First Case

University surgical training programs forty years ago were designed to weed out the weak and the faint of heart. A rigid “geheimrat” hierarchy of Professor, Associate Professor, Assistant Professor, Clinical Instructor, Chief Resident, and a whole series of junior residents made up the pecking order preceding the lowly intern. Us “Bottom feeders” or interns, as we were known, scrubbed on cases but they were so far down the line they were more like observers than participants in a surgical procedure.

Dr. Jordan, competent general surgeon and teacher scheduled an appendectomy for a Saturday afternoon in mid October. Dr. Jordan was an older, insightful surgeon well respected by the junior house staff at the University Hospital. He spoke to us as equals and even discussed diagnoses with us; for though we were fledglings, we were indeed, doctors. This was unusual in that many of the lofty professors didn’t even know our names, let alone deign to speak to us as fellow physicians. Dr. Jordan didn’t walk on water or converse with the Gods. He made us “bottom feeders” feel as if we possibly had something to contribute.

Football, of course was paramount at the University in October and assisting a general surgeon on such a simple case was beneath the dignity of the Chief Resident. Moreover, all of the junior Residents, at the time, seemed to be “occupied” with other important duties.

“Maginn, you scrub and assist Dr. Jordan with the appendectomy. It’s probably a cold one anyway,” said the Chief Resident, pessimistically. Me scrub? A lowly intern as the first assistant? I don’t think so. Had he forgotten where I was on the hierarchical pecking order? But one didn’t question the Chief Resident as he answered only to God and the Chairman of the Surgical Department.

Dr. Jordan and I exchanged the usual pre-op pleasantries at the scrub sink. I could see he was trying to put me more at ease but it wasn’t working. My end of the conversation was terse and clipped as my nervousness and apprehension were readily apparent. I’d never been first assistant before and I was terrified I might injure the patient.

Finishing scrubbing, we entered the operating room and began the complex preparations for an operation. Gown and glove. Prep and drape.

“She’s ready and she’s asleep Doctor, said the anesthesiologist.”
“Scrub nurse?” “Ready doctor.”

“Circulating nurse?” “Ready doctor.”

“Anesthesia?” “Proceed.”

The operating room team was ready.

Dr. Jordan held out his hand and the scrub nurse slapped the scalpel into his waiting fingers in true Hollywood, slapdash style. He hesitated, glanced at her, then looked me straight in the eye and said, “let’s trade places Maginn,” and he handed me the knife. Good Lord! I nearly dropped the scalpel. We switched places at the operating table. I was now on the patient’s right side and the lead surgeon. I looked at Dr. Jordan and said almost apologetically,

“Dr. Jordan, I’m not a resident. I’m really only an intern. I’ve never even “first assisted” before”. I was shaking. There, my sheepish confession was out. But I still held onto the knife.

“I’m fully aware of who and what you are, Maginn”, he said firmly. “Come on let’s get on with it. I’ll keep you out of trouble. You know what to do. You’re going to have to start sometime. This is it. It’s your time.”

I’d read so much and observed for months till I could hardly contain myself as I watched others perform at the operating table. I had itched to get that knife for years and, now that I had it, I was shaking. Damn it, get hold of yourself! You’ve wanted the knife all your life and now you’ve got it. Go for it. And so I did.

Incision. Clamp and tie bleeders. Dissect and identify tissue planes. There was complete silence in the operating room.

Dissect down to the peritoneum. Slowly. Slowly. Clamp and tie bleeders as we go. Identify the colon. Find the appendix. Watch out for the small bowel. Grasp and elevate the darned thing. Clamp it, tie the base, excise it. Purse stringthe base and invert the appendiceal stump. It’s out! Now close in layers. No drain. Skin sutures. Dressing.

From the Circulating nurse, “Sponge count is correct, Dr. Maginn.”

FINIS !

A quiet “well done,” from Dr. Jordan as he turned and walked out of the OR. No “atta boys” and no mawkish congratulations.

“Write the orders and dictate the note for me will you, Maginn?”

“Yes sir,” I said as I removed the drapes. (with a flourish, I might add). Then, trying to be as casual as I could, I pulled off my OR gown. My sweat soaked scrub suit became evident to all. The heretofore hidden tension and stress of my first encounter with the scalpel, was obvious to the entire OR crew. I was mortified and embarrassed.

But then, there began a slow measured clapping as the entire crew and even the anesthesiologist, acknowledged my initial surgical endeavor as lead surgeon. Leaving the OR I’m sure I was a foot taller than when I entered. My First Case, start to finish. That wonderful man, Dr. Jordan, helped me span the gap between student observer and confident surgeon. He wasn’t the professor. He was an ordinary surgeon, a teacher and a mentor. I’ll never forget him and what he did for me, my confidence and my later career.

In the ensuing forty or so years I guess I’ve done several thousand operations. Some minor and some quite spectacular. But their sheer numbers makes their details somewhat hazy. Procedures, techniques and faces all meld into a mélange of patients and operations now jumbled, juxtaposed and virtually indistinguishable from one another. But the details of the first case? I remember every nuance and every maneuver like it was yesterday. Every blood vessel, tissue plane and suture is vividly recalled.

Yes, I remember my first case, and Dr. Jordan.

By the way, the appendix? It was a hot one.

This entry was posted on Monday, October 27th, 2008 at 8:00 am and is filed under Short Stories. You can follow any responses to this entry through the comments feed. You can leave a response, or trackback from your own site.