Tuesday, October 27, 2009

The Mystery of Otolaryngology

The unbelievable has happened this week. I have been home before about 9 or 10 pm in the evening! With all of this free time I hardly know what to do with myself. Perhaps that is why I began to ponder otolaryngology.

Ah, ENT, a specialty that medical students strive to match in. But after being exposed time and again to the specialty in the OR and the gross room, I really have to wonder why is this field so popular? The high income aside, of course. Maybe someone out there in the blogosphere can enlighten me on this?

Here is the way I see it. The surgeries that we get specimens on are long, brutally long, lasting the whole day or even into the night. They seem to involve digging around in very small spaces in the face with random names that I tried to block out of my brain soon after that unit in first-year anatomy. Even worse, these spaces are often filled with puss, fungus, tumor, necrotic debris, or other goodies.

They dig and dig to pull out a tiny little piece of tissue and then call us for a frozen section. Um, okay, we'll see what we can do with this limited sample. Granted it is being pulled out of someone's maxillary sinus so it's not like any more tissue can be obtained. Sigh... but it can make things difficult.

Then the next day the specimen arrive on my bench in 19 tiny parts which all have to be measured, inked, and dictated. If they need decalcification it slows everything down for another day.

Wait, this was supposed to be about ENT, not my work, so I digress. But let's talk about enucleation for a minute. I hate these specimens. Not a lot grosses me out at this point, but seeing an eye staring up at me out of a container really freaks me out. The eye had a long suture attached to one end. When I called the ENT surgeon (very nice guy) to ask about orientation, he told me, "oh that was just for us to pull on."

Whoa... pulling eyes out of the socket. Another reason, or not, to do ENT.


Rach said...

ENTs pull eyes out of sockets? Wow, I'm confused.
(Word verification: hyper)

Resident Anesthesiologist Guy (RAG) said...

Yes, VERY long surgeries can be expected when on an ENT rotation. They also assist Neurosurgeons "gain access" to portions of the brain when it involves more face than scalp (like pituitary tumors, etc). Mindnumbingly boring once the patient has their airway secured and other items performed, as a H&N tumor can make intubating quite difficult.

See? I'm increasingly satisfied that I *never* send a pathological specimen (unless I'm in the ICU and bronch someone) for which the pathologists can find grief.

WolverineDoc said...

yep. much rather deal with crazies than with eyeballs. yelch!