The Full Doctor Experience

July 3 and 5, 2013

Surgery does not comprise the entirety of a surgeon’s work. Oftentimes pre-med students, including myself, hyperbolize the magnitude of the operative procedures in the work of a surgeon. I’m not saying that some hyperbole is unwarranted; surgery saves lives, restores function, and is an integral part of many branches of medicine. My last week, however, has altered my view of the role of surgery. The less noticed work of problem solving, organizing, communicating, and patient interaction are vital to being a successful doctor. They are the building blocks leading to the apex of surgery. The last two days I spent in Tenwek Hospital involved not only the most interesting and complex surgeries of the entire trip, but also allowed me to participate in the tasks that comprise the critical foundation upon which surgery can occur. This gave me a more complete understanding of what it means to be a doctor.

In the lifespan of a patient’s care, surgery comprises only a few hours of it. The majority of the patient’s care is spent in the less acknowledged pre- and post-operative work.  I spent my last week with the orthopedic team, during which I contributed to this work.

First, the doctor’s passion for patient health results in rigorous pre-operative efforts. The first step in a patient’s care (for orthopedics) usually begins in the casualty ward (the hospital ER), where doctors on call stop any bleeding, stabilize the wound with temporary bandages, and order x-rays. The following morning, during rounds, the team collaborates and critically analyzes the x-rays. Doctors employ high degrees of problem solving as we determine the best solution for the patient (despite my limited knowledge of orthopedic injuries, this is perhaps my favorite part of the pre-op work). This requires the surgeon to have great intelligence, communication skills, and organization – expressing his idea, considering others’, explaining the situation graciously to the patient, and executing the plan. The clinic is another significant aspect of a surgeon’s work, to which I had the opportunity to contribute this week. Here, the doctor can spend 10 consecutive hours seeing a seemingly endless line of less traumatic injuries (those not requiring the attention of the ER) and checkups. I assisted by attaining the patient’s x-rays, cutting off and applying bandages, and seeing that the doctor’s orders for x-rays were carried through.

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Second, the genuine care that doctors have for their patients also results in a great time investment post-operatively. Hours are spent re-analyzing the x-rays, prescribing and monitoring post-op therapy, minimizing and understanding the significance of the patient’s remaining pain, and keeping on top of infection (a HUGE problem in developing countries such as Kenya – I have assisted in multiple surgeries whose sole purpose is cleaning out a severely infected, open wound). Once the patient is deemed stable and capable of caring for himself, he is ready to be discharged, another facet of a doctor’s work. Filling out the discharge forms can seem tedious. But for me, it was a very satisfying process. By this point I had participated in the total transformation of an individual’s physical state: going from incapacitation (in severe cases) to restored motility. It was a joy to witness this.

Of course, this is not to downplay surgery; it is the apex of all these preparations.  Without it, a patient could remain permanently disabled or even die. In these two days, I was able to assist in both the most complex and interesting (in my opinion) cases of the trip.

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The most complex:

The most complicated case was not meant to be so. The x-rays seemed to indicate that the surgery was going to repair a relatively straightforward distal humerus fracture. Unfortunately, the x-ray was only from a single perspective. After slicing through the triceps muscle, we discovered that the fracture was severely comminuted (broken up into many pieces) instead of a single break. This required an entirely different approach. The surgeon sewed the triceps muscle back up, extended the incision to half way down the forearm, and cut through the ulna, leaving the triceps attached to the freed, proximal piece.  This exposed the entirety of the fragmented humerus by allowing the triceps to be pulled up like a flap. I then assisted the surgeon to delicately piece the bone together using traction, screws, and plates, over the next 3 hours.

The most interesting:

I found the most interesting case to be a synthesis of the anatomy of orthopedic surgery, the delicacy of ophthalmic surgery, and the artistry of plastic surgery. It was restoring the function of a man’s thumb, a small but critical appendage. There are three tendons that are responsible for the motion of a thumb, and all three had been severed. On top of this, the wound was three months old and significant scare tissue had accumulated. The surgeon cut into the wrist, exposing the matrix of tendons, arteries, and connective tissue, found the two pieces of each tendon, and sewed them together. It was awesome.

Surgery is an essential component of a patient’s care, often responsible for transforming a patient’s health. Despite it being my favorite part of a doctor’s work, it does not comprise the entirety of a doctor’s work. Of equal significance is the time before and after surgery, ensuring that the patient is brought to full health. Inadequate thought before a procedure can lead to a less effective surgery; insufficient attention given after a procedure can lead to incomplete healing or devastating infection. My time at Tenwek has taught me that a doctor’s work is multifaceted, an intertwined body of responsibilities all geared towards the restoration of a patient’s health. The beauty of working with Christian, missionary doctors is that all these responsibilities are also geared toward the rejuvenation of the patient’s spiritual health. Every opportunity is one to demonstrate the love of Christ.

Praise God for this opportunity,

David Holmes

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