Friday, August 20, 2010

My Sister and Orthopedics

My sister is in her final year of medical school.  She is doing her Orthopedics rotation.  She is not terribly thrilled by it.
            “Nope.” She lay back on her bed and shrugging with elaborate casualness. "Surgery doesn't do much for me.  It’s just glorified butchery.  Change that – no glory.  Just butchery.”
            “Skilled butchery, surely?” I said.
            We were skyping, and she wrinkled her nose at me in the video.
            "You’d be surprised.”  She said darkly.  “And Orthopedic surgeons are the worst.  They’re such snobs. They’re boy doctors and they're all built like brick houses because they have to be strong enough to re-align someone’s leg.  It’s a club made up of all the boys who used to play rugby in university.  Enough said, right?”  She sniffed.  “And I have to be with them for eight whole weeks.  So no, in answer to your question, I’m not particularly thrilled about it at all.”

She called me after her first day with a rather superior look on her face.
            “There was a gorgeous registrar at the orientation today.  You can tell he used to play rugby, but he was so handsome that the extra muscle looked really good on him.  They were sorting out who was going to teach whom and I was staring at him and praying ‘Please be my teacher, please be my teacher!  And while you're at it - let it be ethical to date my teacher!!”
            “And is he your teacher?”
            “No. But it doesn't matter.  He gave a talk and when he opened his mouth – Tabubilgirl, he was a total orthopedist. It was so disappointing. He’d looked like such a normal person.”
            “Seven weeks and four days, babe.”
            “Huh.” She looked depressed and rung off.

On day two, she called me again.  In the video window she was laid out across her bed like a load of damp laundry.
            “Big day?” I said.
She laughed weakly without opening her eyes.
            “I assisted on a complete knee replacement, watched an arthroscopic surgery and assisted on a hip replacement review.”
            “What do you mean by assisting?”
            “Standing by, handing instruments, handling retractors and pulling back big chunks of flesh… everything.”
            “How do you do a knee replacement?”
            She sighed and said “I’m too tired to explain it properly” then sat up and explained, with hand gestures (the pulling and hammering ones were rather disturbing) for almost forty-five minutes.
            “You take a knife and slice down through the thigh and knee and calf, and then you retract all the flesh and hold it out and away.  That’s the part I did.  Then you carefully lift off the patella and the ligaments and sort of slide them around to the side.  Then you go in and isolate the tibia and the fibula, and you take out the electric saw and slice off the ends of the bones and it makes the most disturbing sound.”
            “How much do they take off the ends?”
            “Not much.  Half a centimeter maybe?  Just enough to make it even and flat.  Do you know what Orthos wear in surgery?
            “A Welding shield?!?”
            “Just about!  There’s this construction helmet type thing that comes down into a big face shield that sits, like, six inches out from your face.  You put that on first, and then you put on your scrubs over the top.  That movie Outbreak?  Just like that. And there’s an air supply; it’s hooked up to a battery pack that you wear on your back and air comes out of a set of vents all along the top of the shield and aims downward to keep away condensation and blow away any bits of things that stick to the front of the mask.”
            “Bits of things?”
            “OH yeah.  When the doctor pulled out the circular saw I squinched up my mouth and closed my eyes -and then I realized: Hey! – all the flying bits of bone and flesh and blood were landing on my shield!  Not all over my face! “
            “Yeah… It’s pretty messy.   They have tables and tables of hammers and guides and templates and they keep checking for size and swapping them out and everything gets covered in blood. And when it’s all sawed and grinded they pick an artificial joint and match it up with the tibia.  Then they do it with the femur.  Then they fill the bone with cement and stick pins in everything and slide the patella back around and sew it all up. It takes about an hour, tops.
            And then I went and watched an arthroscopic knee exploration which was very soothing after all that blood.   Yet still, somehow, entirely gross.
            In the afternoon I assisted on a hip replacement review, which I signed up for because I naively thought it meant a post-operative interview, but what it actually meant was that the patient had had a hip replacement and it kept dislocating, so they had to redo it.
            After this morning, which went really well, I had started to think that orthopedics might be pretty interesting and something I could totally do, but then that hip replacement happened. And it was….. messy.
            The knee replacement was okay because you can place a tourniquet on the thigh and actually see what you’re working on, but there’s nowhere to put a tourniquet on a hip.  My gloves were soaked in blood.  I had blood up to my elbows and blood on my mask and down my gown and all over my little fabric booties.  It was brutal.
            It was also a mess– the patient had had the original surgery done somewhere else, and there weren’t any notes.  The scar showed that the original insertion had been done in the wrong place and even after the doctors opened her up and rummaged around, they couldn't figure out what size replacement had been used the first time.  So in the end they just picked a new size and shoved it in and waved it around to see if it fit – and then did it again until they found one that worked.
            The leg part of the hip replacement is a pin with a ball on the end– they just chop off the end of the femur and pipe it full of cement and stick the pin in.   But the really really horrible part?  First they had to get the old cement out.  And there was a lot of it.  And do you know how they did it?
            Before he started, the senior consultant said ‘She’s got pretty bad arthritis, so we’ll have to go really gently here.’  Then he picked up a hammer and started bashing at the chopped-off end of her femur.
            I thought ‘That’s supposed to be gentle?’ Only I said it out loud because he looked at me and went “Yea-ah...” and looked at me like I was a total baby.
            My God.   He just hammered and hammered and all sorts of things were flying all over the place and then” -my sister's voice became very low and quiet- “there were times when I had to turn away and go away to my happy place.  I didn’t need to faint or anything, honestly.  I just couldn’t LOOK.”
            “Where’s your happy place?” I asked, fascinated.
            “Anywhere but there.  At one point I even had to sing my happy song.  I’m standing there, holding back half of the poor woman's thigh with a retractor, and singing the Carpenters under my breath.  “E-very sha na na na, every oh oh oh oh….”
            And then they put her back together.  Like - that’s it. The cute registrar said “Give us some tension?” And the other doctor said “Right-oh” and they both went “Uuuhhhhrrrr” and pulled her leg really hard and then let it all sort of …. squish back together.”
            There was a brief reflective silence. Then she sighed.
            "I’m going to go have dinner now.  Are you hungry?  I'm hungry."
            “You do that.” I said weakly, and she pushed herself up from the bed and logged off, while I sat in front of my computer, contemplating the possibility not eating anything at all - not for a while, anyway.

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