Wednesday, July 26, 2006

Funny 2 - Where's My Skin?

This is the hilarious story from my colleague:

We see patients with skin cancers who come to have Mohs micrographic surgery. It's done by a dermatologist who has had specialized training in surgical procedures where small pieces of skin are taken out and immediately looked at under the microscope to make sure that the margins of the resected skin are clear. The goal is to have a extremely good (ideally perfect) cure rate for local cancer, as all the tissue margins should have been visually confirmed to be free of tumor, while at the same time, sparing as much normal skin as possible. Even with this technique, the patients are usually left with a sizeable defect that needs a further surgical procedure (complex linear closure, flaps, or grafts) to close properly.

We assist the Derm surgeon as she does Mohs cases. We try to be as helpful as possible, learn different closure techniques, and get to do some of the more straightforward closures.

So a few days ago, my colleague, Dr. X, in his first day on surgery, happens to be assisting the surgeon.

All's going well, besides the fact that he can tell the surgeon is not in a good mood. She's really quiet the whole time, and doesn't really explain what she's doing or thinking. So he's just trying to be helpful, blotting to clear the field, cutting sutures, retracting, etc. Meanwhile, she's doing her thing, and as she's repairing the wound, he finds it strange that she's snipping tissue and tossing it in the garbage can. (Usually all removed tissue goes to pathology.) So he's trying to make sense of it without asking Ms. In a Bad Mood, and figures that it's probably because our surgical trays are pretty small and given all the instruments and what not, she's probably just trying to keep things on the tray clean. So a little later, she cuts a odd looking piece of tissue and throws it onto the tray, where it lands onto a 4x4 gauze. They hit a bleeder so take some time to take care of that issue. X's running out of clean gauze and tries to get some from the tray but finds the ratty looking piece of tissue lying on one of the few remaining pieces of gauze. He picks up the gauze and tries to shake the tissue off onto the tray. Tissue is sticky. So he pulls it off, and following the surgeon's example, tosses the tissue into the trash can. Procedure goes on, half the defect is closed, things are going well. Then she turns to the tray and starts moving things left and right.

Surgeon: WHERE'S MY SKIN?
X: What do you mean?
Surgeon: MY SKIN! Where did it go? It was here a moment ago!
X: (Feeling faint) Uh, it's in the trash can...
Surgeon: WHAT? THAT WAS THE SKIN GRAFT!!!

Disclaimer: No patients were harmed in the procedure. The patient ended up having an alternate closure with a very nice result.

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