Orthopedic Surgery

It was with some trepidation that I entered my first surgical rotation. After all, surgery has the reputation of being the most difficult, the most time consuming, the least satisfying, and the place where one encounters the largest egos. This was simply not the case with orthopedic surgery. In fact, my experience was far removed from the image that was painted for me. I was assigned to the 'Hand' service of the orthopedics department, with attending physician Dr. Bruce Toby, chief resident Tom McCormack, third year resident Kevin Bowers, and second year resident Jim Rotramel. They were among the nicest people I've ever encountered.

I learned a great deal about upper extremity anatomy, carpal tunnel syndrome, shoulder problems, and fractures, although I'm not sure I learned a lot about patient care. Most orthopedic inpatients get a "Hihowareya - seeyalater..." in the morning and about the same at night. As a student I wasn't required to do very much with patients' care and I did little in the way of procedures.

As per the usual in surgery I didn't do much but hold retractors, but I was right in the midst of things and everyone took the time to show me various structures and explain what was happening. Dr. Toby is an extremely skilled microvascular surgeon and performed some wonderous operations. I assisted in the operating room for the re-attachment of a severed hand, an operation that took nearly 12 hours! I also assisted in the removal of a segment of necrotic bone from the upper arm of a woman who would have otherwise lost her arm. I watched the placement of a graft into a severed ulnar nerve to restore sensation in the hand of a man who had been showered with buckshot at close range.

My moment of glory came on the last day of the rotation. It had promised to be a long, slow day. The only thing scheduled was the harvest of a man's sural nerve. The nerve was to be used a graft for the patients facial nerve. As someone who did not believe in going to doctors, the poor fellow had allowed much of the side of his face to be eaten away by an indolent and generally harmless skin cancer. Dr. Toby often works with the ear-nose-throat team on vascular free flaps and autologous nerve transplants to restore nerve function along with the reconstruction. It turns the surgery into a "one step" operation. I assumed that I would simply hold skin hooks for the duration and that would be the end. Imagine my surprise after he opened a small incision, located the nerve just above the ankle, and handed the scalpel to ME! With a less than steady hand I managed to dissect and free nearly 15 inches of nerve. Of course there was careful supervision, but almost all the work was done by me. I was floating on air for days afterward!

I must admit that there was something very satisfying about the "bone doctor's" work. They almost always have something to do or something to try. It is a decisive field of medicine. If I were ten years younger I certainly would consider undertaking the rigors of an orthopedic surgery residency.

last updated 11/20/95

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"Prophesy to these bones, and say to them, 'O dry bones, hear the word of the Lord'"
Ezekiel 37:4