Tuesday, January 09, 2007
I never wore a white coat. Sleeves rolled up, open collared is how I dressed in my office. (Well, early on, I not only wore a [non-white] coat, for some reason I presented myself with a collection of the most garish ties imaginable. "Oh yeah," people would say when I was mentioned. "The guy with the ties." Somewhere along the line, I got tired of it, and opted for comfortable. Meanwhile, I developed a small lipoma on my left arm, which never bothered me but which, as time went on, I realized people were noticing. I'd be sitting in front of a patient, gesturing this way and that as I explained (beautifully and patiently, I might add) some surgical subject or other, and I'd notice a distracted glance at my arm. Surgeon with some sort of growth, a tumor, not the guy for me....
So I took it off. Laid out all the stuff I'd need, sat on a chair resting my arm on the bed in one of my exam rooms, painted it up (my arm, not the bed) with betadine, stuck on a sterile drape, injected local, made a little cut, squeezed out the lipoma, taped up the wound. My medical assistant had asked if I wanted her there to help, and I'd told her no, just listen for the sound of me hitting the floor, in which case she was authorized entry. Turned out fine:
There are lots of stories of surgeons operating on themselves: setting up mirrors, taking out their own appendix under spinal anesthesia. And of course there's the recent saga of the young hiker who cut off his own arm to escape being trapped between rocks. The latter is understandable and more than admirable, if barely imaginable. The former is some sort of showboating, or the mistaken belief that no one could care for oneself as skillfully as oneself. In my case, I think -- being a rather small deal -- it was just wanting to avoid a fuss. I've had a couple of patients who've wanted to watch their operation. In the case of hernia repair under local, I've accommodated the request (properly angling a mirror for viewing while lying flat -- sitting up would have made the surgery impossible). I enjoyed describing what I was doing, hold up this or that structure in the process. Never had anyone faint or otherwise bail out ex post facto.
In the Air Force I worked with a medic who told me a surgeon he'd known had attempted his own vasectomy. As had I, he'd set up all the stuff and excused everyone from the room. Unlike me, he materialized in the hall a while later, unsuccessfully holding his bleeding scrotum, staggered around a few steps before passing out, unceremoniously, in front of the crowd of nurses and medics that had gathered awaiting just such an outcome.
If alone on an island with my Swiss Army knife, I guess I'd take a stab, as it were, at my appendix if I felt I had no other choice. Don't think I'd have tried the vasectomy.