Facing my personal El Guapo

For those of you who haven’t watched ‘the three amigos’, El Guapo is a synonym for something that needs to be overcome. Another way to say it would be ‘facing my dragons’.
Either way you say it, today I had a chance to face my personal El Guapo. I wrote a few days ago about Dr. K, the cardiac surgeon who let me help out in surgery during the brutal day when I got yelled at and pimped by everyone. He is an incredibly brilliant and gifted surgeon, but aggressive, obnoxious, and intimidating. After getting told off for not suturing properly, I dreaded the thought of facing him again. When I saw him last week at the seminar I cringed and hoped he wouldn’t talk to me. Alas. Avoiding El Guapo was not my destiny.
Today my supervising doctor sent me to go watch open heart surgery with Dr. K. I had stayed up Monday night with a piece of chicken I’d thawed from the freezer and practiced suturing for hours. The needle kept slipping out of my tweezers and I picked it up again and again, getting the needle tangled in the thread when I tried to tie knots. As I approached the hospital I felt slightly sick. What would I say to Dr. K? Even though I’d worked hard, I didn’t feel like my suturing skills had improved.
When I walked into the operating room nursing station the head nurse shook her head when I explained who I was.
“This morning’s case is a very complicated case and it would be better if you didn’t come. You can return in the afternoon, if you’d like.”
I suddenly felt a sense of injustice. I was here to face my fears and learn how to be a good doctor. Just because it was inconvenient for the staff, I wasn’t going to back down.
“I was told to come today.” I argued.
“I’m sorry.” The nurse said.
Suddenly Dr. K came striding towards us, saying something to the nurse about something he was annoyed about.
“Dr. K!” I said quickly. “Can I watch your case this morning?”
He barely looked at me. “Sure. Whatever.” And walked away.
The nurse gave me a cold glare but I felt a thrill of victory. I ran after her to the change room and went in, changing into scrubs and tucking my hair under a net and my shoes into shoe covers. And I went to the OR.
Generally medical students just stand and watch unless they are in their 3^rd and 4^th year doing their clinical rotations. I found a stool and perched at the head of the patient, next to the anesthetist, who was very kind and explained things to me as she went along.
Dr. K breezed in with the surgical assistants and began the surgery. The patient was a complicated case as he had already had heart surgery and this was a ‘redo’ valve replacement, with one of his major arteries being stuck to the inside of his chest. I watched and asked the odd question and was asked the odd question in return. Dr. K kept making rude jokes and then laughing at me. I didn’t think he could see me blush under the mask, but perhaps he could read my eyes. I tried to keep my head up and I made the odd joke. Dr. K said something about my sewing skills and I said, “Hey, I’ve improved! I stayed up last night practicing on a chicken.”
The surgical assistant and Dr. K both turned incredulously. “A chicken?”
“Just a piece I thawed.” I explained. “It’s more like human tissue than a grapefruit, after all.”
An hour later or so, Dr. K spoke to me without looking up from the open chest cavity.
“If you stay for the next case”, he grunted, “You can scrub in and I’ll let you suture on the leg graft.”
I was ecstatic and under my mask I’m sure he could tell I was grinning.
“Anyone who tries as hard as you,” he continued, “ought to be given a chance.”
By the time the next case came around I was feeling trepidation. Would I be able to suture after all? I watched the beginning of the case from my vantage point and there was a new surgical assistant who was very nice and explained things to me.
“I’m going to scrub in for this case.” I told her when she asked.
“Oh, this is probably not a good case for a beginner.” She said nicely. “But on another day you might be able to scrub in when we have time to teach you.”
“Oh, she’ll be fine.” Dr. K spoke up, waving his forceps at me. “She’s scrubbed before and she knows what she’s doing.”
Oh dear.
I went into the hallway and scrubbed my arms with iodine soap and rinsed them under the tap, opening the door with my shoulder and holding my clean hands up in the air. One of the nurses gave me a sterile towel and then draped a gown around me and tied it in the back, and then slipped surgical gloves over my hands. I took my place at the bedside next to Dr. N, the surgical assistant, keeping my hands up and trying not to fog up my glasses when I breathed. O God, please help me get it right.
For cardiac bypass surgery, it is common to take out a surface vein in the leg called the great saphenous vein and use it as a graft in the heart, turning it backwards so as to reverse the valves. One of the surgical assistants had made long cuts down the length of the man’s leg and had dissected out the vein and removed it, and it was lying like a fat worm on a sterile sheet while he closed the leg back up together.
He put the needle grippers and tweezers with needle attached into my hands and showed me where to put the first stitches. As I started to put the needle in I had to still my shaking hands. I fumbled with the instruments for a while and managed to get the stitches in.
“Do you know how to knot?” He asked me.
“Sort of.” I started to do it the way I had seen Dr. K do it and my hands got all tangled up. Finally I put down the needle grippers and began to wind the thread around the tweezers and knot it by hand the only way I knew how.
“Oh, you do it that way.” The surgical assistant said. “That works too.”
I finished suturing one cut and then I did a second one and used the stapler to close them up.
“That looks good.” He complimented me.
Let me tell you, that one little line made my day. I felt like I had slain my dragon right then and there.
“Stand closer.” Dr. K ordered me. “You might as well stay scrubbed in and help me.”
And he let me assist for the rest of the afternoon. At one point a suction tube came loose and sprayed blood in the air and all over Dr. K’s front. He looked up at me.
“Is there blood on my face?”
I smiled. “No, you look good.”
The nurses started to laugh. “She said you look good, Dr. K!”
“You’ll do fine here.” He said with a grin.
I stayed 11 hours and when we finished I stapled the man’s chest closed, swabbed up the blood and then covered his incisions with smooth white bandages. It felt wonderful.
I’ve always said I won’t be a surgeon. I didn’t want to spend the rest of my life staring at 4 square inches of a person’s body. But there’s something about rising to the challenge that appeals to me. I don’t know if I’ll be a surgeon, but I do know that avoiding my El Guapo, whoever or whatever he may be, is not my destiny.
“For God has not given us a spirit of timidity, but of power, and love, and a sound mind.”