Last Friday I had the opportunity of shadowing in the OR. It was with the same peds ortho surgeon as my last post about shadowing in clinic. He was so welcoming and very eager to teach, and the OR was no different. I made sure to ask which cases to prepare for during my clinic day since I wanted to be ready for any questions and to just have an idea of what was going on.

I arrived at the hospital at around 6:45 AM.  I was then escorted to the locker room by the unit clerk. I locked up my belongings and changed into some surgical scrubs. I was excited to see what the day would hold so I wasn’t really tired. Plus I had my compression socks on so you know I was ready for anything. And by anything I mean being on my feet all day. Sidenote: if you don’t have compression socks you should totally invest in them - they keep your feet from hurting after walking all day, and help with circulation which, in turn, helps to prevent varicose veins and edema. Basically compression socks changed my life when I was working 16-hour days on my feet before med school. Now where was I? Oh right, my OR day.

A nurse was waiting for me outside of the locker room, she was our OR nurse for the day. The surgeon hadn’t arrived yet so she asked if I wanted to go see our first patient and have some consent forms signed while we waited to head into the OR. We went to see the first patient and got to chat a bit with the anesthesiologist we would be working with all day.

7:30AM - Our first surgery was a tarsal coalition patient. Although tarsal coalition is a genetically inherited  condition, children do not typically become symptomatic until adolescence. It can be quite painful for patients and results in a stiff, painful foot that limits everyday activities. The surgery only lasted about an hour. It was a quick resection of the coalition which was then replaced with a fat graft. Even in surgery it was apparent that the foot was so much more mobile and flexible than before.

9:45AM - Spondylolisthesis of L4. This is described as a forward or backwards slip of a lower lumbar vertebrae, usually L4, L5 or on the sacrum. This results in an abnormally aligned spine and can be painful. It isn’t that common in peds patients, but our patient had a particularly severe case. The surgery involved a direct repair of the spondylolysis with wire loops and bone grafting from the iliac crest (hip bone). This was the longest surgery of the day at almost 4 hours long. Even though I was wearing a lead gown to protect me from the xrays taken during surgery I was freezing by the end of it (seriously, I was SO cold that my skin was sore at the end of the day from shivering!). I was impressed at the number of people in the room. During the first surgery there was the surgeon, his first assist, a surgical tech, a nurse, an anesthesiologist and myself. During this surgery there were an added 4 people in the room: an EMG tech (who monitors muscle activity), two xray techs, and an ortho hardware “expert.” As if the amount of people in the room wasn’t intense enough, the actual surgical bed was both huge and intricate since the patient had to be strategically placed in a prone position (face down) while allowing access to the spine.

1:15PM - Lunch time. I was starving. We headed to the doctor’s lounge and found all kinds of free, delicious food!

2:00PM - ACL reconstruction. At about 2.5 hours in length, this surgery was my favorite of the day by far. I had no idea that before you actually repair the torn ligament, a graft must be taken first. It can also be from a cadaver, though it isn’t the preferred method. The graft was taken from the patellar tendon and this took about one hour. The ACL reconstruction was then performed through arthroscopy. Inside of the knee is weirdly beautiful - the contours are smooth and pearlescent. It was pretty cool to see. I was impressed at the amount of hardware that goes into an ACL repair. It seems like there's a specific tool for each step, which I suppose is probably common in ortho or any other surgical field.

4:45PM - Before leaving for the day we went to check up on the spine patient and prescribe extra pain medication. We also visited another surgeon's patient on the ward.

5:30PM - Done for the day. Leaving the hospital and into some fresh air outside felt really good.

As med students and future physicians we learn every bit of physiology in the human body, or try to anyway. It is easy to forget that those structures and their functions are real, tangible things that are very different from and infinitely more dynamic than the figures we memorize in our textbooks. To be able to see inside the human body and manipulate it to improve someone’s quality of life is a huge privilege, and an even bigger responsibility. Walking up to the family in the waiting room is another very special experience. No matter what the procedure, a patient's family or loved ones await anxiously for news that the patient is okay and done with surgery. Even if I don’t end up in a surgical field I have an immense appreciation for what surgeons, anesthesiologists, and surgical staff do.