A Flying Monkey
An essay in which I remember the joys of operating
Welcome to Brief Op Notes. In this newsletter, you’ll find my explorations on the medical profession, reflections on my residency training, and my experiences in learning to become a surgeon.
There is a long tradition of physicians who are also writers: Arthur Conan Doyle, William Carlos Williams, Atul Gawande, Abraham Verghese - but women are conspicuously absent from this list. I hope to continue in this tradition, while adding my own perspective.
My first few essays here will be from the archive of my writings. I originally published this essay on my previous platform on May 2, 2022, when I was a surgical intern, and am now reprinting it with some minor edits.
“Have you guys ever fallen asleep standing up?” asked Theo one afternoon as we sat in the work room, waiting pointlessly on hold for nurses who would never pick up the phone. “It’s glorious.”
We laughed, then nodded.
“But not as good as a caffeine nap,” said Amit.
“What’s a caffeine nap?” Jill asked.
“It’s when you chug a shot of espresso and then nap for 15 minutes. You wake up with the energy of an eight-year-old on Christmas morning.”
It was late March – we had passed through all the known phases of intern year, from frantic panic to frustrated helplessness, to burnout and fatigue – and we were now finally starting to get a taste of the last phase: the comfortable relaxation that comes with increased efficiency and knowledge of how the hospital works, with absolutely no increase in responsibility.
As anyone who has seen Scrubs can imagine, this has led to its fair share of shenanigans.
“Ok guys. Who paged me to Taco Bell?” Amit texted in our intern group one day. Jill and I nearly rolled over with laughter, and then actually did when this was followed up with, “Ok seriously this needs to stop. I just called the post office.”
For as much fun as I’ve had at work, I know there is a difference between amusement and joy. Spending time with my co-interns, playing jokes on each other – these are amusing. But have you ever felt a deep joy, something so strong that you can feel the adrenaline kicking in, pumping blood through your heart, and sharpening your focus? Something so profound that you feel like you have suddenly connected with the universe on a deeper, more meaningful level?
For some people, it’s music. For others, drugs. It cannot come as a surprise that for me, it’s operating.
For some people, it’s music. For others, drugs. It cannot come as a surprise that for me, it’s operating.
Last month I did my first skin-to-skin laparoscopic cholecystectomy – making the incision, getting the gallbladder out, and closing up the port sites.
It was really thanks to my chief resident at the time, Stan. I was stuck redressing a complicated wound in the SICU when he called me, asking “Are you almost done? We’re going to start in a few minutes.”
The skin on a woman’s leg had avulsed off due to a car accident, and we were trying to get it to take – I was making puncture marks in the skin and then dressing it like a skin graft. I was unsure that this would help at all, but I didn’t have any better ideas, so here we were. I quickly handed my tools over to my medical student so I could talk on the phone.
“I’m almost done! I’m coming, go ahead.” I said.
“No we won’t start without you – we’ll wait.”
The thought of my chief resident, my attending, and the entire OR staff waiting for an intern to start a case made me feel more guilty than I could bear, so I looked over at my medical student and asked, “can you handle the rest of this?”
She nodded eagerly.
“Ok, just come to the OR when you’re done and let me know that you finished,” I said, throwing off my gloves.
I ran down the seven flights of stairs to the OR, huffing and puffing into my mask, to a room that was fully set up. The patient was draped, my chief was scrubbed, and I could hear the steady beeps of the anesthesia monitor. The OR nurse looked bored.
Is this what it feels like to be an attending? I wondered as I rushed to get my gloves and go scrub.
When I was scrubbed in and we were all set up, the OR nurse called for a time out.
“She’s going to do the time out,” Stan said, looking me straight in the eye. My attending just smirked in the background.
“This is Jamie Latoya,” I started, spewing out her birthdate and medical record number, “and today we’re doing a laparoscopic cholecystectomy, possible open.”
“Is this a high risk procedure?” the anesthesiologist asked.
“Not when she does it,” Stan joked, winking at me.
Then, I was soaring. Okay – more like stumbling through port placement, awkwardly jerking the camera around, and asking for instruments by saying “that hook thingy” rather than knowing their real names. But in my mind – I was flying.
But in my mind – I was flying.
I felt that lurch in my stomach that is both frightening and incredible all at once, the kind you get when riding a rollercoaster.
And I wasn’t even a rollercoaster fanatic as a kid. In fact, the big, tall ones made me feel queasy, and I had enough sense even as a child to know that throwing up on the car ride home would ruin the whole day. But your standard, run-of-the-mill rollercoasters? Those were my favorites. While my baby brother sat enjoying a stick of cotton candy, I would drag my dad on my third run of the third-tallest roller coaster in the park. A steep climb, a few turns, and unseen corners, and then one big drop – that was perfect for me. I wanted to be thrilled by the adventure, but secretly, I wanted to know that it would all be okay.
I felt that third-highest roller coaster feeling again when I was a medical student – I was just a first year, spending my summer shadowing one of the faculty surgeons (I’ll call him Dr. Morgan) in the daytime, working on research at night. It was my last day with him, just a week before we were set to start classes again in the fall. It was a short case in the ambulatory center: a melanoma on a lady’s arm. When we were set up, prepped and draped, the scrub nurse held out the scalpel for Dr. Morgan.
“She’ll take the knife,” he said, gesturing towards me.
I just looked at him for a moment, eyes wide – the only part of my face visible behind a scrub cap, mask, and eyeshield.
“Go ahead,” he encouraged me, smiling, “it’s your last day with me, you deserve to cut a little.”
And so I took out a melanoma.
That day, holding a knife for the first time, was candy being dangled in front of me, though I didn’t realize it then. I was being enticed, being handed a golden key that would unlock wonders. I hadn’t earned any of it yet.
There is a saying we have in surgery: “you can teach a monkey how to operate.” As a first year medical student, I was the monkey.
There is a saying we have in surgery: “you can teach a monkey how to operate.”
I have such vivid memories of these moments in medical school, when I got to do, and fix for the first time. Those moments became rarer as I spent less time in the operating room and less time doing clinical tasks. Procedures that, as a student, I would have found new and exciting, were now routine and tedious.
But finally, finally, I was feeling it again, just when it was beginning to seem like I would never feel that way again.
I will admit it was probably one of the longest lap choles I have ever been a part of: 3 hours for an uncomplicated, barely inflamed gallbladder. But on the other hand – as Stan said – I didn’t lose a single drop of blood.
I had other firsts that week. The next day it was also my very first time presenting at M&M – morbidity and mortality, a weekly conference held by every surgical department in which we discuss and analyze cases that go wrong, and talk about what we could do better. Typically, interns don’t present at M&M; partly because the operations we do very infrequently have interesting complications, and partly because we don’t yet know enough to deal with the barrage of questions from attendings. But for some reason, my chief resident determined that it was time for me to be thrust into center stage, onto the chopping block.
But for some reason, my chief resident determined that it was time for me to be thrust into center stage, onto the chopping block.
For twenty minutes my computer refused to load, mocking me as I desperately watched the loading circle go round and round. But just in time, I connected, and then miraculously, it went much better than I could have imagined. I presented my case and my literature review, correctly answering every question that was thrown my way. My courage grew as I heard my co-residents cheering for me in the next room. When I finished and walked out, my chief clapped me on the back, saying “You’re going to have a hard time doing better than that for your next one.”
I walked back to the table, trying to hide my grin (unsuccessfully).
That week I felt like I had earned something. That all the work I had been doing actually meant something.
There is a second part to the saying, that is often forgotten. “You can teach a monkey how to operate,” it starts, but it continues on to “but you need a surgeon to know when, and why.”
If, as a first year medical student, I was the monkey, I now finally feel like I’m becoming the surgeon. And it is amazing.