And just like that, four weeks of orthopedic surgery have already come to an end! Time for a little (okay, long) recap, shall we?
Overall, I sincerely enjoyed my orthopedic surgery rotation. My primary preceptor works in Total Joint, which is where I spent my first week. To make sure I got a nice, broad view of ortho surgery, she asked me to rank my preferences for eight different areas, and then got me set up with my top choices, spending one week in each.
Total Joint
I don't think a ton of people can say that on their very first day of PA clinical rotations they got handed a bone saw! I got to cut through the patient's tibia to make the flat surface for the knee joint. I was literally vibrating with excitement as I handed back the bone saw. So cool.
Pro tip #1: Don't forget your shoes at home for your first day! Yup, this girl totally forgot her tennis shoes at home and had to do an entire day in my Toms slip-ons. Luckily I had blue shoe covers on, so no one except my preceptor knew this. Ha!
Pro tip #2: Breathe through your mouth when the cement is being mixed. Did the flying bone chips and blood splatter on my face shield do me in? Nope. But the cement... yup! I got super lightheaded from the overpowering smell and unfortunately had to step away from the table. My preceptor did a great job normalizing this for me, reassuring me that almost passing out meant nothing about my ability to do well in surgery. Needless to say, the next time cement was used, I breathed through my mouth only and did just fine.
If you're worried about feeling faint in the OR, you are not alone. I was seriously scared that I wouldn't be able to handle the OR. I've had vasovagal experiences in the past with PEG-tube placements and seeing brand new ostomies, so I had real concerns about all the gore in surgery. However, I think having gone through Gross Anatomy at the beginning of PA school really helped with exposure therapy.
During my cement episode, I turned to my preceptor and calmly stated that I felt light headed. I stepped back from the table and the circulating nurse removed all my gear for me. She then walked me back further to the wall and instructed me to sit on the floor with my back against the wall and gave me an ice pack for the back of my neck. Please note, that this does take a minute or two to get done. Speak up sooner rather than later so your gear can safely be removed before you go down! After a couple minutes of sitting, I got up and went to the staff break room to get something to drink. When I felt better, I was able to come back into the OR and watch the last parts of the surgery. No one cared. No one made me feel bad. The surgeon commended me on knowing when I needed to step back before anything bad happened.
This is important -- if you think you may pass out, don't try to tough it out. I've been told this by many people and I couldn't agree more. It is much, much, much better to play it safe and responsibly manage yourself than it is to try and push through and wipe out. One of the residents I worked with later that week told me about how he tried to push through and passed out in the middle of a surgery. This is bad for so many reasons: you can hurt yourself, someone else, contaminate things... just don't. One of the surgery techs told me about a student who waited too long to speak up and passed out while trying to leave the OR, instead smacking his face on the edge of the door. Don't be that guy.
Okay, enough about passing out in the OR. I also need to talk about how I almost broke the sterile field! The surgeon asked for the bovie (a cautery device). I saw the blue cord and lifted up on it to try and find where the bovie was hiding (a number of things actually sit on the patient and can get lost in the folds/creases of the sterile drapes). Unfortunately, the bovie had fallen off the patient and below the level of the table, therefore making it unsterile.
"STOP!" the surgeon shouted when he realized what I was doing. Luckily I hadn't brought the bovie up onto the patient, but it likely brushed up against my gown on the way up, so I stepped away from the table, got a new gown and gloves, the bovie cord was snipped and a new bovie was connected, and I got to jump back into the surgery. Important lesson learned!
As a student, you are thinking about so much all at once. Retracting properly, using the suction well, learning about the surgery, listening to the surgeon and other staff, and trying to function safely in this very foreign sterile OR environment. It's a lot! Chances are pretty good you'll make a mistake. Don't be offended when you're corrected. Be honest if you think you did something wrong. Learn, and move forward.
During my week in Total Joint, I had three surgery days and two clinic days. On my clinic days, I got to do my first ever joint injections! Those are actually a lot of fun. I watched about three injections before my preceptor asked if I wanted to give it a go. Yes!
Preceptor: "Is it okay if Olivia does your injections?"
Patient: "Sure." *I get myself all situated in front of him* "Wait, is this your first injection ever?"
Me: "Umm, yes." *pauses, trying to figure out some way to reassure him* "...but I've practiced on mannequins!"
Patient: "Yeah that's not really the same thing." *laughs*
Me: "Yeah, I suppose you're right, it's not."
Luckily, he still let me do his injections and they went really well! I also got to watch a joint aspiration and remove surgical dressings for a patient who was two weeks out from her surgery. Overall, a really great first week.
Orthopedic Trauma Surgery
This rotation was so much fun! Granted, I think I needed to see a chiropractor after I was done, but I had an absolute blast working with some really smart residents and surgeons. I was a little worried about being at a teaching hospital and that I wouldn't get good hands-on experience with residents and medical students around, but I got really lucky in that there were no medical students around the week that I worked with this group. This meant I got tons of great experience without having to fight for my shot.
One of the interesting parts about this group is the overlap with emergency medicine. I got to follow along and assist with evaluating patients, placing splints, and getting surgical consent from patients in the ED.
As cool as that was, nothing compared to this OR experience. I even got to be first assist a few times! Literally on my eighth day of being a clinical student, I was first assisting for a fourth year resident in a surgery. Just us! That was absolutely mind blowing to me, but it was such a good experience.
This week, I was also able to start doing simple interrupted and horizontal mattress sutures, I assisted with wound vac placements, and helped with some post-op splinting as well. I got lots of exposure to many different kinds of fractures, lots of practice with scrubbing and prepping patients before surgery, and lots of experience assisting with the surgeries.
I figured orthopedic surgery was a bit of a wild card for me; I was either going to love it or hate it. After seriously enjoying my trauma surgery week, I felt like this could be a big contender for a job or fellowship after graduation. But it's still early, so we'll see!
Also, shout out to the amazing circulating nurses and scrub techs who provided tons of guidance and tips about handling instruments, staying sterile, proper gowning and gloving, and so much more. Be open to the advice of these very experienced folks!
During my trauma week, I spent four days in the OR and none in the clinic (I could have, but my preceptor and I agreed that the OR time was very valuable, and since the clinic had no patients scheduled that Friday because of resident graduation, it made the most sense for me to skip it and savor all the OR time I could get -- I wasn't going to argue with that!).
Ortho Oncology Surgery
This week was admittedly a little overwhelming. I was paired with a PA who loves to teach, which is amazing, but oncology is a very vast area of medicine and there was so much to be learned. But, this meant the opportunity to go through a lot of different patient cases, review scans, and most importantly, discuss can't-miss diagnoses even if I don't end up in orthopedic oncology. Don't go messing around in a lipoma until you're 110% sure it's really just a lipoma!!
I was able to sit in on a tumor board meeting, during which cases were presented and the pathologist provided insight into the different diagnoses. Earlier in the week, I had assisted with an open biopsy for a patient with a lesion in her humerus; during the tumor board meeting, I was able to find out the results -- Rosai-Dorfman syndrome. And while this isn't cancer, there's a chance the patient will need both steroids and chemotherapy to treat it. So cool!
I also had the chance to take a sample during another open biopsy down to pathology and see this team work to help differentiate if a patient had melanoma or multiple myeloma in his bone, so we could proceed with the rest of the surgery accordingly. Turns out it was melanoma, and I was given a laser to burn that area of the patient's bone and hopefully help kill any remaining cancer cells. A laser.
During this rotation, I was also able to assist with probably the wildest surgery of my entire career. We did a radical resection of most of a child's femur and a large portion of his tibia to remove osteosarcoma and replaced this with a custom implant. It was amazing to watch the surgeon carefully dissect away basically all of the soft tissue on the child's leg to complete the bone resection. He also did a rotational muscle flap which was cool to see as well. Honestly, I'm still reeling from this experience!
Hand and Upper Extremity
Thanks to the 4th of July holiday, this part of my rotation was cut short and I could only spend four days in this subspecialty, but it was a good experience nonetheless. I spent three days in clinic and only one in the OR, though (which was a bummer because this girl loves her OR time!). When I was in the OR, I assisted on a distal radius fracture repair with a plate and screws and carpal tunnel release, and then observed a small finger amputation (due to destruction from a giant cell tumor) and a distal biceps tendon repair.
I found this clinic time to be valuable especially because I felt like I was starting to get in my groove with patient evaluations, determining what special tests to complete during the physical exam, the right questions to ask the patients, and then how to give my preceptors an efficient oral presentation. My preceptor started pushing me to make treatment recommendations, and while I wasn't always right, it was good to start exercising that part of my brain as well.
I also had the chance to following a patient to hand therapy to watch a special splint be made for him. The occupational therapist who did this even gave me some of the material to try and make a splint for myself (it was ugly, you guys!!). I appreciated the chance to see this particular patient encounter from start to finish, and enjoyed having insight into what other members of this team are able to do for the patients.
Overall Thoughts
I'm absolutely amazed that my first rotation is already done. It was seriously bittersweet to turn in my badges knowing that this wild ride of ortho surgery is already behind me. Again, I requested a rotation on orthopedic surgery kind of as a wild card; I didn't really know what to expect and wasn't sure if I was going to like it. I think it was amazingly valuable that I got the chance to work in so many different areas in just a few short weeks, and I could certainly see myself working in a couple different orthopedic subspecialties in the future.
If I could have done anything differently during this rotation, it would have been a better commitment to studying for my EOR. I spent a lot of my evenings focused on ortho content, as to prepare for the actual work I was doing on this rotation. But since this isn't really going to be the content on my EOR exam, I'm a little nervous that I'm behind on my studying. Time to kick it into high gear I guess!
Thanks for reading,
Olivia
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