Sharp right lower quadrant pain.
Fever.
Diffuse peritonitis with marked leukocytosis.
Six weeks into his surgery clerkship, the medical student knew exactly what his symptoms indicated: emergent appendectomy—or risk letting his inflamed appendix burst, spreading its toxic contents through his body. Despite the stabbing, twisting, knifelike pain in his abdomen, the medical student realized this was his opportunity to make his mark, despite the clerkship moving virtual and being stuck at home. This was his Honors moment.
He hunched over, clutching his stomach with his right hand and guided himself downstairs to the garage with his left hand on the railing. He rummaged through his parents’ tool bench, cluttered with old tennis rackets and rollerblades to find what he needed. He threw his supplies into a wooden toolbox he built in woodshop as the pain grew more intense with every pounding heartbeat. Box cutter. Stapler. Pliers. Beads of sweat grew on his forehead and slithered down into his eyes as he tried to recall his surgical equipment lectures. Tweezers. Rags. First-aid kit. His vision started to blur as he gripped the orange handle of the toolbox tighter. He didn’t have much time.
He hoisted himself up the stairs, back to his bedroom, grasping both his tools and his abdomen. He threw his supplies onto his bed and he propped himself up with pillows. He rolled his shirt up, and he pulled off his belt and shimmied his pants down to expose the right lower quadrant. Latex gloves on, he hurriedly wiped down his tools and exposed skin with Clorox, wincing each time his hand reached for a new decontaminant wipe. He took as deep a breath as his boiling appendix would allow, and he bit down on his belt. He grasped the box cutter and grimaced out of both the pain and the fear of what he was about to do. The cold, rusted blade dug into his torso. The skin was tougher than he imagined.
The emergent appendectomy was successful with no apparent complications. The appendix was, in fact, infected and would have ruptured if it had come out any later. Technically, the operation couldn’t have gone much better—given the circumstance. The medical student was ambulatory one day post-operatively. The surgical site was quite swollen, but the leftover Z-pack he found in his parents’ medicine cabinet staved off any infection. After a week, the staples came out. The medical student ran his fingers over the raised scar, proud of his work. He submitted his report to his clerkship team and got back to work a few days later to finish the remainder of his surgery rotation. His gait was still hunched over and his incision site still burned with a laugh or a cough.
—
The next morning, the residents and attending quickly reviewed the medical student’s case report and images after rounds. It took them more than a moment to recall who exactly this student was. While scrubbing for their next case, the residents pointed out the tight, parallel sutures closing the medical student’s abdomen were well done, but the ends of the sutures were cut too short on one side and too long on the other. The attending nodded in agreement, adding that the jagged, raised edges of the incision scar indicated that a paring knife should have been used and not a box cutter. He reminded the residents of the excellent suturing and wound healing from a case two weeks ago when another medical student gave her grandmother a Whipple surgery from home. They gowned and gloved and began their next case before submitting grades later that evening.
Clerkship Grade Report for Medical Student
Evaluator: Surgery Attending
Comments: Medical student showed above average surgical knowledge. Competent at patient presentation and management. Helpful member of the team—though a bit arrogant. Surgical skill, decisiveness, and commitment need improvement.
Grade: Honors High Pass Pass Fail
J.Reed McGraw (@reedmcgraw) is a rising second-year medical student at PSOM, a former college swimmer, and a proud Ohio State alum. He can be reached at [email protected]
