Surgery - the early days

Today I completed the second day of my surgical clerkship.  I have observed/assisted/evaluated 24 patients including 3 surgical cases in which I was allowed to scrub in and perform what I believe are the duties of the first assistant in surgery.  I use the phrase, "I believe" because I have been allowed to perform the duties that my books describe as "first assistant" duties, however I haven't done anything beside suction, retraction, suture following, and a few other things.  Whatever my official capacity has been, though, I have thoroughly enjoyed the experience.  Having a patient open in front of me is, in a word, awesome. 

But the greatest asset to this clerkship so far has been how much of a humbling experience it has been.  Over the didactic year, I became good at getting the academic answers correct.  I got good grades and generally felt that I had a handle on the information despite my mad-dash late-night cram sessions before finals.  I always felt that I had done well.  The surgical clerkship has been a different animal altogether.  My feeling is one of uncertainty most of the time (unless I'm transcribing a pre-op exam note which is pretty straightforward).  For example: musculoskeletal anatomy has always been something I have had extensive use for as an Athletic Trainer.  I have utilized knowledge of the origin, insertion, and action of muscles of the leg, thigh, trunk, shoulders, etc. many many times and I felt that I had a good handle on this information.  But yesterday as we worked on a patient's thigh, my preceptor quizzed me on which muscle bundle he was holding in his fingers.  I looked at it, at it's orientation with the surrounding tissue, at the blood in the field, the smoke from the electrocautery unit, and I stated without certainty the muscle that I thought it was (because it looked like that's what it should be).   As it turned out, I was lost in the anatomy of the thigh and didn't know what I was looking at.  That feeling of being lost is unfamiliar and uncomfortable, but I believe this may be the most valuable thing that I learn in the coming month: how to challenge my personal comfort boundaries while at the same time remaining somewhat confident. 

As a side note - I know academically that challenging my comfort zone is key to increasing knowledge and understanding, but actually doing it is quite a bit different.   And it seems that understanding the difference between academia and the "real world" is yet another key component of the clinical year.   My there is so much to learn!