My first cut was not the deepest


They say the first cut is the deepest. For me, this was definitely not the case.

It is a typical Tuesday afternoon, and I am preparing for my third case of the day when the intern I am working with informs me that he needs to leave for clinic. It will be just me and the attending for this next one.

I report to the OR, feeling a little nervous and not sure how this attending will react to a third-year medical student being the only one around to help. I grab my gloves and am helping position the patient on the table when he arrives.

“Good afternoon Dr. Lamberton,” he chimes, “will you be helping me out on this one?”

“Yes sir, it looks like it’s just you and me today.” I brace myself for his response.

“Well, that sounds just fine,” he smiles and motions for us to go scrub.

We re-enter the room and drape the patient in the usual fashion. I’ve never been to the ballet, but I have been to the operating room, and when you watch this choreographed dance, it feels pretty similar.

“Alright, now Dr. Lamberton is going to read the time out,” my attending’s voice thunders.

I look up from the suction I’m securing to the drape, surprised, and make my way to where the scrub nurse is holding the patient’s chart. My voice is only mildly shaking as I muster my most commanding tone.

“This is patient _________________, MRN _________________ born _________________. Consented for a _________________ under general anesthesia.”

I look to anesthesia, and they take over, the rest of the team following. I’m grinning behind my mask as I step back to my place across from my attending. He nods to me with a fatherly approval. We work together to mark our incision site. The scrub tech hands me a lap sponge in addition to my suction, so I can keep the field dry for the Attending while he makes the incision.

“Please hand the scalpel to Dr. Lamberton.”

I drop the suction I’m gripping (almost off the sterile field) and try to maintain my calm as the scrub tech hands me the scalpel.

This is it, I’m thinking as I place the scalpel on the skin. This is my moment. I’m a surgeon now.

With all the concentration and focus pinned on the tip of the blade, I begin to carve my masterpiece. Commanding my hands not to shake as I bring the knife along the 5 cm of marker that directs where my incision would go. I reach the end of the line, removing the blade from the skin. I turn to hand the scalpel back to the scrub tech, and as I’m preparing to state the words I had heard so many times before – my attending clears his throat.

“Why don’t you try that again.”

I look down at my work of art only to discover, to my horror, that I had barely cut through the dermis. Sheepishly, I take another stab at it. I see my attending nodding his head slightly as he grabs the Bovie and continues the surgery.

My great moment wasn’t as graceful as I had dreamt it would be — but when are they ever? For me, some of the most influential moments in my life have been ones that occurred completely on accident. You can’t plan for moments of growth and progress, you can only place yourself in an available position and capture the opportunity placed in front of you.

This story isn’t about me capturing a moment. While it’s certainly cool that I got to make the first cut (and a moment I won’t soon forget), the real amazing thing was the opportunity that was placed in front of my attending that afternoon. He was burdened with the load of an inexperienced assistant, and instead of complaining or ignoring me and my tightly clenched suction, he elevated me to a position in which I did not belong and gave me the tools to inhabit such a place.

In the academic hospital environment, you encounter a share of physicians who are burnt out, not just on patient care, but on teaching. I can only imagine how frustrating it must be to encounter us students, who half the time are more concerned with studying for our shelf exams than actually learning how to treat patients. We regurgitate the minimal knowledge that we have and expect to be sent home early as a reward. It’s easier just to send us away — I know because when my medical school sends first-year medical students to shadow us third-years for a couple of weeks I find myself sending them home as early as possible.

I have often found myself frustrated, feeling like I am not being taught anything during my long days in the hospital. Then I try and remind myself that teaching is a two-way street. To effectively be taught you must present yourself as a student eager to learn. To be present and invested in my duties in the hospital in a way that invites those around me to divulge their knowledge. Practicing this attitude has placed me in situations where interns offered to spend extra time teaching me practical things like placing admit orders and writing operative reports. It’s had me encountering chief residents who handed me cautery tools and an attending who let me operate with the robot.

That’s the beauty in really teaching someone — it’s not about asking the hardest questions or assigning the latest articles to read. Those are great tools in assessing someone’s preparedness and self-directed learning process, but to truly teach means lifting the student from where they were so that they can take in the view from where you are. In correlation, to really learn we have to place ourselves out in the thick of it, away from practice questions and review books and embrace the knowledge that masterful teachers can pass down to us.

I was blessed with such a teacher that afternoon, and I hope that one day I can strive to be a surgeon who raises up those around me in the same way he did with me. In the meantime, I will continue to fight against my cynicism and laziness, and practice being a student desperate to learn.

Tessa Lamberton is a medical student.

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