Week One: Life with the Plastics, Learning OR Rule Number 1, and Making a New Belly Button

This week marks the beginning of my immersion term in the Department of Plastic Surgery with my mentor Dr. Jason Spector. In my short time here I am starting to get a feel for the breadth of the things that Plastic Surgeons ( referred to around here as the Plastics team ) do on a daily basis. Plastic Surgeons deal with many soft tissues and operate on muscle, fat, fascia, skin, and everything in between. Going into this experience, I had an idea about the cosmetic side of plastic surgery  but I had greatly underestimated the vital functional purposes of plastic surgery. For example, after an orthopedic procedure the plastic surgery team comes in to close the wound and they are the ones to consider the strength of the closure, the healing of the underlying bones that would benefit from proper vascularized muscle placement, and the resulting scar formation and healing process.

Starting immersion I was immensely curious about surgical techniques but very intimidated about viewing a surgery because I am the type of person that passes out while giving blood. My first day in the OR I was very nervous but it was absolute fascinating. It was a personal triumph for me to make it though and the most surprising part of immersion so far was how much I enjoyed the OR. Before my first day in the OR everyone told me I had to follow one rule: Don't touch anything blue. As soon as I got into the room I understood what they meant. I have spent years practicing sterile technique in a bio safety cabinet but it is very different on the operating room scale. That is where the rule comes in: anything blue or anything on a blue surface is sterile and can't be touched unless you also are sterile, scrubbed in, and dressed in a sterile blue gown. I watched things from a keloid scar removal, to an abdominal hernia repair with fat removal, to the closure of a scoliosis repair with implanted titanium rods. During the Hernia repair, the fat and underlying connective tissue was moved to expose the muscle with the intestine poking out. After the intestine was put back in place, muscle layer was sutured, surgical mesh applied, and excess fat trimmed, they started to put the patient back together. However they made one more incision first to make a belly button. I was so focused on watching the hernia get repaired and the excess tissue get removed it didn't occur to me that this patient had just lost a belly button. This detail brought back the human and individual aspect to case and reminded me again of the lives that were being improved through these amazing surgical feats.

Figure 1: The sunset in NYC