Surgery

For once, not on me.
No, I'm on my required surgery rotation. I'd been warned about the bad hours - the extensive standing around holding a retractor and not being able to leave to go to the bathroom or scratch that itch on your nose because you'll contaminate yourself. I was expecting to be miserable, and I've surprised myself in how much I'm liking it.
It's at least in part because my last rotation was pediatrics which I loathed despite the decent hours and a nice preceptor. Any rotation that meant I no longer had to deal with screaming children and obnoxious parents would be glorious, but surgery in particular is the most interesting rotation I've done thus far.

For once I actually feel like I'm doing something, even when it's something as small as putting in a couple stitches, holding a retractor or suctioning - what I'm doing actually helps to some degree. I'm no longer just writing notes that no one reads or watching someone else write orders all day.

Actually feeling like I'm doing something useful - what a revelation!

I was in on a total hip replacement recently. I was a little more complicated than a routine replacement, and we were in the OR for a little over 8 hours. My feet and back were killing me less than half way through but there was no way I was going to scrub out and miss any of it. Seeing all the structures in the hip in a way I hadn't looked at them, even in anatomy, being there for all the intraoperative decisions to observe the thought process - I was fascinated. But it was this surgery that Impressed upon me more than any other the surgeon's motto:

The Enemy of Good is Better

The case was tricky, and the surgeon had to take out more bone than he would've liked. When putting in the prosthesis, the fit wasn't exact, and we tried several combinations to find the one that would have the least likelihood of dislocation. When putting in the final pieces, the final cap wasn't perfectly parallel to the prosthesis like it was supposed to be and that screw we couldn't get flush with the mechanism, but the surgeon said "good enough"

Having been a surgical patient, I know the sound of that, the thought of that, is terrifying. I don't want it "good enough," I want it perfect! But so many surgeons have fallen prey to the thought that they can get something just a little better, and then wound up ruining the whole damn thing. Perhaps we could have gone back, re-drilled that hole and made the screw lie flush, or perhaps that would have caused the already weak bone to fracture. It wasn't worth the risk.

Surgery is one of those rare fields in medicine where you are physically confronted with your work and its flaws, and it can be hard to beat back that perfectionist urge that says "yeah it does the job, but I can do better," but for the sake of your patients, the enemy of good is better.