Does She Know?

The lights were bright and hot as I looked down toward the patient underneath the blue drapes. Every step of her operation had gone perfectly and now it was time to close. We had just completed her abdominal hysterectomy and I still couldn’t believe that I had held her uterus in my hands. I was enthralled with the entire process of the operation and now here I was, a third year medical student on his first day in the operating room holding the organ that grows another life. I was amazed at the skill and ease with which the surgeons operated and it filled me with energy and dreams of my future career where I might one day be the surgeon performing this operation. In the excitement of seeing my first operation, I had nearly forgotten the patient underneath our drapes. I had forgotten that my excitement came because of her pain and discomfort. I did not know this patient well, having just met her that morning before surgery, but she was a very sweet and kind woman who was more than happy to allow the student into the operating room. As she was being prepped and I was scrubbing in with the surgeons I began to wonder. Does she know that this is the first surgery I will be in?

Once the operation was complete and the incision was being closed, I started to feel a combination of anticipation and nervousness. I had a feeling the senior resident was going to ask if I wanted to assist with the final suturing of the skin. I thought that I would be ready for this moment with all of the practicing that I had done at home during my virtual clerkships during the height of the pandemic, but suturing fruit or rubber models can only get you so prepared for the real thing. When the senior resident asked the surgical tech to hand the needle driver to me I immediately felt my pulse quicken and a drop of sweat run down my back. Even though I had been hoping for this opportunity to come, I still found myself full of doubt and unsure of my skills, which put me in a strange position. As a student I want every opportunity to learn and improve my skills, but I also want to make sure that the patient is getting the best care possible. It’s hard to imagine that the best possible patient care includes letting a medical student close a wound. Does she know that this is my first skin closure on real skin?

The first few stitches went well, but when I looked up and saw how quickly the resident was working, I became very aware of how slowly I was working. When I tried to move a little quicker my hands began to feel clumsy and uncoordinated. My hands were far from the steady hands a patient would expect their surgeon to have. What if the patient knew how much my hands shook? Once the resident noticed this, she gave me words of encouragement. She reminded me that it’s okay to take my time, and told me that I was doing a good job. But still, I felt guilty because was my good, good enough for the patient? Wouldn’t it have just been better to let the resident close the skin? With the support and encouragement of the resident, I eventually finished my portion of the skin closure, and I felt very proud and accomplished–the sutures I put in looked good. Then I started to worry. What if I messed up and they came undone, or left my patient with a scar? Would my learning have really been worth it for her then? Did she know a student would be placing any of her sutures? And if she did know, would she have let me?

As a medical student I am constantly finding myself in these strange and uncomfortable situations every day that I work with patients. I am always eager and excited to do new things, but there is always a thought in the back of my mind that asks, is it really the best for the patient if I do this instead of the attending? The easy answer is no, but then I would never be able to become the physician I desire to be. I am grateful for every opportunity that my patients have given me to learn, and the woman from this surgery is at the top of my list. She didn’t know that I would be there when she scheduled her surgery, and she didn’t know that I would have any hand in it. So now I sit and wonder, does she know how grateful I am, and does she know how honored I feel to have been part of her care? I hope she does.