Surgery?

I started writing this weeks ago but life has been busy, which is good and bad. When life is too busy to spend time reflecting, I think it is a red flag, warning me to slow down. Or a sign that I should be more aware of how I am spending my time and to keep myself accountable. So here is my recent-ish reflection, delayed as it may be. I know my mom eagerly awaits my posts (: I love you mom, thanks for always believing in me and cheering me on wherever I am and whatever I am doing.

here is an extremely random picture of me bc I know some of you appreciate that haha

Believe it or not, we completed our first anatomy exam a month ago. As I prepared to return to Israel, one of my most prominent prayers was that I would enjoy school and feel motivated to learn. I struggled to study sufficently and efficiently last year. I trust God will never give me more than I can handle, but I didn’t see how I could make it through another year with this daily battle. Although I shouldn’t be surprised, I am in awe of how much I have enjoyed school so far. Praise the Lord for his faithfulness! During anatomy, I didn’t just learn the material because I had to, I learned it because it was exciting and it drew me in. The mornings spent in the classroom were interesting, but the afternoons in the lab were my favorite. We worked with cadavers to explore and understand the heart, lungs, vessels, and muscles in the thoracic cavity. The human body fills me with wonder and admiration for our creator. Somehow all the tubes and tissues inside of us function together and allow us to be human. I love how we are symmetrically unsymmetrical. We have two arms, two eyes, two pectoralis major muscles, but only one stomach, one aorta which isn’t even in the middle, and two different sized lungs. As humans, we share almost identical components physically, but they can be connected and expressed in vastly different ways. The reference books demonstrate the expected human body, but every single one of us has variations as simply as the branching of our arteries or the number of nerves. We are the same, but different. Different, yet the same. It’s a beautiful paradox one can’t escape.

Thoracic Cavity :)

Working with cadavers reminds me how fragile life is. I walk around from day to day like I’m fairly indestructible, not worrying about little bumps, bruises, or cuts. But as the shell of a living being, cadavers are made of exactly the same materials and elements as I am, but they are so fragile. The nerves and arties need to be handled with care and delicate motions. I realize I am living and they are not, and in this way my cells have the clear advantages of a constant blood supply and communication with my brain. But we are all breakable and we weren’t made to live forever. We grow, we plateau, and then we begin to grow old, decline and decay, long before and long after we have breathed our last breath. I don’t think cadavers and I are so different. We are both clinging to our former states while moving, though often unwillingly, toward what is ahead. From dust to dust we go.

Some of you may be horrified by the thought of cadavers, and justifiably so. Some of my classmates would agree with you. No one likes to be confronted with death, especially not so directly and repetitively. I have classmates who swear they are done eating meat after beginning anatomy lab, but there are others who are as enthusiastic as me. Am I wrong for loving cadaver lab and the opportunity to learn anatomy in this way? Maybe. But maybe not. I could fill pages with reasons for and against the practice, but I will keep it short and to the point. Cadavers should be treated with the utmost respect. It is clear they are no longer living, but they once were. They are representations of future patients and give medical students the chance to carefully explore the human body with its complexities and variations without the risk of harming a living being. I’m so thankful for this opportunity and for those who decided it was important enough to gift what remained as they passed from this world to the next. Becoming a cadaver isn’t for everyone, and that is okay. Learning from cadavers isn’t for everyone, and that is okay too.

As students, we have keys to the cadaver lab so we can go in and review on our own. I went several times with different classmates, but somehow goal is always to go when the fewest people will be there. Jack and I went one Shabbat morning before church and had the lab gloriously to ourselves. Jack made the comment, “what a weird thing to do before church”. This couldn’t be more true when I stop to think about it. If there was an award for the weirdest pre-church activity, I think we would have been some of the forerunners haha.

Even though my enjoyment during anatomy and cadaver lab took me by surprise, it shouldn’t have. During a chat with my dad, he reminded me of how I thoroughly enjoyed it during undergrad as well. He couldn’t have been more correct. I had always suspected my medical interests lay more in the surgical realm, and this felt like a tangible piece of confirmation. I have started looking into different surgical specialties and I am trying to find more specific direction, but it honestly makes me feel excited. Surgery is a tangible and physical intervention that can result in huge improvements in quality of life.

I recently started shadowing a cardiothoracic surgeon, Dr. Yael. She is absolutely incredible and has been very willing to explain her procedures. During the first surgery I observed, she removed the inferior lobe of the left lung. A gnarly, insidious tumor had taken over the majority of tissue that needed to be removed. She also removed several lymph nodes to send to the lab to check for spread of the cancer through the lymphatic system. To make things even more interesting, she performed the surgery with a robot. If you are imagining a robot with a face and its own hands and legs, think again (: It’s called the da Vinci and I am including a photo (not from the surgery I observed of course) to give you a better idea of what I am talking about. The surgeon places their hands in the controls as if they are gripping the surgical instruments, while watching through a 3D monitor. With this type of intervention, only small incisions are necessary and the surgeon is able to be much more precise. I have seen many surgeries without this type of technology, and I can vouch this method also had much less bleeding and a clearer field of view with the laproscopic camera. As on observer, I also had a spectacular view of everything going on inside the thoracic cavity. I could see the heart beating powerfully within its protective sack and the lungs inflating and deflating. Using the robot does make the procedure a much longer process. I think I was in the operating room almost 4 hours, which was atleast 2 hours longer than I expected (: I considered leaving once 1pm rolled around, but I was too invested. With incisions no larger than 1.5 inches in length, I tried to imagine how they would remove the large portion of the lung after it was completely detatched. They had to widen one of the incisions, but not by much. With the detached lung tissue was still inside the body, they bagged and deflated it, and with a little effort, it slid out.

One of my favorite parts of medical school are the moments when I find myself in complete awe of the human body. Removing a lobe of the lung is not a trivial thing. It’s a decent amount of tissue. The patient may not be 100% what they were before, but overall there isn’t a significant change in long term lung function. Wow. After observing Dr. Yael, I’m not convinced robotic type surgeries are for me. Dr. Yael has been a surgeon much longer than this technology has been around. When I asked her opinion, she told me she loves the new technology. It’s still in the slightly clunky phase with a lot of room for growth, but it’s a start. As phenomenal and impressive as it is, it felt similar to a video game set up. It takes work to orient yourself and to adjust the view of the camera throughout the procedure. There are numerous buttons and controls to keep track of. I have never been a very successful gamer haha and I don’t relish looking at a screen for the majority of my day. I do see the many benefits robot assisted surgeries offer and it is very exciting for the medical field. Even so, I left this experience feeling confused and a little disheartened. I found myself asking, is there a place for me in the medical field? Is there a specialty I could imagine going to day after day and still wanting to continue? I have been wrestling with this and praying about it for a while. I will continue to wrestle, pray, and most importantly trust. It is often much easier for me to doubt than have faith.

Lobes of the Lungs: the BLUE portion of the left lung was what I observed being removed

Dr. Yael operates on Tuesdays and Wednesdays, and invited me to come back whenever I wanted. I returned the following week and joined her in the operating room (OR for short) once again. So far, one of my favorite things about the surgery department is how incredibly friendly everyone is. When I arrived to the surgery wing, a surgeon passing by immediately stopped, introduced himself, and helped me find the hair cap and shoe coverings required for the OR before making sure I knew where I was going. I experienced the same openness while surgery was going on. The nurses, the anesthesiologist, the intern, and the whole team were happy to see me both times. I also love the comradery in the operating room. Everyone works together, laughs together, and focuses together. The operation I observed was to fix a leaking lung. Previously the patient had arrived to the Emergency Department with a pneumothorax. This means the normal pressure in the thoracic cavity had been disturbed enough to cause one of his lungs to collapse. Even after the team had fixed the pneumothorax, the lung had continued to leak for 12 days, which is bad news. The surgical team went in, found the problem without any difficulty, and removed the leaky portion. The procedure was performed without the robot, but made use of a laproscopic camera.

An example of a pneumothorax. It is a very serious situation.

After watching my second procedure, I feel much more at ease about potentially pursuing surgery. It feels like if surgery is slowly wooeing me. Again and again I have realized I’m not the type of person who does something once and falls in love. It is a slow process for me. I have to become aquainted and understand to appreciate it fully. Many of you may be aware that I LOVE basketball. I even have a sweater that says, “this girl LOVES basketball”. But this wasn’t always the case. Basketball won me over, day by day, practice by practice. When I compare myself to people who know immediately whether they love something or not, it’s very discouraging. God made me uniquely myself and only when I embrace that truth, can I lay my worries at his feet and live in his peace.

I recently stumbled upon a surgical specialty called "Global Surgery". One of the premises is that you learn a specified number of essential surgeries and can then to work as a surgeon in rural areas. The Global aspect can mean forming partnerships with other counties, maybe just in the realm of research, maybe as someone who lives and works there. But it can also mean working in the U.S in a rural and medically resource poor setting. I am very excited about this possibility and it was a huge encouragement to find an area of medicine which I am excited about. Whether this is what God has for me or not, I don't know. But I feel peace in the waiting and in living in what he has put in front of me now.

A few weeks ago, the sermon at church was about fear. I was deeply convicted. Most of the time, when people ask me how I’m doing, I don’t respond with, ‘Oh I’m living in fear’ or identify fear in myself as a chronic problem. However, I do often admit to being stressed, anxious, or walk around with a long list of things I need to get figured out before I can feel okay. There are two closely connected sources of these emotions. Fear and lack of faith. I’m fearful it won’t work out or be okay. And I doubt God’s goodness in his grand plan and timing to work everything out. Not only is this unhealthy for me, it is also sin.

2 Kings 6:15-17

When the servant of the man of God rose early in the morning and went out, behold, an army with horses and chariots was all around the city. And the servant said, “Alas, my master! What shall we do?” He said, “Do not be afraid, for those who are with us are more than those who are with them.” Then Elisha prayed and said, “O Lord, please open his eyes that he may see.” So the Lord opened the eyes of the young man, and he saw, and behold, the mountain was full of horses and chariots of fire all around Elisha.

It is easy to see why the servant is afraid. I think we can sympathize with him and may even say he is justified in his fear. But as he is caught in his panic, his fear controls him and he is overwhelmed. “What shall we do?”, his fear blinds him to truth and keeps him from dealing with the situation. But if we put our faith in God and truly trust Him in times of trouble and peace, we can confidently say there is nothing to fear. Elisha saw something completely different because he wasn’t blinded by fear and panic. He PRAYED boldly and held firm instead of allowing fear to consume him. Giving way to fear gives Satan a foothold. And all it take is a foothold for the enemy to get comfortable.

2 Timothy 1:7

For God has not given us a spirt of fear, but a spirit of power, and love, and a sound mind.

God has given us everything we need to overcome fear and choose what He has for us. It isn’t his desire that we live in fear, but in freedom. I doubt this is news to many reading this. But I know it is hard for me to acknowledge ways I am letting fear control me. It’s much easier to give it another name and make excuses. But only when I accept it for what it really is am I able to surrender it.

1 John 4:21

There is no fear in love, but perfect love casts out fear. For fear has to do with punishment, and whoever fears has not been perfected in love.

When I am fearful, I can’t be fully emmersed in the love of God. There is a division separating me from him because I am refusing to put my trust in him. When I consider my desire to be a surgeon, it can feel impossible. It’s a competitive specialty, it makes having a family very challenging, I don’t know how it will fit in with other aspects of life that are important to me, if it is something I could continue to do day after day, and the list goes on and on and on. It’s easy to convince myself that if God just showed me how the next step is going to work out, I would be satisfied. If He could just show me right now whether I’m going to become a surgeon, that would be enough. But then I would wonder about the next piece and then the next and on and on. He is merciful in how he shows us exactly what we need to know when we need to know it. And the rest we truly can trust Him with. Of course it is much easier to say this than to put it into practice. If it is His plan for me to become a surgeon, He will make a way as long as I remain faithful to Him and follow His leading. If that’s not His plan for me, He has something else that is beyond better in the end. Because His ways ARE higher than my ways. I’m reminding myself to choose God’s love and faithfulness over fear. There will continue to be moments when I fail or when I forget, moments when I let fear overcome my faith. But as 2 Timothy 2:13 says, “If we are faithless, he remains faithful – for he cannot deny himself.” How great the Father’s love is, how vast and beyond measure.