Indexing Title: CLeyson’s Medical Anecdotal Report 06-03 

MAR Title: The surgeon’s teacher! 

Date of observation:  March 2006 

Narration 

It was one ordinary operating day, when 55 year-old female was scheduled for thyroidectomy for a multiple colloid adenomatous goiter. I was the one assigned to operate on her. This will be my first thyroidectomy for the year and as a personal assessment, I am not very comfortable in doing head and neck operations. I am scared of the NECK! 

At the start of the operation, I prayed that the procedure will go on smoothly, without any complications and to finish in just an hour or two. In the induction of anesthesia and at the start of the operation, everything went smoothly, until I reached and palpated the area where the thyroid was supposed to be located. The anterior mass was only the front act. Behind the cystic mass there lies the hard, fixed, rough surfaced thyroid gland. Then I assessed the left lobe and found out that there were three small hard nodules. At that moment, my benign diagnosis condition comes into a 360 degrees turn; it seems to be a malignant mass. I immediately referred the patient to our service consultant. When I finished describing my intra-operative findings, he agrees with my suspicion, he said that we have to do a total thyroidectomy and possibly a modified radial neck dissection. My alarm clocks alarmed!!! I immediately asked him if he could assist me for I haven’t done even one MRND. I was relieved that he said yes. But he instructed me to start dissecting the left lobe. After taking all the instructions from him, I called in the relative and explained the patient’s condition and the finding new planned procedure.  

I thought that my anxiety was finished, but I came to realized that it was not when my service consultant entered the operating room. It was then that I realized that he will assist me in the operation. I must admit that I am not that prepared for such operation. I failed to read something, even small information regarding neck dissection. A lot of “what ifs” came into mind.   

When he scrubbed in and assumed the position of the first assist I could feel myself shaking for such apprehension. I could see my hands shaking. I knew that he noticed my nervousness because he suddenly said “hey! Relax ka lang tingnan mo oh nanginginig ka. Sige ka baka may mainjure ka niyan” and then he laughed. After hearing those words from him I started to control my emotions and I was successful. During the course of the operation, our consultant patiently guides me to the step by step procedure of the modified radical neck dissection. He patiently explained the dos and don’ts of the technique. And he also taught me some secrets on how to make the operation easier.

Insights (Physical, Psychosocial, Ethical) (Discovery, Stimulus, Reinforcements)  

In residency training, the learning process is very different from what we were used to.  No classroom, no specific subject for a specific time and no specific teacher. In our daily life as a resident we meet different teachers everyday…these are the patients, the consultants, colleagues, nurses and the other hospital staffs. These people teach us every little subject known to man. It is up to us to choose what to pick up and what to leave behind.  

In this particular patient, she taught me that not all that are obvious are true picture of the disease. She made me remember an advice that whatever your plans pre-operatively will not always pushed through after you have opened up the patient. We should be prepared for the inevitable; we should be familiar with the different kinds of operations techniques that may be needed in cases that we will be doing for the day. 

It is quite hard to imagine the techniques that we read on. We are overwhelmed by the process that we studied. When the time comes that we will perform these operations anxiety and fear will find us. But sometimes you will be surprised to discover that once a consultant showed you how to do it, you will find out that the operations are quite simple.  These are the reason why the consultants are here; they will enhance what we learned from our readings and teach us some secrets to perform the operations easily, techniques that we hardly see on textbooks. This is how the experts teach us.