As I positioned my scalpel in my hand, I kept reciting in my head, "hold it like a pen." I moved the scapel along an imaginary vertical line. As the blade pierced the skin, making the incision took some effort. The skin was tough, pink, and leathery. There were some sparse gold hairs sticking out. Making the slit was not easy and once the blade slid through the layers of tissue, the skin openly nicely, revealing the white layers of fat and a dark pink band of muscle beneath. With the would open, I was ready to practice to throw my first suture into the pig's foot. 
Suturing requires fine motor skill and hand eye coordination. You must learn how to correctly load your needle drivers with a crescent shaped needle, work with open incisions, position your hand and tie knots (among other things under the watchful eyes of skilled surgeons). Along with a basic familiarity with some core techniques, practice and repitition represent mainstays of this beautiful craft."It takes a lot more practice than you think. And when you think you have it, you realize you need more practice," said a first-year surgery intern, who was assisting us during our practice suturing session.
During the third session in our surgical skills elective, we applied what we learned over the last two weeks (knot tying, running sutures, instrument ties and other suture styles) to our first real set of tissues: pig feet. As I threaded the black suture through the incision I had cut, I could not help put think of Babe and Charlotte's Web. Poor pigs. I never knew suturing pig's feet require so much work. According to the surgeons in the room, working with human skin should not be as difficult (what a relief).
Along with repairing the incisions we made on the pig's feet, we also had a pig's liver to practice cautery. In cauterization, a current is applied to a tissue to stop bleeding or burn tissue. The Bovi, a type of cautery machine, has two buttons. When the yellow button is pressed, the tissue smokes and leaves a nice clean incision (this cuts tissues). The "coag" button is pressed to control bleeding (coagulation). The smell of burnt pig liver is unpleasant and left a lingering odor on my skin that took four good handwashings to remove.
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There is a certain amount of thought that goes into each motion. You must think of your body's position relative to your patient, how your knots look, how your hands move, how your needle is loaded, how the wound is closing (and this is just a sample of some of the considerations made when suturing a pig's foot). I can not even begin to imagine the complex multi-tasking and list of things that must be considered when you operate on real patients.
There is something satisfying to see a nice clean wound closure after so many efforts of threading and rethreading. My favorite suture is a continuous running stitch; it looks like baseball stitching on skin.
As I sutured to the end of the incision, I thought of what the seasoned surgeon's tell us about knots, "Remember to square your knots." Yes, square those knots.
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I really found this surgical skills session to be the most valuable. It is satisfying to use my hands and learn the basic techniques, so that I will be prepared when I make first real incision.
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2 comments:
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