Knife? Scalpel? Scissors? As Dr. B received each equipment, my eyes darted between the nurse’s hand and the surgeon’s hand to the patient’s belly. I was in scrubs holding a bowel grasper inserted into a laparoscope with my eyes fixated on the monitor marveling at the intricacies of the digestive system. The patient was undergoing a gall bladder removal surgery. Lactic acid began to build up in my hamstring as I adjusted the grasper as instructed and held it still as soon as I hear “stop Aisha!” It felt like I have been doing this for years because everything seems strange yet routine. I watched the puncturing, the blood squirts, the incisions, the stitching, and listened to the humorous doctor’s anecdotes during surgery.

I watched the first procedure- keloid removal- behind the cloth separating the patient’s head from the rest of the body. I call it the anesthesiologist hang out spot. I was so fascinated by his experienced hand and perfectly calculated incisions before he commented,” so Aisha this is really nothing technical, it’s just a keloid removal.” My brain screamed, “no doc, this is the fanciest thing ever.” As I stepped out of the OR, I was taught how to scrub my hands from my elbow to my fingertips. After every procedure, I sat in the doctor’s lounge with several other surgeons who were waiting to be paged. I felt intimidated at first but later motivated and excited. Back to the beginning, before the next surgery, the gallbladder removal, I did my scrubbing ever so religiously, held my hand up my torso, backed the door open into the room, and waited to be ‘gloved’ by the nurses. Timeout process was done by a nurse and this includes saying the patient’s name, age, the name of the procedure, allergies, and other few important information and then every member of the team says, “I agree.” Following that procedure, I observed and participated in the loosening of the internal sphincter of the rectum and the insertion of a feeding tube into a patient’s stomach.

After lunch, we transitioned from OR to seeing patients at the general surgery office. I saw minor cases such as a nail in the foot to a pervasive case of skin cancer. The patient-doctor interaction was a fun-filled one because Dr. B has an unparalleled sense of humor. I would come out of the exam room giggling. I noted how important it is to ask specific questions to give a diagnosis. It is like collecting pieces of puzzles to form a big picture; because most patients would not divulge every bit of their history and symptoms to the doctor. Now I see why the MCAT is so convoluted; it is not only an evaluation of your success as a medical student but also a preparation for your success as a physician. One of the most intellectually stimulating parts of my experience is learning how to read a CAT scan. Many of the post-op follow-up patients had undergone an operation to treat either a hiatal hernia or an inguinal hernia. A hernia is the bulging of an organ or tissue through an abnormal opening. When I saw the CAT scan, I wondered what information could be possibly drawn from a piece of white and black image; it made no sense. Dr. B then explained that the CAT scan image is like a loaf of bread with raisins randomly embedded in it. The bread is thinly sliced throughout section by section to find the raisins. Similarly, for humans, the CAT scan generates slices of the body in a cross-section, from head to toe. The less dense parts are black such as the lungs and adipose tissue and the very dense part is white such as the bone. Between this spectrum are organs and tissues with various shades of gray. As the day went by, after seeing many patients with a hiatal hernia, I could luckily guess through the CAT scan that a patient has this condition.

I saw the frustrations and difficulties that come with being a physician. The day has its highs and lows. Without the right information, an improper diagnosis can be made. I have so much respect for the technicians and nurses as much as I do for the doctors. Things won’t simply operate smoothly without them. They play an enormous role in setting the stage for the doctor to perform. I heard the pronouncement of people as being dead and at that moment, it felt like the world had stopped. After so much effort and hours put in to save a life, the thought of not seeing that hard work manifest into reality is heart-wrenching and it definitely takes a toll on the doctors because they cared. However, I see this as a feed-forward activation: every failure should only propel us to perform better next time. “What can I do differently?” should be the question. Sometimes there are no answers and I think one has to be okay with that.

I remained mute the whole time and only asked questions when I knew I would not be interrupting Dr. B. During some office examination, I had some profound emotional moments which I also kept muted. A patient told the doctor that he had pain in his upper right abdomen. He had a burn scar on his right chin which he got from a gas explosion when he was young. He had done a skin graft on the left and forgo the right because he decided to accept his deformation as he got older. After answering series of questions and analysis of results, Dr. B diagnosed him with gall stones and suggested the removal of his gall bladder. The patient had a choice to make or so I thought. The patient began with a sad face, “ I want this pain gone. I cannot live a normal life. This pain prevents me from playing with my grandchildren. It’s alienating.” Previously, I was thinking to myself that this was just a gallstone. But after listening to the patient, I felt how much pain he felt because it is like being helpless and plunging towards decline while life is happening around one. It is not a good feeling. I know how it feels to be away from one’s loved ones and the discomfort or pain of not being able to enjoy bonding activities with one’s family would only aggravate one’s condition or cause depression. I silently wished him well and left the room with a smile which I hoped would make him feel a bit better. It is good to be alive and even better to be healthy and to live a quality life. Pheew! That was a lot to take in in one day.

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