October 10th, 2011
09:24 AM ET
Anthony Youn, M.D., is a plastic surgeon in Metro Detroit. He is the author of “In Stitches,” a humorous memoir about growing up Asian American and becoming a doctor.
Autumn. The air turns cool and crisp, leaves change color, and third-year medical students descend on hospitals to learn to be real doctors… by practicing on real people.
As a plastic surgeon, part of my job includes the art of suturing. Over the past 15 years, I’ve repaired more than 10,000 cuts, incisions, bites, and wounds.
I’ve seen it all — people who’ve been sliced by beer bottles, attacked by wild animals, and even injured by — I want to be delicate here — “personal, intimate devices.” I’ve done so much suturing that sewing up people has become second nature. I can repair a dog bite to the face blindfolded.
I began by learning how to tie surgical knots. I had never been an Eagle Scout or a sailor so my experience tying knots was limited to looping the laces on my Nikes. I started with a “knot-tying practice board.” The board consisted of shoelaces and a simulated surgical incision made of plastic and rubber bands.
The first time I picked it up I felt as if I had six thumbs on each hand. It took several hours, but at last I got a feel for tying knots. Then I became proficient. And then I became a knot-tying wizard.
Next step, the real deal. Suturing. Many hospitals save their old, unopened sutures so their industrious students can practice. In order to impress the surgeons and get a good grade, I had to dazzle them with my suturing skills. The pressure was on.
First, I collected a ton of unused sutures from the hospital. Then I borrowed some surgical instruments from my father, an ob-gyn. Finally, I went to the local butcher shop and bought a dozen pigs’ feet. I brought them home and stuffed them into my freezer. Why? The texture of the skin on a pig’s foot is very similar to human skin.
Every evening I’d come home and practice. I’d cut the pig’s foot with a steak knife and practice stitching it together, over and over, countless times, until my fingers got sore. If the butcher didn’t have any of Porky’s piggies, I substituted chicken breasts, a decent alternative in terms of skin texture, and much tastier.
By the time I started my third year, I was ready for real live human beings, who thankfully, for both of us, were usually fast asleep.
The first person I ever sutured was a young mother who allowed me to repair her surgical incision while her ob-gyn supervised. I’ll be honest. I was a nervous wreck. My hands trembled, my pulse raced, sweat dripped down my forehead. For a moment my vision blurred. The simple incision whirled, expanded, and contracted. I felt as if I was peering through a kaleidoscope.
Then I closed my eyes and pictured my trusty pig’s foot.
I visualized myself suturing. I opened my eyes. I felt calm. I took a deep breath. With the doctor guiding me, I tied a perfect surgeon’s knot. I began suturing, slowly. Smoothly. Effortlessly.
That moment — the first time a nervous, inexperienced medical student sutures a live patient — is not only a common occurrence, it’s a crucial component of a surgeon’s education. In order to become excellent surgeons, medical students need to practice on real people.
Full disclosure. If you are undergoing surgery and you meet a medical student prior to the procedure, it’s likely that student will practice suturing on you. I’ve been that student hundreds of times, however, unless the patient asked, the surgeon never openly admitted to the patient that I was going to be the one doing the suturing.
The surgeons often omitted this important piece of information to avoid the patient needless worry. I often would lie awake at night concerned that the sutures I tied that day would unravel, the incision would open up, and the patient’s guts would fall onto the floor.
Although this never happened, I wouldn’t want the patient worrying about the same thing. Truthfully, the surgeons who oversaw me always made sure that my suturing turned out exactly the way they would have done it themselves.
Of course, a patient has rights. A patient can refuse to allow a medical student to participate in his or her care. I understand if a patient feels uneasy allowing a medical student to suture while the patient sleeps. But to those of you who allowed me to practice on you when I was in training: My patients today and I thank you.
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