clinic setting. I’m at the site with a fellow classmate and we’re assigned with different PAs every day. The service has 14 PAs and they’re all over. There is one chief, some seniors, and the rest are juniors. The PAs run the ortho floor, assist in hospital clinic hours and outpatient clinics, and many of them operate. Many of the juniors are recent grads of my school’s program which is pretty fun. I don’t even know how many attendings are in the department, but they deal with joints, sports medicine, trauma, and there are others who are non-operating.
The surgery I’ve done the most is called a total knee arthroplasty, commonly called a knee replacement. Some have been your typical TKA and others have been robot assisted. The first time I scrubbed into one of these surgeries, I was blown away. I think my jaw dropped more than once and I probably said “whoa” too many times. First of all, the PA is the first assist, which is pretty awesome. The tools and equipment they use is unlike anything else and a lot of it is quite heavy duty. I had no idea what really happened in a knee replacement but when I saw the surgeon drill holes into the femur and tibia, and pound cut-up bone back into the hole later on, my mind was blown. It was so crazy to see the surgeon use specific gadgets to cut the bone just so and then fit all the pieces together with implants and cement.
Of course, the surgeries haven’t just been a spectacle for me to enjoy. The first day I didn’t scrub in and only observed but with the surgeons and then PA and the robot, I wasn’t able to see much. The second day I scrubbed in but I had no idea what was going on. The surgeons I was used to working with during my general surgery rotation were very different compared to the ortho surgeons at this rotation. In gen surg the surgeons were the very by-the-book, serious, only-do-what-I-tell-you-to-do type. And at that hospital the residents were the first assist, so as a student, I was there to help but most of the education was for the resident. Here in ortho, the surgeons expect you to jump right in and help. The first time I scrubbed the surgeon told me to not be a statue and be more dynamic. I literally had no idea what was going on and I didn’t know how to help. After the surgery the PA gave me pointers and the next case I observed instead of scrubbing. As I observed I mentally took notes on the steps of the surgery so that I could become better oriented with the surgery. The next time I scrubbed into the same type of surgery, I was with the same PA and he seemed to appreciate how much more I was able to assist with the surgery.
In surgery, being called out is to be expected, but I don’t mind it if it means that I will improve. Of course it would be great if all surgeons spoke to you without bite, but not all surgeons are cool and collected. Overall, the surgeons at this rotation are very willing to teach, which I really appreciate. Many times the surgeons explain what they’re doing and point out anatomy during the surgery, and sometimes afterwards they will even draw out the main idea of the surgery on paper.
Unfortunately, I’m still not a pro at operating in the OR. In class we barely talked about how to function in an OR pre-, intra-, and post-op, which is annoying because a lot of times I stand there not really sure what I should be doing, and I feel like I’m the annoying student that just gets in the way. There was one day I felt like I kept making the wrong move and I just wanted to bury my head in the ground like an ostrich. I walked into the OR without a mask because I was wheeling the patient into the room from the holding area and I forgot to put on a mask. Besides forgetting things like that, I’m also not 100 percent confident on my sterility awareness, which gets me into trouble. The surgeon and the PA were getting gowned after scrubbing and I was also getting gowned, and after I had my first pair of gloves on, I stood there waiting for the next pair. The surgeon looked at me and was wondering what the hold up was, and he was annoyed that I was standing there instead of putting on the gloves myself. I totally forgot that I could touch the gloves after I had my first pair of gloves on. Then after I scrubbed the PA asked if someone could do something with the water and I made a move to fix it, but this was a no-no because I was already sterile, which irked both the PA and the surgeon. After we finished the cases for the day I felt so ashamed. This all probably makes me sound like a train wreck, and I often feel like one, but for some reason, I still like the OR.
Fortunately the PAs have all been nice, and they’re good about teaching. This is really great, but at the same time I’m concerned about what they think of me. Each day I show up and I’m nervous I won’t be able to perform and will disappoint them. They’re all willing to help and only one is my preceptor, so I don’t really know what they think of my capabilities. Another thing that’s always in the back of my head is the fact that each rotation they have two students from my program, and I feel like they compare all of us with each other. I’ll often hear either the PAs or the doctors mention other classmates that rotated through here, and then I wonder how I compare to them—whether I am doing everything wrong, if I’m not capable, if I’m not likable, etc. While it’s good the team is pretty tight-knit and they all talk with each other and speak freely it also can be an obstacle I have to overcome.
I’m hoping in the next two and a half weeks I’ll be able to become more competent in the OR and in the clinic for all things ortho. Though it hasn’t been totally easy, it’s been enjoyable so far.