This patient re-presented with an infection of her wound. Five days ago she came to the hospital because of a large carbuncle on her leg. It was surgically drained. She was warded, so that proper daily care of her wound could be carried out by the nursing and surgical staff. She discharged herself in two days, against medical advice. She came back after the weekend. The wound looking decidedly worse for wear, the pus copious, the stench mind-numbing. She was admitted into theatre for a thorough clean of her wound. The wound was left open, so that granulation tissue could form, and it would be easier to suture it shut.
A few days later, we were in the operating theatre to sew the wound shut. A new surgical trainee was tasked with the job. With limited resources anyone who could help was allowed to assist. That would be the medical student – me. I have witnessed and assisted in several carbuncle surgeries before, and although i do not profess to have an in depth knowledge of the procedure, i was at least familiar with some aspects. And i did some pre-reading beforehand. I saw the trainee struggled with the procedure. He selected the thickest sutures available (which looked like ropes to me, metophorically speaking, when i compared them to the finer sutures used by the more experienced surgeons), and started working on the wound.
The wound was gaping big. This trainee hooked the sutures around the edges and started pulling them shut. When i say pull, i really mean it in the literal sense. He was tugging at the sutures trying to get the wound to close. I stared in silent horror. Anyone could see that the wound ain’t gonna close, and even if it did by some miracle, it ain’t going to stay shut for long, and you are going to be in some serious shit when the wound explodes up on the wards. I kept my mouth shut. My place as a medical student is low on the totem pole. And i do not profess to be fantastic at this, so maybe perhaps, this trainee knew what he was doing. I was rationalizing. I knew that. Surgery is an elegant graceful art. If you have to resort to pure barbaric brute force, you are doing something wrong.
The trainee was sweating now. The head surgical nurse was popping her head in one too many times asking us when we would be done. The surgeon schedule for the surgery after us was here, and we were holding things up. The trainee then made a decision to excise some of the granulation tissue, the very tissue that we had waited patiently for to grow, before we attempted to close the wound. The precious tissue that grew to help cover part of the wound, was now being taken out because the trainee could figure no other way out to close the wound. I looked on, not quite understanding, yet grasping the seriousness of the situation. The trainee started suturing the wound shut. Still it was too big. This time when the trainee heaved the sutures shut, the suture actually broke with a loud snap. There was silence in the room. I could feel the tension. I heard the operating nurses stopped their conversation, and i felt eyes on us. I was at a loss. This trainee was obviously clueless. We were toying with a patient here; i did not like that.
And then in strode the more experienced surgeon, the one who had been introducing me to the techniques of surgery. I felt relieved. He looked at the wound.
“I think we have to do something about that, don’t you think?” he said pleasantly to the trainee.
“I have it under control,” the trainee said stiffly.
I could not believe my ears. The need to pander up to one’s ego, the irrational decision to argue when time is tight, and the fact that someone more experienced was trying to hint that something is not right, and you still did not concede, was bewildering.
The chief operating nurse came into the theatre once more, this time seriously irritated. What was taking a minor surgery so long?
“We are going to have to do skin flap and mobilize the skin to help close the wound,” the surgeon stated with no further room for arguments.
With that, he expertly made the cut, moved the skin flap and had the whole situation under control in minutes. He also selected a finer suture, to suture a more manageable wound shut. The trainee did not say anything.
Ego. I have been prey to it. But as we mature and develop, shouldn’t we get our priorities right? I hope i never embarrass myself like that in future.