These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.
Surgery
Question: Could you tell me if abdominal surgery (cesarean) crosswise or lengthwise is preferred? A student told me that a family member had a “U” shaped scar on the right side.
Answer: The skin incision is usually left to the right to aid in healing and avoid scars for swim suits, etc. The actual incision in the uterus can vary and usually has nothing to do with the external scar. Consequently, top to bottom, or left to right, the incision in the uterus is the same. The choice of skin approach is individual and of little consequence.
Surgery
Question: Will a 17 cm pseudocyst of the pancreas subside over time if
a low fat diet is maintained and all other indications are okay,
or should it be surgically removed? What is the danger of the
pseudocyst bursting?
Answer: Diet doesn’t seem to have a lot to do with pseudocysts with the exception of alcohol. Usually pseudocysts are removed if they do not spontaneously resolve over 4-6 months. The cyst will not burst, however, it will cause chronic discomfort and increase the risk for pancreatitis.
First Major Surgery
Question:What was it like the first time that you performed a major surgery?
Answer: Going into surgery is kind of an interesting experience. One doesn’t perform a major surgery on ones own until late in surgical residencies. However, first experiences in the Operating Room are lasting emotionally. Going into the OR is a lot different than the rest of the hospital. There are a lot of rules about scrubbing your hands, putting on scrubs, gloves, etc. The nurses in the OR are very particular about sterilization and any deviation from established routine is a major sin. As a consequence, there is a lot of criticism and observation of young physicians as they enter the OR to ensure that they don’t break any of these “rules”. This also involves a certain amount of indirect hazing to prove that you belong. For example, “you didn’t wash your hands sufficiently” or “you broke sterilization -you’ll have to leave and regown”. Being in masks and gloves is a little dehumanizing at first. It is also hot! The high intensity lights and the gowns teem up to a real broiler. In any case, once you have bested the nurses, scrubbed, gowned-now you enter the realm of the surgeons. Surgeons by natue are probably the most structured and heirarchal branch of medicine. The chief surgeon does most of the delicate or difficult surgery, the senior residents assist, the junior residents fight over any small procedure-like the sutures or closing- and the medical students hold retractors and try to stand around the edges and look over shoulders to see what is going on. This can be very difficult in a four to five inch cavity of the body. It is impossible in neurosurgery. The patient is drapped and really it is difficult to see them as human-part of the draping process I’m sure. The atmosphere-if everything is going well-is pretty light. Music picked by the chief surgeon, jokes, medical student hazing. The atmosphere in ER is pretty accurate-if you ever watch this show. However, if problems arise it gets deadly silent-and everyone gets progressively nervous. Putting your hands inside a living human during surgery is really an emotional experience. Seeing a heart beat before your eyes or repairing a kidney or appendix is one of the special experiences that makes being a physician such a unique job.
