Doctor, Please...

Chapter 11

I arrived at work the next morning an hour early and sped through some routine general procedures. Derek had offered to take care of his pre and post ops, giving me another hour and a half to practice. When I finally emerged from the skills lab, Richard was standing a few feet away from the door talking to Bailey. I over heard a little of their conversation.
"You know that Dr. Shepherd is sleeping with an intern, and you offered her a permanent spot in his department?!" Bailey said in a hushed yelling tone. Dr. Webber held his hands up.
"Listen to me, I know her mother. Her mother is Ellis Dean." Bailey went silent at Webber's words with a look of shock on her face.
"Yeah, now you understand, plus they said you have seen her skill and knowledge in the Neuro OR." Richard said. Bailey looked unwilling to admit it but,
"Yeah, that girl does have some serious talent and a knack for brains, but seven solo surgeries in a row? For an intern?" Bailey asked, incredulous.
"Yes, I'll just tell the other interns that she has shown incredible initiative, and willingness to learn, as well as being fully capable of performing solo surgeries in a week, when they can even search through stool for foreign objects yet. It will motivate them to be better as well. And it won't look like favoritism." Webber said. Bailey looked thoughtful, like she was planning to agree with him.
"Yeah okay, the other nimwits in her class do need a kick in the ass." Webber celebrated with a small fist bump.
"But don't come crying to me when she kills your patient." Webber waved Bailey off. Then I walked put of the skills lab and met up with Webber.
"Hey Chief. I paged you, twice. I've been looking for you." Webber checked his pager and gave me a confused look.
"Maybe this thing needs new batteries. I didn't hear either of them." He said.
Yeah that's because I didn't actually page you.
"Oh, well. I'm ready. What surgery are we doing today." I asked. He walked fast, in what i assumed to be the direction of the patients room.
"We are doing an open appendectomy today. Can you tell me the steps of an open appie?" He asked, walking by the nurses station and asking for the patient files.
"Make a 3 inch incision between the first and second third of the distance from the umbilical to the axis with a 10 blade, use a Bovie to incise both the superficial and the deep fascia, expose the external oblique aponeurosis, incising in the direction of the fibers, split the external oblique muscles using Roux retractors, visualize the transversalis fascia and the peritoneum. Incise the peritoneum with Metzenbaum scissors, once the cavity is open send any fluid you encounter to pathology for Gram stain and cultures. We will be removing the appendix with an integrated approach. We will identify the basic of the appendix, remove it from the tissue surrounding it which will usually be inflamed. Ligate the appendiceal artery and separate from the appendix. Once the mesoappendix is divided, perform a simple ligation with 2 plane polyglactin tying off the base. We will perform this ligation again, then place a clamp just proximal to the distal ligature on the appendix divide sharply and cauterize the exposed mucosa. We suture the external oblique using absorbable monofilament sutures then we close the incision site with nylon sutures using an interrupted stitch." I said. I was so sure I got that all right.
"Good, we are doing a bowel resection." He said. Webber started walking to the patients room.
"What why? Did I miss a step for the appie?" I asked, jogging to catch up with him.
"No, you nailed it. I just wanted to see if you knew how." He said. I rolled my eyes, luckily I did practice bowel resections as well.
"Oh ok." I said.
"Study your patients charts, don't ignore anything in the history, there could be vital information in the patient history. I read the chart.
'Patient has a history of high blood pressure
Patient takes medication known to thin blood
Patient is obese
Patient has a small heart murmur'
Wow, this guy was going to be a difficult surgery.
"All studied up? Good, go talk to the patient." He pushed me into the room and followed behind me.
"Good morning Mr.Kline, My name is Dr.Dean and I will be performing your bowel resection today. Have you been walked through this procedure at all?" Mr. Kline shook his head.
"So, a small portion of your bowel has died, which could lead to infection or more of your bowel dying, so what we are going to do is we'll go in and run your small intestine to look for the dead tissue, once we find it, we will clamp your intestines about half an inch before the dead tissue starts, just to make sure we get all of it and we will just cut it out. And then we can stitch it back together. After your surgery, you will stay here for about a week so we can monitor you and watch for post-OP infections. Common complications for this surgery are herniation, blood clots, damage to nearby organs, leakage from the place where we joined the bowel together. Although these are unlikely to happen, they do happen, so if you feel anything, even if it just hurts alot, you tell someone, but a little pain after surgery is normal." The patient smiled and he seemed much more relaxed.
Webber and I exited the room and I asked him a bunch of questions.
"So do you want me to prep him?" I asked.
"I don't know. You decide. You are basically going to be an attending surgeon this week, so tell me, do attendings usually prep their own patients?" He asked. No, they usually ask an intern or a resident to do it. But I'm the intern, no I'm the attending.
"So if I'm the attending, does that make you a resident, or should I page an intern? Or a different resident?" He had to think about this question.
"Residents would be angry that you were bossing them around and the other interns don't need to know you're an acting attending yet, so I guess I'm your resident and assisting surgeon." He said. This felt wrong. I was the boss of the chief of surgery today.
"Okay well, then go prep the patient...please?" I asked him.
"No." He said. I knew from his tone he was trying to teach me something.
"What?" I asked him. He laughed.
"Wynter, you are my superior today. Does Derek ask you to prep a patient with a small voice. No. You need to be confident and assertive if you want to be an attending surgeon." He said. So I treated him like Derek would treat me.
"Okay, go prep the patient, and I'll meet you in the OR." I said, handing him the file and walking away. I had no clue what to do now, so I turned around and asked Webber if that was okay.
"Yes, Dean. Perfect, now don't ruin it. Go." He said. I smiled and went to find Derek. I found him in the reading room, looking at some head CTs and MRI's.
"Oh my God that is a HUGE hemangioblastoma. You almost never see them get that big! How are you gonna get that?" I asked. He smiled at me and turned away from his gargantuan tumour.
"Well hello to you too." He said, wrapping his arms around my wait and pulling me in for a quick kiss. I closed the door and turned back to the tumour.
"God, I would kill to be on this case. I'm doing a bowel resection. And, Webber put me in charge of him. I dont want to boss my bosses bosses boss around. That's alot of stress." I whined. Derek just laughed and kissed me on the forehead.
" Well, I would love to have you on this case but you are too busy being a Surgical Goddess right now to worry about an extremely large hemangioblastoma. And also being extraordinarily sexy while doing it." He said, licking his lips in preparation for the deep kiss he planted on my lips. I smiled up at him.
"My patient should be prepped and ready to cut, so I should go, but just remember if this goes well there will be lots of celebration sex tonight." I said. Then I turned and left just in time to see him look up and say "Please let there be no complications" I giggled and walked into my First Surgery unprepared for what would happen next.