Plastic Surgery

I haven't posted in a while--I apologize. Last month I was the intern on the Plastic Surgery service. I spent quite a bit of time in the emergency room sewing ears back on and repairing holes in peoples' faces. When a patient is told that a plastic surgeon is coming to repair the laceration on their face, they are probably expecting Dr. 90210 to show up. Little do they know that I am only 9 months into my surgery training!

In addition to all of the cosmetic surgery that plastic surgeons are known for, plastic surgeons also do a lot of reconstructive surgery involving every conceivable part of the body. The bain of a plastic surgeon's existence is the decubitus ulcer aka pressure sore aka nasty, smelly hole in your backside. Patients who are immobilized after a spinal cord injury or debilitating illness run a high risk of developing erosions over their sacrum or the back of their hips. Once these sores develop, they can take forever to heal and can become infected. Anyone who has smelled an infected pressure sore knows that there is not a worse odor in the world. Plastic surgeons are often called upon to clean these ulcers out and cover them with viable surrounding tissue.

I was called into the ER to see a 400 pound Samoan man who had the most extensive pressure sore I had ever seen in my life. The ER doc called me to tell me that this mountan of a man was bleeding from somewhere deep inside the ulcer bed, and my job was to clean it out and stop the bleeding. I said "thanks doc" but didn't mean it.

As I approached his bed, the stench was overwhelming. My eyes began to water, my nose started running, and my stomach began churning. Between dry heaves, I said hello to the giant Samoan and told him to turn over onto his stomach. I pulled the dressings off him and stared into the abyss. This guy had a wound that must have been a foot long and almost a foot deep. I saw blood oozing up like lava from a volcano.

I grabbed my electrocautery, held my breath, and dove into the dark chasm. I cleaned out rotten, infected tissue and looked for the source of the bleeding. Finally, when I was about to lose hope, I found an artery that was sending a pulsatile stream of red blood into the air. I turned the cautery on and fried the artery until it was completely cooked. With the bleeding stopped and the necrotic tissue removed from the wound, I climbed back out of the pressure sore and packed it full of gauze.

I drove home and for a week I could not get the stench out of my nose. I don't get paid enough to do this kind of work.