Tumor excision: new remedy for morning sickness

Clinical is starting to get good.

And when I say good, I realize I may have a completely distorted and sick sense of the thought.

I am over halfways through my first Family Practice clinical. I can guarantee you that on any given day, I will see at least one of each of the following:

1. Sinus infections, bronchitis, or pneumonia
2. Chronic disease management---particularly hypertension, diabetes, and high cholesterol.
3. Well child visits

Yesterday, the schedule was about 90% acute respiratory issues. Tis the season!

Last Friday, I went to my clinical site for a quick 1/2 day practice before my OB appointment. I was expecting to see about 3 cases of upper respiratory and 2 of chronic disease management.

My morning was moving along as expected...until....

I met the Physician's Assistant at this small clinic I'm doing my rotation at. I hadn't met him before. He works limited hours and I am only there once/week. Our paths hadn't quite crossed.

He turned my predictable morning right around when he said:

"I have a patient coming in later today for probable squamous cell carcinoma excision. How about you take that one under your wing?"

Those who know me, know that I learn best by being thrown into the hot coals.

"Sure! Just so you know, I haven't done anything like that before, nor have we had class on surgical procedures yet. I don't even know how to do sutures. But I'm excited to learn! And--oh yeah! If I have to leave it's because of this constant nausea that's likely my assistant for the next 7 months".

So at 10:30, with my baby nausea kicking into full gear, I went back to the surgical room. I got scrubbed in, gloved up, and the Physician's Assistant marked the area we were cutting out.

It was about the size of a golf ball, on the underside of an elderly man's arm.

It definitely looked like skin cancer, so rather than doing a small biopsy and having that come back likely positive, and needing a 2nd appointment to excise a larger area, we were going to remove the entire area with a clean border around the suspicious area. You have to get good clean margins on pathology specimens.

He marked it, I injected it to numb the patient up.

(PS: the patient was completely aware that I was a novice. He didn't care one bit.)

Then came the fun part...the scalpel.


The best comparison I have is that it felt like cutting through the fat on skinless chicken. Know what I mean? I cut a large area and then we pulled that back far enough to be able to cut the underside free. I felt like I was sawing on chicken lard, except it was human lard.

I was so proud of myself when I broke the last string free!

Then I realized there was a big ol' gaping hole that needed to be sutured, and I hadn't sutured before. So the Physician's Assistant demoed 2 stitches and set me loose.

I know it won't earn me any small scar awards, but my mentor didn't care nor did the patient. "Just get it stitched up as close as you can" was the goal. I put in 10 stitches.

When I was admiring my first minor surgical procedure results, I realized....

my nausea was completely GONZO!

How's that for a weirdo? Rather than hard candies, ginger, or crackers, try putting your nose amongst human flesh and blood next time.

My adrenaline rush completely covered up my nausea.

I am a sick, twisted individual.