The diary of an assistant

Alhamdulillah I have assisted in a lot of operations this rotation (i.e. "semester", for Ahmad's benefit). Being an assistant is a harder job (and quite important) job than I had expected.

It requires you to be in awkward standing and crouching conditions depending on the height of the operation table and the site of the operation field. Like grumpy Prof S was a really short guy (up to about my chest). Usually the table is set at the most comfortable for the tallest person then the shorties stand on a stool but since he's the Prof, the table is set for his height. (He hates tall people by the way and both my registrar and I are tall people hahah!). So through all his operations we had to bongkok our backs til maximum capability. Subhanallah.. sakitnya belakangku.

You also have to learn to read minds anticipate what the major operator wants to do next. Is he going left, right, up or down after this? Doing a certain kind of operation a few number of times helps because you sorta go through the motions of the operation and know what step comes next. When I first started I didn't even know how to properly drape a patient (put those sterile green sheets over them) kahkah. Sekarang dah terer (cewah senang je haha). And each surgeon has their own method of doing the same operation. And they all have their own idiosyncracies that you have to learn about.

You also have to read body language and "jargon" of the surgeon(s). A flick of the hand could mean 'take the retractor out' or 'hold the retractor here', 'pull the drain tube this way'. "Uh hum" could mean 'step on the diathermy switch', 'get the diathermy tip and press it to my forceps', 'move the retractor that way' or 'cut this stitch'. This is the hardest part I think. Sometimes the surgeon has been operating for years and years and expects everyone to know what they mean. If that's your first time operating with him..adoi nayalah kene marah kalau lambat respon. But well your only argument is 'how am I supposed to know that *hnggh* means something.  I didn't learn that in medical school'. And sometimes you don't know who they're addressing. They just give instructions but sometimes it's for you or for the scrub nurse.

Have you ever held your arms in front of you? See how long you can keep that up before it gets tiring and cramps up. That's basically what an assistant does most of the time. You can't rest your elbows on the patient (though sometimes you can't help it...sakit laa bahu) because otherwise they'll get a bruise from your pointy elbow digging into their face or chest or something. And because the patient is all covered with green drapes with the exception of the operation site (tutup aurat ekk..bagus tul hehehe); after some time we tend to forget that there's a person under there and treat it like a table instead. Tak sengaja hehehe.

An assistant also has to pay attention to the operation even though holding the retractor is extremely boring. Sometimes you tend to daydream or look elsewhere just to fight the boring-ness. It's always that exact time you are not paying attention that the surgeon catches you at it and brings you down.

Surgery is an apprenticeship; as it has been historically. Just like the hairdresser apprentice has to start off sweeping hair off the floor of the salon before actually cutting any hair.

You start off just observing from afar (medical student life). Then you get to assist. Then if you've assisted long enough, slowly you start to do more and more until eventually after several years, you are the primary operator i.e. the surgeon.

I started off just holding the retractor or lap camera but gradually they let me use the diathermy (a electrically charged tip that burns tissue therefore cutting it), do stitches, put drain tubes in and other things I thought I never would get to do as an mere intern here. (Admittedly back in malaysia, the housemans get to actually do the surgery).

Everyone starts from the bottom. There's nothing demeaning about that at all. It keeps you humble.